Transcript Droopy Lids - Lynn`s Lecture Help

Droopy Lids
Lynn E. Lawrence, CMSgt(ret) USAF
CPOT, ABOC, COA
Objectives
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Anatomy of the Eye Lid
Different Types of Droopy Lids
Causes of Droopy Lids
Why Does this Impact Vision?
When Is To Seek Surgical Intervention?
Testing
Lipid Secretion: Meibomian Glands
What eye is this?
(WC Posey, Diseases of the Eye, 1902)
Transillumination of
meibomian glands
How does the lipid layer aid in contact lens wear?
(Transillumination image from Dry Eye and Ocular Surface Disorders, 2004)
Anatomy
Anatomy
What function does the pupil have?
Natural Folds
Muscles of the Eye Lid
Muscles
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Riolan’s muscle
Levator
Muscle Muller
Orbicularis Oculi
The Eyelid
• 7 Layers of the eyelids
1. Skin-thinnest layer
2. Subcutaneous
connective tissue
3. Striated Muscle
4. Sub-muscular connective
tissue
5. Tarsal plate or fibrous layer
6. Smooth muscle
7. Conjunctiva
(Bulbar/Palpebral)
How are Hordoleum and Chalazions treated?
Lacrimal Pump
• Pump Action
– Lids
• Lateral/medial
• Muscles
• Disease
– Punctum
– Canniculli
• Lacrimal Sac
• Nasolacrimal Duct
• Facial Nerve Palsy (7th
CN)
Eyebrows and Eyelashes
• Eyebrows
– Thickened ridge of skin with short
hairs
– Diverts perspiration
• Eyelashes
– Also protects
– Sebaceous glands at base of each
lash are called Glands of Zeis
which produce a lubricating fluid
• Fluid can harden and clog the
gland, producing a stye or
painless chalazion. If painful
and infected it is called an
external hordeolum
Cataracts (myotonia) are caused by?
Functions of the Eye Lid
• Protection
– From debris
– light
• Pump – moisturize the
globe by spreading tears
across the eye
• Pushes excess tears and
bacteria from the surface
• Provides oil for the tear
film
What Are Droopy Lids
• Droopy lids occur when
the function of the eye
no longer meets it’s
normal required
function or position
• This can be unilateral or
bilateral
Causes of Droopy Lids
Over 425 cause of droopy
eyelids
• Aging
• Muscular
• Neurological
• Congenital
• Acquired
– Disease
– Trauma
Marcus Gunn
Rachel Schoffner, ESG, Memphis, TN
• Marcus Gunn phenomenon
(a.k.a. Marcus Gunn JawWinking[1][2] or Trigeminooculomotor Synkineses) is an
autosomal-dominant condition
with incomplete penetrance, in
which nursing infants will have
rhythmic upward jerking of their
upper eyelid. This condition is
characterized as a synkinesis:
when two or more muscles that
are independently innervated
have either simultaneous or
coordinated movements
Yamada K, Hunter DG, Andrews C, Engle EC (September 2005). "A novel KIF21A
mutation in a patient with congenital fibrosis of the extraocular muscles and Marcus
Gunn jaw-winking phenomenon
Facial Nerves
7th Cranial Nerve – Facial Nerve
Bells Palsy
Cranial Nerves
Ptosis
• Ptosis /ˈtoʊsɪs/ (from
Greek Ptosis or πτῶσις,
to "fall") is a drooping
or falling of the upper
or lower eyelid. The
drooping may be worse
after being awake
longer, when the
individual's muscles are
tired
Dermatochalasis
• Dermatochalasis is a
medical condition,
defined as an excess of
skin in the upper or
lower eyelid, also
known as "baggy
eyes."[1] It may be
either an acquired or a
congenital condition. It
is generally treated with
blepharoplasty.
Eyelids are the pump for tears
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Punctum
Tear coverage
Exposure issues
Diagnosis assistance
Common Lid Conditions
Other Diseases
Terms Associated With Droopy lids
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Lagophthalmos
Dermatochalasis
Blepharoptosis
Eyelid Crease
Medial/Canthal webbing
Inflammation/edema/infil
tration
• Herniated orbital fat pads
• Prolapsed lacrimal gland
• Eyelid laxity
Why Does this Impact Vision?
• Interferes with the
passage of light to the
retina
• Decreases acuity
• Limits peripheral field
of vision
• Changes posture
• Causes fatigue
• Impacts self-esteem
• Changes lifestyle
Seeking Surgical Intervention
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Why?
Lifestyle change
Job performance
Insurance coverage
Cosmetic
Before and After Surgery
Testing
• Insurance vs Cosmetic
• Visual field testing
– HVF
– Goldmann perimeter
Review
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Anatomy of the Eye Lid
Different Types of Droopy Lids
Causes of Droopy Lids
Why Does this Impact Vision?
When Is To Seek Surgical Intervention?
Testing
References
• Yanoff, M, Duker, JS. Ophthalmology. Mosby,
St. Louis. 1999. pp. 8.1-10.
David M. Mills, MD
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Recommended Texts
David M. Mills, MD
32
Thank you
[email protected]