Ординатура / Офтальмология / Английские материалы / Oculoplasty and Reconstructive Surgery Made Easy_Garg,Touky, Nasralla_2009

Pediatric Eyelid Abnormalities 59

Inflammatomy Disorders

Blepharitis

It is a condition of inflammation of eyelid margins. It causes redness, discharge, irritation and discomfort. Commonly associated with scalp dandruff.

Management: This condition is managed by antibiotic with steroid ointment and 3% soda bicarbonate for eye lashes cleaning. Antidandruff shampoo is also advised twice weekly.

Stye

It is an acute inflammation of fat sweating glands of the eyelids (Zeis or Moll). Here a painful swelling and occurred in the lid margin (Figure 18).

Management: It is managed by hot formentation, antibiotic cream and analgesics. Sometime incision and drainage of pus may be required

Figure 18: Stye of left upper lid

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Figure 19: Chalazion of left upper lid causing mechanical ptosis

Chalazion

It is a chronic granulomatous (non-infective) inflammation of the fat secreting meibomian glands of the eyelid. It causes a painless swelling near the eyelid margin (Figure 19).

Management: It is managed by hot formentation, antibiotic drops, analgesic, intralesional injection of triamcinolona (5 mg per ml) and Incision and curettage.

Internal Hordeolum

It is a inflammation of the meibomian gland associated with blockage of the duct. Here pain is more intense and swelling is away from the lid margin.

Management: It is managed by hot fomentation , antibiotic drops and oral antibiotics if associated with pre-septal cellulitis.

Molluscum Contagiosum

It is a viral infection (Pox virus). Multiple, pale, waxy, umbellicated swellings are found over the skin of the eylid

(Figure 20).

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Figure 20: Molluscum contagiosum of right lower lid

Management: It is managed by Incision and curettage with tincture/iodine/pure carbolic acid and cryotherapy

Viral warts, herpes simplex or Herpes zoster infection of the eyelid along with contact dermatitis may also be encountered.

To conclude, pediatric abnormalities poses challenges for an ophthalmologist. Patient’s cooperation is a limitation for adequate assessment in pediatric age group. Careful planning of management is required as pathology may change with the growing age. In conditions of eyelid abnormalities like coloboma, where there is risk of loss of vision or, where obstruction of vision may prove amblyogenic needs to be managed immediately. Cosmetic consideration is also critical for child’s psychological development. It is important to carefully assess and plan the technique of intervention for gratifying results.

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BIBLIOGRAPHY

1.Beard C: Ptosis, 3rd edition. St. Louis : CV Mosby Company 1981.

2.Duke-Edler S. System of Ohthalmology. Vol 3. Normal and Abnormal development. Part II: Congenital Deformities. St. Louis, C.V. Mosby Co., 1963 p.827.

3.Grover AK, Gupta AK. Proceedings of the Golden Jubilee Conference of All India Ophthalmological Society, New Delhi 1992; 54-56.

4.Grover AK, Mittal Sanjay. A Clinico-pathological study of levator muscle for Congenital Ptosis. Thesis is submitted to Delhi University.

5.Mustarde JC. Colobomas of the eyelids. Repair and reconstruction in the orbital region, 2nd Edition, pp 364-372. Edinburgh. Churchill Livingstone 1980.

6.Mustarde JC. Epicanthus and telecanthus. Int. Ophthalmol Cli. 4: 1964

7.Mustrade JC. Colobomas of the eyelids . Plastic Siurgery in infancy and childhood. 2nd ed. pp243-249. Edinburgh. Churchill livingstone 1978.

8.Saunders DH, Flanagan JC. Disorders of the lids.Pediatric Ophthalmology. 3rd edition. Pp 334-354.W.B. Saunders company.

9.Troutman RC, Converse JM, Smith B. Plastic and Reconstructive Surgery of the eye and Adnexa. Washington DC, Butterworths, 1962.

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Pathophysiology

•It is due to disinsertion of the lower lid retractors.

•Or secondary overaction of marginal orbicularis muscle.

Treatment

Reattaching or plicating of the lower lid retractors.

Differential Diagnosis

Epiblepharon in which a fold of skin pushes the lashes against the globe and tends to correct itself with growth of facial bones

SPASTIC ENTROPION

Causes

1.Recent ocular surgery.

2.Inflammatory eye condition.

Pathophysiology

Acute lid swelling and orbicularis spasm.

In which preseptal orbicularis muscle overrides pretarsal orbicularis and lid margin turns inward.

Treatment

•Treatment of inflammatory eye by antibiotic and steroids.

•Taping of lid.

•Local anesthesia infiltration.

•Botulinum injection in orbicularis muscle will break the cycle of ocular irritation and orbicularis spasm and lid malposition will resolve.

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Prognosis

•Botulinum toxin treatment has proven successful in temporarily

•Elimination of the spasm.

CICATRICIAL ENTROPION

Pathophysiology

Caused by contracture in the conjunctiva and the tarsus or both leading to shortning of posterior lamella of lid.

Causes

Secondary to:

•Acids and alkali.

•Burns.

•Trachoma.

•Steven-Johnson syndrome .

•Mechanical trauma.

•Cicatricial pemphigoid.

•Viral

Clinical Picture

•Blepharo conjuctivitis

•Meibomitis

•Rounding of posterior lid border and posterior migration and keratinized epithelium and secondary trichiasis.

•Keratoconjunctivitis sicca.

Treatment of Cicatrizing Entropion

•Trichiasis is treated by electrolysis, cryosurgery, argon laser therapy or excision of lash follicles.

•Cicatricial entropion is treated by mucous membrane graft.

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Figure 1: Epiblepharon

Figure 2: Involutional entropion

Figure 3: Distichiasis

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Figure 4: Trichiasis without entropion

Figure 5: Trichiasis

A B

Figure 6: Upper and lower lid entropion

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Figure 7: Upper lid entropion

Figure 8: Lateral tarsal strip procedure