Lecture Seven: Eyelids and Third Eyelid

CN 7

What is the innervation of the orbicularis oculi?

CN 3

What is the innervation of the levator palpebrae superioris?

Sympathetic

What is the innervation of the muller's muscle?

CN 7

What is the innervation of the Levator anguli oculi medialis?

CN 7

What is the innervation of the retractor annuli oculi?

CN 5 — ophthalmic

What is the sensory innervation of the upper eyelid?

CN 5 — maxillary

What is the sensory innervation of the lower eyelid?

Meibomian glands

What glad secretes lipid (the most superficial aspect of the tear film that prevents evaporation)?

Meibomian gland openings

What is this picture showing?

Eyelid agenesis

What is this picture showing?

● Lubrication

● Surgical correction

● "Managing the consequences"- Cryotherapy for the hairs

Treatment Options for Eyelid Agenesis?

Lip-to-lid surgery

What is the most common surgery to fix eyelid agenesis?

Replace the upper lid with some of the lower lid skin.

Describe the following surgery for eyelid agenesis: dziezyc-mill IH amp surgery.

Neonatal ophthalmia

- Infection in the eyelid before they open

What is this picture showing?

Force the eyelid open sooner than usual with a blunt instrument

What do you want to do if you suspect neonatal ophthalmia?

abnormal adhesion between the bulbar and palpebral conjunctiva, often due to inflammation or trauma.

Symblepharon?

congenital condition where the palpebral fissures are abnormally small, leading to restricted eyelid opening.

Blepharophimosis?

Macroblepharon (enlarged palpebral fissure)

What is this picture showing?

Medial canthoplasty (not lateral)

What is the treatment of choice for macroblepharon?

- Solves lagophtalmos

- Solves medial lower lid entropion

- Solves medial carbuncular trichiasis

- Keeps cornea from being exposed to the nasal fold

What does a medial canthoplasty to treat macroblepharon fix? (4)

A) Normal eyelid

B) Distichiasis (cilia emerge from the meibomian gland orifice)

C) Ectopic cilium (the cilium arises from the meibomian gland, but emerges through the palpebral conjunctiva)

D) Trichiasis (normal cilia or hairs arising from a normal location reach the cornea due to altered facial or eyelid conformation)

What is this picture showing?

Distichiasis

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Distichiasis

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Cryotherapy

What is the best treatment option for distichiasis?

Ectopic cilia

What is this picture showing?

- Corneal ulceration (dorsal central)

- Blepharospasm

- Tearing

(usually young dogs)

What are the clinical signs seen with ectopic cilia? (3)

what age?

The eyelid surrounding the cilium is clamped with a chalazion clamp for hemostasis, and the eyelid is everted. A wedge of palpebral conjunctiva including the ectopic cilium and its follicle is resected en bloc.

What is the treatment for an ectopic cilium?

where the eyelid (usually the lower lid) turns inward, causing the eyelashes to rub against the cornea and conjunctiva. This leads to irritation, discomfort, and potential corneal damage.

what is entropion??

- Congenital

- Spastic

- Cicatrical

What are the 3 causes of entropion?

Entropion (eyelid margin rolled in)

What is this picture showing?

- Lid tacking

- Cut it out technique

- Clamp technique

What are the surgery options for entropion? (3)

Entropion

If an animal has entropion and ectoprion, which should you treat first

outward turning of the eyelid

ectropion?

- Congenital

- Cicatricial

- Paralytic

What are the 3 causes of ectropion?

Ectropion (rolling out of the eyelid)

What is this picture showing?

Entropion + entropion

What is this picture showing?

1/4 - 1/3

With ectropion surgery, what is the maximum amount of eyelid margin you can remove from the average dog?

Cruciate (figure eight) sutures

What sutures should be use for eyelid repair with ectropion?

- Full-thickness lid resection (wedge resection)

- V to Y plasty

What are the surgery options for ectropion?

V to Y plasty

What is the treatment for cicatricial ectropion?

V to Y plasty (treatment for cicatricial ectropion)

What is this picture showing?

Horses

What species has lacerations parallel to the lid margin?

Dogs and cats

What species has lacerations perpendicular to the lid margin?

no

is facial fold removal recommended?

eyelid inflammation

what is Blepharitis?

Blepharitis

The following are potential causes of what?

- Juvenile pyoderma

- Localized demodecosis

- Hordoleum or style

- Chalazion

- Bee sting

- Uveo-dermatological syndrome

Uveo-dermatological syndrome

What am I describing?

- Seen in Akita dogs

- Depigmentation and erosive lesions of pigmented tissues

- Treatment is systemic immunomodulators

Meibomian gland adenoma

What is the most common eyelid tumor?

Dermoid (skin in the wrong place) of the eyelid

What is this picture showing?

Meibomian gland adenoma of the eyelid

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Benign

Are melanomas of the eyelid usually benign or malignant?

Papilloma (skin mass) of the eyelid

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Melanoma of the eyelid

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Benign

Are the mast cell tumors of the eyelid usually benign or malignant?

Histiocytoma of the eyelid

What is this picture showing?

Sarcoid

What is the 2nd most common eyelid tumor in a horse?

Mast cell tumor of the eyelid

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Squamous cell carcinoma of the eyelid

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Squamous cell carcinoma of the eyelid

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Pavletic lip flap

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35%

The third eyelid produces what % of tears?

Cats

What is the only domestic species with a muscle to the third eyelid?

Contraction of the extrinsic muscles of the eye retracts the globe and causes movement of the third eyelid?

How do most domestic species move their third eyelid?

Replace it! Do not remove it. Will cause dry eye (KCS)**

What should you do with a prolapsed 3rd eyelid?

Prolapsed 3rd eyelid (cherry eye)

What is this picture showing?

The pocket technique:

- Remove the bend cartilage

- Incise the bulbar conjunctiva on the inner surface of the eyelid

- Suture the conjunctival incision

What is the most common technique for replacing a prolapsed third eyelid?

- Great Dane

- Saint Bernard

- German Weimaraner

- Short-haired pointer

- Mastiff

What 5 breeds are predisposed to bent cartilage of the 3rd eyelid?

- Leave alone if not bothering

- Surgical removal

- Thermocautery

What are the treatment options for bent cartilage of the 3rd eyelid?

● Recurrence*********

● Corneal ulceration

● TEL lacrimal gland cyst

surgical complications ?

Bent cartilage of the 3rd eyelid

What is this picture showing?

Follicles on the 3rd eyelid

- Chronic manifestation of conjunctivitis

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Hemangioma of the 3rd eyelid

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Squamous cell carcinoma of the 3rd eyelid

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Adenocarcinoma of the 3rd eyelid

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FB

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Chronic superficial keratitis (pannus)

what is this pic showing?