Common Abnormalities Eyelids

The lids normally cover the upper and lower margins of the iris. The palpebral fissures should be symmetrical. The palpebral aperture is narrowed in blepharospasm (spasm of the eyelids) and photophobia (light sensitivity), which are often associated with painful eye conditions. Photophobia also occurs in migraine and in association with meningeal irritation.

Ptosis (upper lid drooping) can be due to congenital or acquired levator palpebnte paresis (third nerve palsy), or to sympathetic paresis (Horner's syndrome. Fig. 6.9. p. 198).

Lid retraction, with widening of the palpable aperture, is obvious when sclcra is visible above and below the iris (Fig. 7.4). It occurs in hyperthyroidism, usually with a lag of Ihe upper lid on looking down (lid-lag) and when the eye is pushed forward (proplosed) by retrobulbar tumours or inflammation. Proptosis is also called exophthalmos. It is common in auto-immune thyroid disease. The periorbital (issues are loose and the lids swell easily. Periorbital oedema occurs commonly in congestive heart failure, glomerulonephritis, hypersensitiviiy reactions and thyroid

Dysthyreoid Eye Disease
Fig. 7.4 Proptosis and lower lid retraction in dysthyroid eye disease.

disease. There may be associated conjunctival oedema (chemosis).

The lids may turn in (entropion) (Fig. 7.5), causing corneal damage, or out (ectropion), causing watering. Both malpositions occur in the lax tissues of the elderly but can also result from conjunctival or skin scarring respectively.

Common lumps on the lids include styes (microabscesses of lash follicles), tarsal cysts (pea-like swellings of the larsal glands) and rodent ulcers (basal cell carcinoma).

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