By Dr.Ashraf " Md " , Ainshams university

1. Eye lid anatomy Layers 1.skin + S.c. tissue (no fat) 2.muscle layer 3.S.m space 4.fibrous layer 5.palpebral conj.

2. Sagittal section of the upper eye lid 1.skin & SC tissue 2.Muscle layer 4.fibrous layer 3.sub muscular layer tarsus OO L.P.S Mullers m Orbital septum tarsus Orbital septum 5.conj.layer Lashes,Zeis,Molls

3. Eye lid anatomy Orbicularis oculi Levator palpebrae superioris Muscle layer

4. Eye lid anatomy Fibruos layer (orbital septum/tarsus)

5. Eye lid anatomy tarsus Palp.conj . Meibomian glands orfices

6. Eye lid anatomy

7. Lid margin - anterior lamella? -posterior lamella?

10. Complications

13. Complications Anterior blepharitis

18. Posterior blepharitis

21. Distichiasis cryotherapy

23. Malposition of the lid margin

25. Cicatricial Entropion Trachoma M/I CAUSE

29. Treatment SURGICAL

31. Snellen's operation (tarsal wedge resection)

32. Snellen's operation (tarsal wedge resection) tarsus Skin &muscle incision Wedge resection entropion

33. Posterior lamellar advancement 1 2 3 tarsus Ante.lam. Post lam. skin

34. LL involutional entropion Temporary Permanent Everting sutures Wies op. (trans. Bleph. & marginal rotation ) scheme

35. Everting sutures

36. Wies oper.(transverse blepharotimy & marginal rotation)

37. LL cicatricial entropion Severity Mild Moderate severe Weis op. (trans bleph & marginal rotation ) Tarsal fracture Tarsal graft scheme

38. Tarsal fracture

39. Congenital entropion Skin & muscle operation When ?

41. Cicatricial ectropion Area of scarring Z-plasty scheme localized Diffuse & extensive Free skin graft

42. Z-Plasty

43. Paralytic ectropion Neurological consultation Recent wait 6months +temporrary meas Lateral tarsorrhaphy Old Band support Lateral tarsal strip Does not improve scheme

44. Lateral tarsorrhaphy

45. LL Support Lateral tarsal strip

46. Involutional ectropion Site Medial part Diffuse scheme Punctal inversion Horizontal lid shortening

47. Horizontal lid shortening

48. Punctal inversion punctum Lid margin Palp conj .

49. Abnormal lid positions

51. Mechanical ptosis Causes Large tumors Severe lid edema Anterior orbital lesions

52. Apneurotic ptosis

53. Congenital ptosis

55. Blepharophimosis syndrome

57. Causes of pseudoptosis Lack of lid support Contralateral lid retraction

59. 3-Degree of ptosis

61. 4-Levator function

65. Fasanella-Servat procedure Excision of upper border of tarsus, lower border of Muller muscle and overlying conjunctiva ..

66. Levator resection Shortening of levator complex Indicated for any ptosis provided levator function is at least 5 mm Amount determined by levator function and severity of ptosis