Eyelids
INTRODUCTION 2
Anatomy 2
Terminology 3
General considerations 3
NON-NEOPLASTIC LESIONS 3
Chalazion 3
Other eyelid cysts 5
Xanthelasma 6
BENIGN EPIDERMAL TUMOURS 7
Squamous cell papilloma 7
Seborrhoeic keratosis 8
Actinic keratosis 8
BENIGN PIGMENTED LESIONS 9
Freckle 9
Congenital melanocytic naevus 9
Acquired melanocytic naevus 9
BENIGN ADNEXAL TUMOURS 10
Syringoma 10
Pilomatricoma 10
MISCELLANEOUS BENIGN
TUMOURS 12
Capillary haemangioma 12
Port-wine stain 12
Pyogenic granuloma 13
Neurofibroma 13
MALIGNANT TUMOURS 13
Rare predisposing conditions 13
Basal cell carcinoma 15
Squamous cell carcinoma 17
Keratoacanthoma 18
Sebaceous gland carcinoma 19
Lentigo maligna and melanoma 19
Merkel cell carcinoma 20
Kaposi sarcoma 20
Treatment of malignant tumours 22
DISORDERS OF THE EYELASHES 25
Misdirected lashes 25
Eyelash ptosis 27
Trichomegaly 27
Madarosis 27
Poliosis 27
ALLERGIC DISORDERS 30
Acute allergic oedema 30
Contact dermatitis 30
Atopic dermatitis 30
BACTERIAL INFECTIONS 31
External hordeolum 31
Impetigo 31
Erysipelas 31
Necrotizing fasciitis 32
VIRAL INFECTIONS 32
Molluscum contagiosum 32
Herpes zoster ophthalmicus 32
Herpes simplex 33
BLEPHARITIS 34
Chronic blepharitis 34
Phthiriasis palpebrarum 37
Tick infestation of the eyelid 38 blepharokeratoconjunctivitis 38
Angular blepharitis 38
Childhood
PTOSIS 38
Classification 38
Clinical evaluation 39
Simple congenital ptosis 41
Marcus Gunn jaw-winking syndrome 41
Third nerve misdirection syndromes 41
Involutional ptosis 44
Mechanical ptosis 44
Surgery 44
ECTROPION 45
Involutional ectropion 45
Cicatricial ectropion 47
Paralytic ectropion/facial nerve palsy 47
Mechanical ectropion 50
ENTROPION 50
Involutional entropion 50
Cicatricial entropion 51
MISCELLANEOUS ACQUIRED
DISORDERS 51
Varix 51
Dermatochalasis 52
Floppy eyelid syndrome 52
Blepharochalasis 55
Eyelid imbrication syndrome 55
Upper lid retraction 55
Lower lid retraction 55
COSMETIC EYELID AND
PERIOCULAR SURGERY 56
Involutional changes 56
Non-surgical techniques 56
Surgical techniques 56
CONGENITAL MALFORMATIONS 57
Epicanthic folds 57
Telecanthus 57
Blepharophimosis, ptosis and epicanthus inversus syndrome 59
Epiblepharon 59
Congenital entropion 59
Coloboma 59
Cryptophthalmos 60
Euryblepharon 61
Microblepharon 61
Ablepharon 61
Congenital upper lid eversion 62
Ankyloblepharon filiforme adnatum 62
INTRODUCTION
Anatomy
The skin (Fig. 1.1A) consists of the epidermis, dermis and related structures (adnexa).
Epidermis
The epidermis is comprised of four layers of keratin-producing cells (keratinocytes). It also contains melanocytes, Langerhans cells and Merkel cells. The layers of the epidermis around the eye are described below; cells migrate superficially, undergoing maturation and differentiation through successive layers.
Keratin layer (stratum corneum or horny layer) consists of flat cells devoid of nuclei.
Granular cell layer (stratum granulosum) typically consists of one or two layers of flattened cells containing keratohyaline granules.
Prickle cell layer (stratum spinosum) is approximately five cells deep. The cells are polygonal in cross-section and have abundant eosinophilic cytoplasm. Their free borders are united by spiny-appearing desmosomes (cellular junctions).
Basal cell layer (stratum basale) comprises a single row of columnar-shaped proliferating cells containing melanin derived from adjacent melanocytes.