Lecture 1: Eyelids

Innervation?

Oribularis oculi

CN VII

Innervation?

Levator palpebrae

CN III

Innervation?

Muller’s muscle

Sympathetic

Innervation?

Superciliaris/corrugator supercilious

CN VII

Innervation?

Retractor annuli oculi

CN VII

Sensory innervation for upper eyelid

CN V (Opthalmic)

Sensory innervation for lower eyelid

CN V maxillary

A?

Medial palpebral ligament

B?

Horner’s muscle

C?

Levator anguli oculi medialis muscle

D?

Levator palpebrae superioris muscle

E?

Frontalis muscle

F?

Oricularis oculi muscle

G?

Retractor anguli muscle

H?

Malaria muscle

Name the eyelid glands

• Meibomian (tarsal) glands

• Glands of zeis and moll

• Glands of Krause and Wolfring (accessory)

A?

Meibomian gland

B?

Conjunctiva

C?

Meibomian gland orifice

Eyelid agenesis

What surgery is used to correct eyelid agenesis?

Lip to lid surgery or dziezyc millichamp surgery

Neonatal opthalmia

What area is most commonly affected by eyelid agenesis?

Upper lateral eyelid, lower eyelid usually not affected

Blepharophimosis

• Needs medial not lateral canthoplasty (almost always)

Macroblepharon

What does canthoplasty solve with macroblepharon cases?

• Largophthalmos

• Medial lower lip entropion

• Medial carbuncular trichiasis

• Keeps cornea from being exposed to nasal fold

Cilia emergy from the meibomian gland orfice

Distichiasis

The cilium arises from the meibomian gland but emerges through the palpebral conjunctiva.

Ectopic cilium

Normal cilia or hairs arising from normal location reach the cornea due to altered facial or eyelid conformation

Trichiasis

How do you use neonatal opthalmia?

Use blunt tool to gently open eyelid and treat like ulcer

Distichaisis

What is the best treatment for distichia?

Cryotherapy

• Normal cilia erupting from palpebral conjuctiva

• Corneal ulceration (dorsal central cornea)

• Blepharospasm

• Tearing

Ectopic cilia

Who is more commonly affected by ectopic cilia?

Young dogs

What is resection of ectopic pregnancy cilium?

• The eyelid surrounding the cilium is clamped for hemostasis and eyelid everted

• Wedged of palpebral conjunctiva including ectopic cilium and its follicule is resected en bloc

What are the causes of entropion?

Congenital, spastic, cictricial

How do can you fix entropion?

Lid tacking or lid tissue removal

What are the types of entropion?

Congenital, cicatricial, paralytic

How can you correct entropion?

• Wedge resection

• Full thickness lid resection

• Lateral canthus triangle techinique

How do you perform an eyelid margin repair?

1. SQ mattress suture

2. Figure eight at eyelid margin

How is cicatricial entropion treated?

V to Y plasty

Cicatricial ectropion

What suture pattern is used for eyelid laceration?

Figure 8

Who is eyelid tacking used in?

Puppies or very small dogs

Juvenile pyoderma

Localized demodecosis

Hordeoleum or stye

Chalarzion

Uveitis-dermatological syndrome

What kind of suture is used for entropion surgery?

Snug single sutures under the eyelid

Dermoid

Why is important if you do not cut parallel during entropion surgery?

Does not create the ectropion affect we are aiming for

Meibomian gland adenoma

Papilloma

Papilloma

Melanoma

Histiocytoma

MCT

Why do you put figure eight in upper lid?

Allows for proper eyelid apposition

SCC

What equipment is needed for suture anchor techinique to replace third eyelid gland?

Gass muscle hook, tenotmy scissors, 5-0 nylon suture

Ways to correct prolapsed third eyelid gland?

• Suture anchor technique to ventral rectus tendon

• Pocket techinique

Why should you not remove prolapsed gland?

Can develop dry eye (KCS)

What breeds often get bent cartilage of the third eyelid?

• Great Dane

• Saint Bernard

• German Weimaraner

• Short-haired pointer

• Mastiff

What is the treatment for bent cartilage of the third eyelid?

1. Surgical removal

2. Thermocautery

Third eyelid adenocarcinoma

What is the most common eyelid tumor?

Meibomian gland adenoma

Which cranial nerve innervates the orbicularis oculi muscle, responsible for closing the eyelids? a) CN III b) CN V c) CN VII d) CN II

c) CN VII

Which of the following is NOT a function of the eyelids? a) Protection of the globe b) Production of tears c) Distribution of tears d) Production of aqueous humor

d) Production of aqueous humor

What is the term for the condition where a hair emerges from a meibomian gland opening? a) Trichiasis b) Distichiasis c) Entropion d) Ectopic cilia

b) Distichiasis

Which of the following is a treatment option for distichiasis? a) Lid tacking b) V to Y plasty c) Cryotherapy d) Medial canthoplasty

c) Cryotherapy

What is the definition of entropion? a) Turning out of the eyelid b) Inflammation of the eyelids c) Turning in of the eyelid d) Drooping of the upper eyelid

c) Turning in of the eyelid

Which breeds are predisposed to entropion? a) Persians b) Cocker Spaniels c) Shar Pei, Chow, Bulldog d) Beagles

c) Shar Pei, Chow, Bulldog

What is the definition of ectropion? a) Turning in of the eyelid b) Inflammation of the eyelids c) Drooping of the upper eyelid d) Turning out of the eyelid

d) Turning out of the eyelid

Which of the following is a cause of ectropion? a) Corneal pain b) Facial nerve damage c) Excessive tearing d) Meibomian gland blockage

b) Facial nerve damage

What is a chalazion? a) Inflammation of glands of Zeis or Moll b) Granulomatous reaction in and around meibomian glands c) Turning in of the eyelid d) Turning out of the eyelid

b) Granulomatous reaction in and around meibomian glands

What is the most common eyelid tumor in dogs? a) Squamous cell carcinoma b) Melanoma c) Meibomian gland adenoma d) Histiocytoma

c) Meibomian gland adenoma

What is the function of the meibomian glands? a) Produce sweat b) Produce the mucoid layer of the tear film c) Produce the oily layer of the tear film d) Produce the aqueous layer of the tear film

c) Produce the oily layer of the tear film

What is the primary function of the third eyelid? a) To produce the oily layer of the tear film b) To protect the corneac) To control eyelid movement d) To produce the mucoid layer of the tear film

b) To protect the cornea

Which of the following is a common breed for third eyelid gland prolapse? a) German Shepherds b) Great Danes c) Cocker Spaniels d) Persians

c) Cocker Spaniels

Which is NOT a treatment for a prolapsed gland of the third eyelid? a) Suture anchor technique b) Pocket technique c) Surgical excision d) Suturing to deep periorbital tissue

c) Surgical excision

What is the term for a congenital notch-like defect of part of the eyelid? a) Entropionb) Ectropion c) Coloboma d) Chalazion

c) Coloboma

What is the function of the retractor anguli oculi muscle? a) To close the eyelids b) To elevate the upper lid c) To maintain normal size of the palpebral aperture d) To elevate the nasal portion of the upper lid

c) To maintain normal size of the palpebral aperture

Which nerve provides sensory innervation to the upper eyelid? a) Maxillary branch of CN V b) Ophthalmic branch of CN V c) CN VII d) CN III

b) Ophthalmic branch of CN V

What is a common cause of eyelid lacerations? a) Chronic allergies b) Meibomian gland blockage c) Bite wounds d) Autoimmune disease

c) Bite wounds

What is the primary treatment for follicular conjunctivitis? a) Antibiotic ointment aloneb) Surgical removal of the third eyelid c) Removal of follicles and steroid-antibiotic ointment d) Warm compresses

c) Removal of follicles and steroid-antibiotic ointment