Ординатура / Офтальмология / Английские материалы / Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001
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Meibomian gland carcinoma
•Very rare aggressive tumour with 10% mortality
•Predilection for upper lid
Nodular
Hard nodule; may |
Very large tumour |
mimic a chalazion |
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Spreading
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Diffuse thickening of lid |
Conjunctival invasion; may |
margin and loss of lashes |
mimic chronic conjunctivitis |
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Histology of meibomian gland carcinoma
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Cells contain foamy vacuolated |
Cells stain positive for fat |
cytoplasm and large |
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hyperchromatic nuclei |
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Melanoma
Nodular |
Superficial spreading From lentigo maligna |
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(Hutchinson freckle) |
• Blue-black nodule with |
• Plaque with irregular |
• Affects elderly |
normal surrounding skin |
outline |
• Slowly expanding |
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• May be non-pigmented |
• Variable pigmentation |
pigmented macule |
Kaposi sarcoma
•Vascular tumour occurring in patients with AIDS
•Usually associated with advanced disease
•Very sensitive to radiotherapy
Early |
Advanced |
Pink, red-violet lesion |
May ulcerate and bleed |
Merkel cell carcinoma
•Highly malignant with frequent metastases at presentation
•Fast-growing, violaceous, well-demarcated nodule
•Intact overlying skin
•Predilection for upper eyelid
Treatment Options
1.Surgical excision
•Method of choice
2.Radiotherapy
•Small BCC not involving medial canthus
•Kaposi sarcoma
3.Cryotherapy
•Small and superficial BCC irrespective of location
•Adjunct to surgery in selected cases
Lower eyelid reconstruction following tumour excision
a |
b |
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Direct closure of small defect
a
b
Tenzel flap for |
Mustarde cheek rotation |
moderate defect |
flap for large defect |
Eyelid-sharing procedure
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Extensive sclerosing BCC |
Total excision of lower lid |
Tarsoconjunctival flap |
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Reconstruction of |
Reconstruction of anterior |
Appearance after healing |
posterior lamella |
lamella with skin graft |
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ECTROPION AND ENTROPION
1.Ectropion
•Involutional
•Cicatricial
•Paralytic
•Mechanical
2.Entropion
•Involutional
•Cicatricial
•Congenital
•Epiblepharon
Involutional
•Affects lower lid of elderly patients
•May cause chronic conjunctival inflammation and thickening
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