Anatomy of the Eyelids

Orbit Anatomy Orbital Septum

The eyelids serve several valuable functions. Most importantly they provide mechanical protection to the globe. They also provide vital chemical elements to the precorneal tear film, and help distribute these layers evenly over the surface of the eye. During the blink phase the eyelids propel tears to the medial canthus where they enter the puncta of the lacrimal drainage system. The eyelashes along the lid margins sweep air-borne particles from in front of the eye, and the constant voluntary...

Evaluation of Eyelid Malpositions

Levator Muscle Test With Rule

A thorough eyelid examination should be included in the documentation of any eyelid malposition. Accurate diagnosis of eyelid dystopia including some determination of its etiology is essential prior to consideration of surgical or nonsurgical correction. An adequate history can provide useful clues to the cause of the eyelid malposition and may suggest the need for further evaluation. In some cases the history may make immediate surgical intervention unwise. The time of onset of the...

Evaluation of Eyelid Lesions

Fluid Filled Cyst Eyelid

The eyelids may be affected by benign and malignant lesions. Most of these are common elsewhere on the body, but when occurring on the eyelid they are often different in character, appearance, and behavior because of the unique characteristics of eyelid skin. A large number of cutaneous and systemic disorders may be associated with eyelid lesions. In many instances the eyelid findings are quite specific for a particular disorder, at other times they may be rather non-specific. These ocular...

Histopathologic Terminology

Blast Cells Atypical Lymphocytes

The use of descriptive terms in histopathology is a valuable method for standard communication which allows both the pathologist and the clinician to understand specific histologic characteristics of biological materials. One or more of these characteristics may be specific for certain lesions, thus allowing a more precise diagnosis. In some cases, knowledge of such characteristics can also help the clinician make a provisional diagnosis that might allow therapeutic decisions such as to biopsy...

Inverted Follicular Keratosis

Inverted Follicular Keratosis

INTRODUCTION Inverted follicular keratosis is a benign skin lesion that is common on the face and less frequently on the eyelids. It occurs in older individuals from the fifth decade on, and is considerably more common in males. It is frequently mistaken for a malignant tumor. These lesions arise from the infundibular epithelium of the hair follicle and therefore are related to epidermoid cysts. Inverted follicular keratosis may be an irritated form of seborrheic keratosis or verruca vulgaris....

Trichilemmal Sebaceous Cyst

Trichilemmal Carcnoma

INTRODUCTION The trichilemmal cyst is also referred to as a sebaceous or pilar cyst. It is derived from the outer root sheath of the deeper parts of a hair follicle and consists of a well-keratinized epidermal wall surrounding semi-solid hair keratin and cholesterol-rich debris, rather than just sebaceous material. Trichilemmal cysts are more common in females and most cases occur in the sixth and seventh decades of life. They differ from epidermoid cysts in that they lack a granular layer in...

Chalazion and Hordeolum

Chalazion Multiple

INTRODUCTION A chalazion and hordeolum are focal inflammatory lesions of the eyelid that results from the obstruction of secretory glands. In a chalazion there is no acute bacterial infection, but rather a chronic inflammatory lesion with circumferential fibrosis. When this involves the meibomian glands they form a deep chalazion, whereas when there is involvement of the more superficial glands of Zeis in the dermis or glands of Moll associated with the pilosebaceous unit a more superficial...

Hughes Tarsoconjunctival Flap Procedure

Hughes Flap Eyelid

The Hughes procedure is a two-staged operation for reconstruction of total or near total lower eyelid defects. As with the free tarsoconjunctival graft, a block of tarsus and conjunctiva is marked out on the ipsilateral upper lid. However, the upper border is left attached superiorly and a conjunctival flap is dissected off of the underlying Muller's muscle to the superior fornix Fig. 10 . The tarsal flap is advanced down into the lower lid defect and sutured to residual tarsus or canthal...

Eyelid Lesions and Tissues of Origin

Gland Moll

The plethora of lesions that can occur on the eyelids is rather daunting, not to say confusing, to the average clinician. Many names are similar and while they may be meaningful to the pathologist based on details of microscopic findings, they often add little to the clinical recognition or management of these diseases. Placing such lesions into a more or less organized system based on anatomical tissues of origin may be a useful exercise. All lesions that involve the eyelids or any other...

Angioedema and Urticaria

Angioedema Pictures Eyelids

INTRODUCTION Angioedema and urticaria are common transient phenomena that result from mast cell degranulation with the release of mediators that promote vascular permeability, causing proteins and fluids to extravasate into the extracellular space. In urticaria fluid collects within the dermal tissue, whereas in angioedema fluid collects in the deeper subcutaneous space. The causes of mast cell degranulation are varied and include both immunologic and nonimmunologic mechanisms. Systemic...

Surgical Management of Eyelid Lesions

Cutler Beard Flap

Some eyelid lesions can be identified by their history and clinical appearance, and then treated appropriately. However, many benign lesions can be confused with more aggressive malignant tumors from which they must be differentiated. When doubt exists as to a specific diagnosis, a biopsy should be obtained and submitted for histopathologic evaluation. Based on the findings a more directed therapeutic approach can then be planned. In some cases such as inflammatory lesions medical therapy alone...

Blepharophimosis Syndrome

Blepharophimosis Ptosis Epicanthus

INTRODUCTION This is a group of related congenital eyelid deformities with a strong autosomal dominant hereditary etiology although sporadic cases also occur. Blepharophimosis refers to a horizontal narrowing of the palpebral fissure, and the syndrome known as BPES is characterized by blepharophimosis, ptosis, and epicanthus inversus. Depending upon the presence type I or absence type II of premature ovarian failure, two clinical forms have been described. Both forms have been mapped to...