Eyelid disorders

Abnormal vision, eyelid disorder, foreign body sensation. 

The eyelid disorders may be related not only to neuromuscular transmission, as in myasthenia gravis, but also to intrinsic muscle weakness and cranial neuropathy. 

Like ptosis and eyelid disorders, abnormal ocular movements in thyroid-associated eye diseases may be consequential to abnormalities at different levels of the nervous system. Apart from myasthenia gravis described under eyefid disorders, the association of exophthalmos with ophthalmoplegia in hypothyroidism has been described. Elevated titers of thyroid antibodies suggest a possible role of autoimmunity (Brownlie et ai, 1975), but concurrent mechanical factors related to exophthalmos cannot be entirely excluded. Hence, the neurological level of involvement remains uncertain. 

Ophthalmic Conjunctivitis optic neuritis photophobia eyelid inflammation corneal opacities (see Warnings) cataracts visual disturbances color vision disorder keratitis dry eyes decreased night vision that may persist. 

A 38-year-old man with a family history of cardiovascular and cerebrovascular disease makes an appointment for a routine physical examination with a physician he has not seen before. He explains that his father died young of a heart attack and that two paternal uncles have suffered strokes in their late 40s. Physical examination reveals yellowish lumps on his eyelids (xanthelasmas, which are often associated with a lipid disorder) and a resting blood pressure of 186/95 mm Hg. There is some excess visceral fat, and his body mass index calculates to 26.5. Total serum cholesterol (476 mg/dL) and triglycerides (288 mg/dL) are elevated and subsequent angiography reveals atherosclerotic restrictions of at least two coronary arteries. 

Five low-weight but otherwise normal-appearing offspring were delivered after 156-l65d gestation. PBB toxicity in the rhesus monkey closely parallels that of PCBs in many respects alopecia and swollen eyelids, low birth weight offspring and menstrual disorders in the dam (ref. 

In India, the spice is used broadly to treat infections in teeth and gums, to prevent and treat throat troubles, congestion of the lungs and pulmonary tuberculosis, inflammation of eyelids and also digestive disorders. 

Ideally the effective dose should be used for the shortest time necessary to secure the desired clinical response. The dosage should be individualized as much as possible to the patient and the severity of the condition. The patient s general health must be considered and close supervision maintained to assess the effects of steroid therapy on the course of the disease and possible adverse effects. With ocular disease the route of steroid administration is an important determinant of the pharmacologic and therapeutic effects observed. Topical ocular therapy is usually satisfectory for inflammatory disorders of the eyelids, conjimctiva, cornea, iris, and ciliary body. In severe fiarms of anterior uveitis, topical therapy may require supplementation with systemic or periocular (local injection) steroids. Chorioretinitis and optic neuritis are most often treated with systemic steroids. 

Modified from Smith RE, Flowers CW Jr. Chronic blepharitis a review. QAOJ 1995 21 200-207 McCulleyJP, Doughert/JM, Deneau DG. Classification of chronic blepharitis. Ophthalmology 1982 89 1 173-1 180 and Wilhelmus KR. Inflammatory disorders of the eyelid margins and eyelashes. Ophthalmol Clin North Am 1992 5 187-194. 

In FES it is thought that sleeping with an everted eyelid causes the pretarsal orbicularis oculi and skin to override the lid margins, which causes the eyelashes to point downward (eyelash ptosis). Because some patients with FES also have keratoconus, an underlying connective tissue disorder may be implicated. 

Evaporative loss can also occnr from abnormal ocular surfece exposure, due to incomplete blink, nocturnal lagophthalmos, exophthalmos, proptosis, cranial nerve VII palsy, lid retraction, or other eyelid position and apposition disorders. Contact lenses may also contribute to an increased tear evaporation rate. 

Allergic disorders of the eyelid include atopic dermatitis, contact dermatitis, and urticaria. Eczema is a common feature of both atopic and contact dermatitis.Table 27-5 summarizes the clinical manifestations and management of each entity. 

Muscular system disorders related to the immune system include myasthenia gravis (MG) and tumors. MG is characterized by weak and easily fatigued skeletal muscles, one of the symptoms of which is droopy eyelids. 

Myasthenia gravis is a progressive disorder characterized by muscle weakness eye muscles are often the first affected. Research has shown it to be an autoimmune disease in which the victim forms antibodies to his or her nicotinic acetylcholine receptors at motor endplates. It is characterized by fatigability and weakness of the skeletal muscles, especially those of the eyes. Approximately 90% of the patients have droopy eyelids and double vision. Treatments include corticosteroids and thymectomy to reduce the actions of the immune system and anti-ChE agents such as pyridostigmine to improve the effectiveness of the receptors that remain. 

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