How to Apply False Eyelashes

Of the Ocular Surface and Adnexa

Conjuntiva Bulbar

Structures of the eyelid. a Overview. Sagittal section through an eye lid. tm tarsalis muscle, t tarsus, ppo palpebral part of orbicularis muscle, Mg Meibomian gland. White arrow excretory duct of Meibomian gland Mo Moll's gland. Black arrows sections through eyelashes. b-e Representative magnifications of the areas marked by a large black arrow in a. b Conjunctival epithelium in the area of the tarsal plate near the fornix. The epithelium consists of columnar epithelial cells with integrated goblet cells (arrows). Tight connective tissue of the tarsus underlies the epithelium. c Conjunctival epithelium in the Fig. 1.2. Structures of the eyelid. a Overview. Sagittal section through an eye lid. tm tarsalis muscle, t tarsus, ppo palpebral part of orbicularis muscle, Mg Meibomian gland. White arrow excretory duct of Meibomian gland Mo Moll's gland. Black arrows sections through eyelashes. b-e Representative magnifications of the areas marked by a large black arrow in a. b...

Ophthalmologyf

Blinding diseases can destroy useful vision unless rapidly diagnosed and treated. The initial routine examination of all infants should be carried out by the primary care physician, and should include direct ophthalmoscopy, and an orderly structural examination to include the eyebrows, lids, and lashes and lacrimal system, conjunctiva, sclera, cornea, iris (note pupils), anterior chamber, lens, vitreous, and fundus (especially optic nerve and macula). Look for symmetry of ocular structures and clarity of optical media (clear cornea, lens, vitreous). The red reflex should be bright and symmetrical. In all preterm infants < 1250 g at birth, after an initial period of retinal development (from 4 to 6 weeks of life), an ophthalmologist trained to screen retinopathy of prematurity should initiate regular ophthalmologic examinations until inner retinal vascularization is complete, follow the progression and regression of retinopathy of prematurity (ROP), determine the need for surgical...

Restrictive Dermopathy

In 2004 a perinatal lethal genodermatosis, restrictive dermopathy (RD Table 1), was linked to primary or secondary lamin A dysfunction (Navarro et al. 2004). Typical RD cases are characterized by intrauterine growth retardation, tight and rigid skin with erosions on flexure sites, prominent superficial vessels, epidermal hyperkeratosis, small O shaped mouth, small pinched nose, micrognathia, sparse absent eyelashes and eyebrows, bone mineralization defects, thin and dysplastic clavicles, pulmonary hypoplasia, multiple joint contractures, and early neonatal death (Fig. 4).

Management options

There is no guaranteed 'sleep' dose of an induction agent, and the drug must be titrated against the patient's response, bearing in mind that it will be responsible for maintaining anaesthesia throughout the onset of muscle relaxation and tracheal intubation. Thiopental is probably still the drug of choice for induction, and the anaesthetist should have 6 mg kg available in the syringe. Suxamethonium has a very rapid onset of action and should not be given until after the eyelash reflex has been lost.

Thick Eyebrows Syndrome

Low Set Breast Microcephaly Syndrome

This infant with Cornelia de Lange's syndrome shows many of the characteristic findings coarse, mop-like hair bushy eyebrows and synophrys (confluent, thick eyebrows) long curly eyelashes short nose with small anteverted nostrils thin lips with a small midline beak of the upper lip long philtrum and downward curving of the angles of the mouth. The infants often have a masklike expression. Figure 3.14. This infant with Cornelia de Lange's syndrome shows many of the characteristic findings coarse, mop-like hair bushy eyebrows and synophrys (confluent, thick eyebrows) long curly eyelashes short nose with small anteverted nostrils thin lips with a small midline beak of the upper lip long philtrum and downward curving of the angles of the mouth. The infants often have a masklike expression. Figure 3.20. In the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome there are varying manifestations of lobster-claw deformity (ectrodactyly) of the hands and feet and there is...

Epibulbar Lipodermoids

Ankyloblepharon Filiforme Adnatum

The coloboma of the lid in the Treacher-Collins syndrome involves the lateral third of the lower lid and may not affect the lid margin. Other lower lid anomalies such as absent lacrimal punctae and irregular lower lid lashes may also be present. Figure 2.36. This complex choristoma located in the superotemporal sulcus of the left eye with the upper lid everted demonstrates die long lashes which may be present. This is different from the lipodermoid noted in the same position in some patients with Goldenhar's syndrome. Figure 2.39. The typical confluent eyebrows, long curly eyelashes, and tele-canthus associated with the Cornelia de Lange syndrome are present in this infant. Telecanthus is the lateral displacement of the inner canthi such that the medial portion of the eye is partially obscured, giving rise to the impression of strabismus and hypertelorism. In hypertelorism the eyes are widely spaced. Because a low nasal bridge may give rise to the impression of widely...

Russell Silver Syndrome

Adult Caudal Regression Syndrome

This infant with Rubenstein-Taybi syndrome presented at term with a birth-weight of 2700 g and a length of 48 cm. Note the prominent forehead, hypertrichosis, downslanting palpebral fissures, epicanthic folds, long eyelashes, hypertelorism, broad nasal bridge, a beaked nose with a nasal septum extending below the alae nasi, and micrognathia. In addition to the findings above, patients with Rubenstein-Taybi syndrome commonly have microcephaly, low-set malformed ears and a high arched narrow palate. Figure 3.173. This infant with Rubenstein-Taybi syndrome presented at term with a birth-weight of 2700 g and a length of 48 cm. Note the prominent forehead, hypertrichosis, downslanting palpebral fissures, epicanthic folds, long eyelashes, hypertelorism, broad nasal bridge, a beaked nose with a nasal septum extending below the alae nasi, and micrognathia. In addition to the findings above, patients with Rubenstein-Taybi syndrome commonly have microcephaly, low-set malformed...

Can Cornelia De Lange Syndrome Be Prevented

Hypertrichosis Newborn

Hypertrichosis in an infant with Cornelia de Lange's syndrome. Note also the synophrys, anteverted nostrils, and lack of philtrum. Synophrys (bridging of the eyebrows in the midline) is seen in Cornelia de Lange's syndrome, Waardenburg's syndrome, and in otherwise normal infants. The skin between the eyebrows usually bears only fine vellus hairs, and when the brows encroach on this area they produce the appearance of a single band of hair above the eyes. Straight eyelashes emerge from the lid margin at a steep angle and extend straight downward rather than exhibiting the gentle upward curve. Such eyelashes are seen in children with severe neuromuscular disease and may be caused by lack of normal muscle tone in the leva-tor palpebri superioris muscle.

View Pictures Of Hydrocephalus

Frontal And Parietal Bossing

A close-up of the face of the same infant as shown in Figure 3.16 at age 6 weeks shows the small face with large head (pseudohydrocephalus), frontal and parietal bossing, hypotrichosis (scalp, eyebrows, and eyelashes), thin skin, prominent scalp veins, prominent eyes, mid-face hypoplasia, and micrognathia. The nose is thin and rather beaked. Figure 3.163. A close-up of the face of the same infant as shown in Figure 3.16 at age 6 weeks shows the small face with large head (pseudohydrocephalus), frontal and parietal bossing, hypotrichosis (scalp, eyebrows, and eyelashes), thin skin, prominent scalp veins, prominent eyes, mid-face hypoplasia, and micrognathia. The nose is thin and rather beaked.

Other Dermatologic Problems

Infants With Abnormal Big Head

The typical facies of hypohidrotic (anhidrotic) ectodermal dysplasia is seen in this infant. Note the alopecia, absent eyebrows and eyelashes, square forehead with frontal bossing, hyperpigmented wrinkles around the eyes, flattened nasal bridge, and large conspicuous nostrils. There are wide cheek bones with depressed cheeks, thick everted lips, a prominent chin, and the ears may be small and pointed. These infants have a thin dry skin, decreased sweating, decreased tearing, and abnormal dentition. The nails are defective in a large percentage of these patients in that they may be thin, brittle, or ridged. If the absence of the sweat glands is generalized, they may have recurrent fever in high environmental temperatures.

Treacher Collins Syndrome

Treacher Collins Syndrome

Close-up of the face of the same infant showing the antimongoloid slant and colobomas of the lower eyelids which typically occur at the junction of the inner two-thirds and outer third of the lower eyelids. Note the absence of eyebrows and eyelashes, the prominent nose and the hypoplasia of the zygomatic bone.

Inspection of the lips and face

If this is indicated by the history, inspect the eyes for signs of jaundice (BASHH, 2005a), and to see if they are bloodshot or if there is discharge (Barkauskas, 2002). Patients with extensive Phthirus pubis (public lice) may occasionally have lice in their eyebrows and eyelashes (BASHH, 2001a). Note if there are any molluscum contagiosum (MC) lesions (BASHH, 2003) on the face or any warts around the mouth (BASHH, 2002a). There is anecdotally evidence that MC facial lesions are associated with HIV, and they can be large and extensive (BASHH, 2003). Then closely examine the lips for

Ocular Surface

The skeleton of the eyelid is a collagen plate called the tarsus (Fig. 1.2). It contains a row of branched alveolar sebaceous glands, unrelated to the eyelashes. These tarsal or Meibomian glands have punctated openings along the free edge of the eyelid close to its posteroir margin. They produce a lipid material whose synthesis is dependent on neuronal, hormonal, and vascular factors 7 . This lipid material is fluid, spreads easily, is a surfactant as well as an aqueous barrier, and must remain functional after a blink. To satisfy these requirements, the Meibomian lipids have a specific composition. Even after delivery, it may be modified by lipases produced by ocular bacteria, and

Functions of Hair

Stout protective guard hairs, or vibrissae (vy-BRISS-ee), guard the nostrils and ear canals and prevent foreign particles from entering easily. The eyelashes can shield the eye from windblown debris with a quick blink. In windy or rainy conditions, we can squint so that the eyelashes protect the eyes without completely obstructing our vision.

Lamin Linked RD

Patient affected with restrictive dermopathy. The taut and thin, translucent skin, together with prominent superficial vessels and erosions, are evident. Joints are fixed in flexion due to generalized joint contracture. The expression is fixed with the mouth open in typical O position microretrognathism as well as absence of eyelashes, eyebrows, and hair can be observed. (Courtesy of Oxford University Press) Fig. 4. Patient affected with restrictive dermopathy. The taut and thin, translucent skin, together with prominent superficial vessels and erosions, are evident. Joints are fixed in flexion due to generalized joint contracture. The expression is fixed with the mouth open in typical O position microretrognathism as well as absence of eyelashes, eyebrows, and hair can be observed. (Courtesy of Oxford University Press)

Lacrimal Gland

Near the anterior margin of the eye lids there are two or three rows of cilia - the eyelashes (Fig. 1.2). In the middle of the lid is the cross-striated orbicularis oculi muscle. The fiber bundles of its palpebral part overlap one another like tiles on a roof. Orbicularis action is triggered by the facial nerve leading to time-shifted lid closure from temporally to nasally and at the same time moving the tears to the medial cantal region and lacrimal lake (Fig. 1.3). The tendon of the cross-striated levator palpebral muscle is inserted into anterior one-third of the tarsus with extension to the skin layer to help define the eyelid crease. The smooth tarsalis muscle originates and lies on the posterior surface of the levator muscle and inserts into the superior tarsal margin. The tone of the latter muscle is determined by autonomic nervous supply, and responds to neosynephrine stimulation. This contributes to the elevation of the upper eyelid. Its action is specifically demonstrated...

Anteverted Nostrils

Mild Microcephaly

Lateral view of the face of the same infant. Note the long eyelashes, the ptosis of the eyelids, anteverted nostrils and the mild micrognathia. Figure 3.184. Lateral view of the face of the same infant. Note the long eyelashes, the ptosis of the eyelids, anteverted nostrils and the mild micrognathia.

Triangular Facies

Triangular Facies

Close-up of the face of the same infant showing again the disproportion between the large head and the small face which tapers to a narrow jaw giving rise to a triangular facies. The fronto-occipital circumference is normal and the fontanelles are enlarged. Note the frontal bossing, prominent eyes, long eyelashes, and downturned angles of the mouth (giving a carp-like appearance), micrognathia, and posteriorly rotated ears. A triangular facies is often the result of a disparity between the growth of the cranium, paced by normal brain growth, and the growth of the facial skeleton whose bones may share in an intrinsic growth deficiency.