OCULOPLASTY SERIES - CLASS 1

Summary

The Delhi Ophthalmological Society hosted the first class of their Oculoplasty series, focusing on eyelid anatomy and embryology. This session, delivered by Dr. Gjan Saluja, covered the detailed structure, layers, and congenital anomalies of the eyelids. Highlights included explanations of the eyelid anatomy from skin to muscle, the development of eyelids in the embryonic stage, and common congenital issues like colobomas and entropion. The session emphasized the importance of understanding these basics for both clinical practice and further learning in ophthalmology.

Highlights

• Dr. Gjan Saluja provided an exhaustive overview of eyelid anatomy, covering critical components like the orbicularis muscle and tarsus. 🏛️
• The webinar also delved into the embryological development of eyelids including the fusion and separation process. 🧪
• Congenital anomalies such as colobomas and entropion were discussed, providing insight into their formation and potential treatments. 🔍
• The session stressed the integration of feedback to continuously improve educational content for ophthalmic learning. 📈
• Participants engaged in a Q&A session, clarifying doubts on topics like congenital entropion versus epicanthal folds. 🤔

Key Takeaways

• Eyelid anatomy is crucial for oculoplastic surgery, highlighting the orbicularis, tarsus, and more! 👁️
• Eyelid development involves a fascinating fusion and separation process during embryology. 🧬
• Understanding congenital eyelid anomalies, like colobomas and entropion, aids in diagnosis and treatment. 🚼
• Interactive Q&A sessions enhance clarity on complex ophthalmic concepts. 💬
• Regular participation in such educational webinars can significantly bolster ophthalmic knowledge. 📚

Overview

Delhi Ophthalmological Society's first session of the Oculoplasty Series took deep dives into the intricacies of eyelid anatomy and embryology, vital for any budding or practicing ophthalmologist. The session was an enlightening mix of lectures and interactive discussions led by Dr. Gjan Saluja, renowned for her expertise in oculoplasty.

The class traversed the journey of eyelid formation, unfolding the complexities involved in its embryological development. Attendees learned about the structural nuances of the eyelid, including the orbicularis muscle and the septum, and the embryonic development stages where the eyelids initially fuse and later separate, signaling their readiness for function.

Wrapping up, the session transitioned into a lively Q&A segment, encouraging active participation from attendees. Here, complexities like the differences between congenital entropion and epicanthal folds were demystified. The session emphasized the program’s commitment to refining educational experiences based on participant feedback, shaping a robust learning environment.

Chapters

• 00:00 - 02:30: Introduction and Welcome The chapter titled 'Introduction and Welcome' begins with a live broadcast setup on YouTube by someone referred to as 'Dr Prof'. The brief excerpt provided focuses on the introductory atmosphere, possibly setting up for a discussion or lecture. The presence of '[Music]' suggests there may be a musical introduction or background element accompanying the live stream.
• 02:30 - 04:00: Program Overview The chapter 'Program Overview' covers the initial moments of a live broadcast or event. It begins with a discussion about technical difficulties, specifically mentioning that a poster appears small on the screen. Despite these issues, the team proceeds with the live broadcast, confirming that they are live and ready to start. This chapter sets the stage for the program, highlighting potential technical challenges in a live setting.
• 04:00 - 06:00: Presentation Introduction The chapter 'Presentation Introduction' begins with a speaker checking the number of attendees, which currently stands at 41. The speaker decides to wait five more minutes for additional participants to join. The chapter contains informal greetings and initial setup for the presentation.
• 06:00 - 23:00: Anatomy of Eyelid The chapter titled 'Anatomy of Eyelid' begins with a warm welcome to the old experts and a brief introduction to a new program initiated under the guidance of Dos. The atmosphere is friendly and there is an indication that the session is live. However, the chapter does not delve into specific details about the anatomy of the eyelid.
• 23:00 - 25:00: Embryology of Eyelid The chapter on the 'Embryology of Eyelid' appears to start with an introduction to a postgraduate education program focused on covering the syllabus for various ophthalmology courses. The program includes webinars and encourages feedback to improve the learning experience. The content on detailed embryological development of the eyelid is not provided in the transcript, but it likely involves discussion on the formation and developmental stages of eyelids.
• 25:00 - 32:00: Congenital Anomalies of Eyelid In this chapter, Dr. Gjan discusses high lead anatomy and congenital anomalies of the eyelid. The session is part of an initiative to reach out and share knowledge, introduced by Professor Rohit Saka.
• 32:00 - 39:00: Lymphatic and Nerve Supply of Eyelid The chapter discusses initiatives aimed at improving knowledge and practice among residents, general practitioners, and ophthalmologists nationwide. It highlights efforts to reach the audience through multiple weekly events, both online and in-person, to address their educational needs and interests.
• 39:00 - 58:00: Common Questions and Discussion The chapter titled 'Common Questions and Discussion' highlights the openness of the program to feedback and suggestions from consumers. Dr. PRL emphasizes that the program is consumer-driven, encouraging participants to request what they need. The chapter introduces various experts, referred to as 'young Turks' of India, who will contribute to the discussions, showcasing their achievements and expertise in the field.
• 58:00 - 65:00: Conclusion and Next Class Introduction The chapter titled 'Conclusion and Next Class Introduction' reflects on the enthusiasm and commitment of young individuals in their early stages of their career in ophthalmology. It emphasizes their desire to learn and improve, identifying them as ideal candidates to teach and guide others. This is particularly crucial as they are familiar with contemporary issues faced while trying to master these subspecialties. The instructor welcomes everyone and expresses openness to receiving feedback, whether positive or constructive.

OCULOPLASTY SERIES - CLASS 1 Transcription

• 00:00 - 00:30 man we are Live on [Music] YouTube Dr Prof okay but it's
• 00:30 - 01:00 it we are live now it's fine but your this poster it's looking very small I don't Know full screen that is on fullen we can start are we live now sir we are live we are live
• 01:00 - 01:30 so how many people have joined till now so we can see that in the participant section uh okay 41 let's wait for five more minutes so hello pun p gjan
• 01:30 - 02:00 good to see our old experts back hi sir hello sir good evening good to see you guys good evening sir hi Vita okay we are live now so good evening all uh let me give a brief intro about this uh program that we have started under the is of Dos then our
• 02:00 - 02:30 president will welcome welcome you all so this dos pep or postgraduate education program is a concept where we are doing two webinar per week one on Monday one on Thursday throughout the year the idea is to cover the entire syllabus of DNB diplom uh diploma Ms and postgraduate opy and we have created a group if you haven't joined please join that group and give your feedback so that will help us in refining our program further so
• 02:30 - 03:00 this is the first program of this series and today Dr gjan is going to speak on high lead anatomy emolog and congenital animalism I with this I would request our president sir Professor Rohit Saka sir to say few word and welcome our coordinators and speaker for today and then we'll move on with the session so um thank you everybody for coming and uh uh this is part of the initiative of doors to reach out to each
• 03:00 - 03:30 and everyone all over the country whether it's residents uh general practitioners and opthalmologist who wish to uh upgrade their knowledge and their uh uh improve their practice so this is the way we want to reach out to you uh multiple times a week uh and there are a lot of physical events also planned so whether it's physical or online we are trying to reach out to you uh to solve your problems to ensure that we cover things that you want to know
• 03:30 - 04:00 and as uh Dr PRL said we are open for feedback so we are looking for your suggestions how we can improve this program this is purely a consumer-driven program so what you need you please ask us we'll be happy to provide and again welcome to um our experts here uh all of them who will participate here are uh the kind of young Turks uh of India who are not only uh uh have uh uh achieved a
• 04:00 - 04:30 lot in their uh young life and oftalmology but are also driven by a desire to know more and learn more so they are the best to be the uh teachers that can help to mold you and understand and are aware of the problems that one faces uh at the present time trying to learn these subspecialties so welcome everybody it's absolutely a pleasure to have you all and as I mentioned we are open for feedback whether it's positive
• 04:30 - 05:00 or negative we want to mold our teaching program so that it is useful to everybody so prop please please go ahead Dr P you can take over from here introduce the speakers and coordinator then we'll start with the lecture okay sir
• 05:00 - 05:30 okay good evening everyone so I welcome you all to the first class of Dos postgraduate education program and it is my privilege to introduce our uh uh moderators for the oculoplasty session who are Dr palvi Sing she's trained from RP Center as in OKO plasty and has also done a surgical Fellowship from the University of California and currently she's in private practice in Ahmedabad our second coordinator is Dr Punit Jen he's also trained from RP Center AIMS in
• 05:30 - 06:00 oculoplasty and is currently a consultant in charge of Opthalmic plastic surgery and oculo oncology services at sharp site I Hospital in Delhi NCR he also done a long-term Fellowship under Dr honavar for oculoplasty and ulo oncology and coming to our speaker for the day is Dr gjan salua she has done MD DNB F frcs fic and fic and pediatric Opthalmology and stabismus currently she's working as a consult in trismus oculoplasty and neuro
• 06:00 - 06:30 oftalmology services at bhia Advanced iare Center in bite chhattisghar so with this brief introduction we'll move on to the presentation of uh Dr gjan uh thank you ma'am for the introduction uh ma'am may I please request you to share the uh presentation yes yes just give me a
• 06:30 - 07:00 couple of minutes as you can see we have a very um uh a a a group which is as I mentioned young but highly experienced with wide ranging experience in multiple places to bring in one place uh their experience and understanding from uh different parts of not only the country but the world so it's absolutely uh I I sure look forward to a wonderful session and
• 07:00 - 07:30 and and we really look forward to having you all participate in the future sessions of the dop program uh should I start the presentation yes Dr Dr I believe ready a very good evening everyone first of all I would like to thank dos for giving me this opportunity and I'll be dealing with IID Anatomy embryology and conial abnormalities to begin begin with the
• 07:30 - 08:00 anatomy of eyet the eyelet can basically be divided into two parts the anterior and the posterior Lam where the anterior Lamela mainly consist of the skin and the orbicularis and the posterior Lamela mainly consist of the tasus and the conjuntiva coming to the layers of eyelid so eyelid has seven layers beginning from the skin followed by the orbicularis then there is orbital SEPTA beneath the receptor is the fat and then
• 08:00 - 08:30 beneath that lies the LPS Eon eurosis and molas these are the retractors of the eyelid and then the conun so coming to the skin of the eyelid it is the thinnest and there is no subcutaneous fat or the underlying tissues are very Loosely attached this results into the formation of a potential space coming to the
• 08:30 - 09:00 orbicularis beneath the skin is the orbicularis orbicularis is divided into two portions the orbital and the palpal parts by the palpal part further divides into the preal and pretal orbicularis as the name is suggesting prasil lies interior to the tasis and precept lies interior to the orbital SEPTA two important bony landmarks to be
• 09:00 - 09:30 remembered in the entire anatomy of eyelid are medial anterior and posterior Lal Crest and laterally the vital Tule so the interior part of this pretas orbicularis forms the anterior crust of the mle Cal tendon and attaches to the frontal nasal process of Maxum whereas the posterior part of the medial
• 09:30 - 10:00 site it inserts into the posterior Lal Crest and is known as the Horner muscle laterally the prassel portion is attached to the whitel Tule rolin muscle is nothing but it is the preal muscle at the lid margin and it helps in the formation of Gray Line coming to the second portion of the
• 10:00 - 10:30 palpal part of orbicularis that is the preal portion laterally this muscle forms the horizontal RAF and medially it inserts into the interior crest of the medial Canal tendon Jones muscle forms deep insertion of preceptive orbicularis coming to the next portion of the orbicularis the orbital part of
• 10:30 - 11:00 the orbicularis it attaches Mally to the medal Canal tendon and laterally it forms an eclipse so you saw that most of these structures were attaching to the medial Canal tendon itself which is further attached to the Lal Crest and laterally everything is attached to the witness Tule now beneath the or bis lies the
• 11:00 - 11:30 orbital sepa it is a thin multi-layered fibrous tissue arising from the perum of the superior and inferior orbital rims in the upper lid it fuses with the LPS Aon Neurosis 2 to 5 mm above the superior tassel bordom so you can see here that in the upper it is fusing with the LPS Aon eurosis 2 to 5 mm above the tassel
• 11:30 - 12:00 bottom and in the lower liad it fuses with the capsu of palpal facia beneath the SEPTA lies the orbital fat so thinning of SEPTA results into the herniation of the orbital fat now you can see here that beneath the septer there were orbital fat paths in the upper lid we have two fat pads that is the upper leg medial fat pad and upper Le Central fat pad and in the
• 12:00 - 12:30 lower lead there are three fat pads lower Le medial lower lid Central and lower lid lateral fat band coming to the ly tractors these are very important to keep your eyes open now the lid retractors mainly consist of theor pal superioris and the molus muscle now the Lev Al Superior it originates just above the analys of Z
• 12:30 - 13:00 from the periorbital of L wing of sphenoid it then extends anteriorly for 40 mm and becom taneous at the witness ligament winess ligament is basically a fascia which is extending from the medial to the lateral part of the orbit so medially it is attached to the tra and laterally it attach attaches to the Lial gland it acts as a fulcrum and is
• 13:00 - 13:30 analogous to the lockwoods ligament in the lower L now once lator turns into an epon Neurosis it gets attached in the form of medial horn lateral horn and downwards it's attached into anterior and posterior forms so the medal horn attaches onto the posterior l normal Crest and the lateral horn it is
• 13:30 - 14:00 attached to the lateral Tule and downwards lator divides into anterior and posterior Parts with the posterior part inserts into the lower half of the taces and the interior half it forms the lid crease it forms the facial slips to the orbicularis and this results into the formation of lid crease beneath the elevator is the mol's
• 14:00 - 14:30 muscle it lies 12 to 14 mm above the tacus and inserts at the superior border of the tacus so we can see here the Mull's muscle is there from the vitness ligament and is attached to the superior border of the tasses it contributes to the island elevation by 2 mm coming to the low L Le retractors so
• 14:30 - 15:00 lower Le retractor is mainly contributed by the capsule of palp fascia which is analogous to the levator it originates as capsul palpal head from the terminal fibers of the inferior rectus muscle so here you can see is the inferior rectus and then from the terminal fibers of the inferior rectus comes your capsul palpal head the capsul palpal head then divides into two and encircles the inferior
• 15:00 - 15:30 oblique so here you can see is the inferior oblique muscle and the capsule palpal head and circle set anterior to this inferior oblique the two portions of the capsu of palpal head join together to form the suspensory ligament of Lockwood this fascia then extends into the inferior phic and fuses with the
• 15:30 - 16:00 tasus and the orbital SEPTA in the lower L now coming to the Tarsus so Tarsus is a dense plate of connective tissue and some uh forms a major structural support to the lids the upper tarel plate measures around 10 to 12 mm and the lower measures around 4 mm its thickness is 1 mm and is attached to the
• 16:00 - 16:30 periosteum through the canl ligins so as I told you everything is going to attach either directly into the canl tendon or indirectly but the structures remain the same the attachments will be almost near that only so located within the tasus are mobian glands which are modified sebaceous gland now this medial Canal tendon again which is a major
• 16:30 - 17:00 architectural framework of your lens is a y shaped tendon it originates as interior and posterior head from the anterior and posterior laral Crest it encircles the laral sack and then splits into two to attach to the upper and the lower tassel plate so you can see here it is originating from the anterior posterior laral Crest it splits into two and circles the Lial sack here fuses and
• 17:00 - 17:30 then splits to attach to the upper and lower tassel plate the lateral Canal tendon attaches to the inner aspect of the lateral Tule which is there here in the inner aspect of the orbital Rim so this Tule is the one which is giving attachments to almost everything in the orbit and the lims so remember that this lateral canel tendon as you can see is around a
• 17:30 - 18:00 bit higher as compared to the medial can tendon so this results into an upward slant coming to the eyelid margin so eyelid margin basically is the Confluence of the cutaneous stratified squamous epithelium the edge of the pretas orbicularis and the conjunctival mucosa Gray Line is the section of fre tasel orbicularis that is the muscle of rolin
• 18:00 - 18:30 lying interior to the tacus mobian glands open just in front of the posterior border as you can see so this is the anterior border this is the posterior border and wom glands are lying here just interior to the posterior border or just in front of the posterior border of the lid coming to the mobin glands so there
• 18:30 - 19:00 are around 25 mobin glands in the upper lid which are slightly more and 20 around in the lower lid eyelashes originates in the interior aspect of the lid margin just interior to the tassel plate so here this is the tassel plate and just interior to the tassel plate lies the eyelashes as you can see and they're arranged in two to three rows now the glands of the eyelid include the glands of Z gland of mole
• 19:00 - 19:30 and the mobin glands we have already talked about the mobin glands which are basically opening just in front of the posterior border and uh if you talk about the other two glands the glands of Z are nothing but they are modified sebaceous gland and they open at the base of the ha follicles if you look here um the gland of mole they are
• 19:30 - 20:00 modified sweat glands and they are also opening in a row near the base of the eyelashes so we can see here these are the eyelashes and it is somewhere near the base of these eyelashes that the glands of moles are present and glands of size they lie at the base of this eyelashes now the arterial supply of the eyelids is mainly from the two sources it is one of the structures which is receiving the blood supply from both the
• 20:00 - 20:30 branches of internal cared artery as well as from the external cared artery so one of the area where there is an asmosis of both the systems internal cared artery it is through the Opthalmic artery and the branches of the supraorbital and laral artery which contributes to the arterial Supply and the external koted artery through the arteries of face angular artery and temporal artery are the branch which are contributed by the external carot D now
• 20:30 - 21:00 these two systems they Anastos and they result in the formation of the arcade so there are two arcade the marginal arcade and the peripheral arcade where the marginal arcade is lying interior to the tses near the follicles and the peripheral archid lie superior to the tses between the LPS and the MERS coming to the Venus drainage so the
• 21:00 - 21:30 preal tissue it drains into angular ve medially and superficial temporal vein in the lateral part the postal tissue drains into interior facial veins and deeper facial branches of the and the deeper branches of the Interior facial vein orbital veins and the teroid plexus coming to the lymphatic drainage so the lymphatic drainage is
• 21:30 - 22:00 basically if you look here that is medial 1/3 of the upper lid and medial 2/3 of the lower lid they are going to drain into the subicular note and medial 2/3 lateral 2/3 of the upper L and lateral one third of the lower lid they are going to drain
• 22:00 - 22:30 into the pre oric nodes so I think this is clear that medial 1/3 of the upper late and medial 2/3 of the lower lid it drains into submandibular lymphs and lateral 2/3 of the upper lid and lateral 1/3 of the lower lid they drain into the pre oric
• 22:30 - 23:00 nodes now the N supply to the legs is by different neres so LPS is supplied by the third cranial nerve seventh nerve supplies orbicular and M is supplied by the sympathetic term the sensory Supply is by the trial n branches the Opthalmic division to the upper lid and maxillary division to the lower lid coming to the embryology of the eyelid
• 23:00 - 23:30 so eyelid formation takes place in these fallowing steps so first there is lid fold formation followed by Fusion of these folds then the eyelid development takes place followed by their separation and maturation of the eyelid structures so it is at around 37 Days the two groups form above and below the eyes that is the dentary IE which is
• 23:30 - 24:00 being formed and you can see here that two grooves are formed and these two grooves then form the eyelid fold these eyelid folds further mature to form the eyelid the upper fold is formed by an extension of the fontal nasal process and the lower is formed by the maxillary process the lens diffuse temporarily by the movement of the periderm cells and
• 24:00 - 24:30 once there is Fusion of the leads the upper lid structures they develop faster and LPS develops at around 2 and a half months of gestation and separate from the superior rectus at fourth month it is at around 28 weeks that both the lids they separate so we can see here that first there is Fusion of the lids followed by maturation of the structures followed by the separation of the
• 24:30 - 25:00 eyelids which takes place as the term progresses now coming to specific development of various structures of the isid mesoderm gives rise to the fibers of the stried muscles endothelial lining of blood vessels surface ectom gives rise to the skin epithelium hair follicles ni glands of Mo mobian glands neural crest cells forms
• 25:00 - 25:30 the tarel plate and supporting architecture lpo Neurosis molers muscle orbital SEPTA or contributed by the neural C cells now congenital anomalies of the eyelid results from defect in any of these stages of the island development so first is if there is faure of formation of the eyelid folds
• 25:30 - 26:00 that results into a rare abnormality that is known as Aeron where there is total absence of the isid as we can see in this picture and it as I told that it results because of the failure of lipf development and neural crystell migration the syndrome Associated is the ablon macrostomia syndrome crypto thalmus results from the failure of development of palpable
• 26:00 - 26:30 aperture and there is a continuous skin which is extending from the forehead to the cheek in rudimentary forms incomplete Lids may be seen and underlying Globe is usually micro thalmic Associated syndrome is Fraser syndrome where Crypt of thalmus is associated with syndi Thea of isin are partial or full thickness defect which are triangle in shape where the base lies towards the
• 26:30 - 27:00 margin and upper L colobomas are usually seen at the junction of medial 1/3 and lateral 2/3 and are commonly associated with golden har syndrome lower L Coloma on the contrary are usually seen at the junction of lateral 1/3 and medial 2/3 and is associated with the Trisha cooline syndrome associated with the short slopy palpal fissure hyperic
• 27:00 - 27:30 orbits and defective lateral margins when associated with the cliff pallet they can be an Associated difficult soling also now the other syndromes which are associated includes the Char syndrome which includes the coloboma heart defects vasia growth retardation genital abnormalities and ear abnormalities and pH A syndrome associated with Crypt of thalmus and
• 27:30 - 28:00 synic the Manitoba syndrome is associated with the L colobomas cryp of thalmus and triangular growth of hair extending from scalp to eyebrow bifet nose and anatasia the management depends upon the size and location if it is small you can simply close by canthotomy if it is medium siiz then you need to make a flap and if it is large then L sharing
• 28:00 - 28:30 procedures are preferred eny lefron are partial or complete adhesions between the superior and inferior eyelids and are characterized by the fine sces of tissue connecting upper and lower Lids eperon is presence of a riment skin fold and there is an excessive skin fold which is going to cause the same it insinuates in the downg Gaze and most most of the times it resolves spontaneously however if there are
• 28:30 - 29:00 lashes rubing to the cornea you need to have an intervention congenital entropion results from the disinsertion of the lower lid retractors there is no extra skinfold here but there is in turning of the lid margins Ting sutures and HS procedures are the surgical options pite ectropion results from shortening of the interior and posterior lamula and requires skin
• 29:00 - 29:30 grafting epicanthal folds are skin folds in the medal Canal area and they can be epican super ciliaris that is from above the Bro to the lateral aspect of the nose Okay so from above the Bro to the lateral aspect of nose epicanthus taralis from the lateral side of upper to mle canthus epicanthus palpalis which is equally distributed between the upper
• 29:30 - 30:00 and the lower lid epicanthus inverses which is originating from the lower lid and extending to the medial canus surgical management here includes doing a w plasty mustard is double z plastin conial Tois is caused because of the LPS infiltration by fibrofatty tissue lit La poor LPS action faint or absent Li grease are its characteristic feature requires early intervention in cases of
• 30:00 - 30:30 anisometropic lopia depending upon the LPS action one can either plan LPS reection or a sling surgery bpes Syndrome has tosis associated with bosis epicantus inversus and tantis it is of two types the type one which is associated with female infertility and type two which is also autoral them but not associated with
• 30:30 - 31:00 infertility ufon is caused because of the outward and downward displacement of the lateral caners and as I told that the normal position of the lateral caner tendon it is above slightly and cranial facial abnormalities are associated with the same tantis is characterized an increase distance between the inner canai here the inter can distance is increased but
• 31:00 - 31:30 the P inter pupilary distance remains normal so it is basically the lateral displacement of the canal tendons causing an increase in the interanal distance in hyperism there is increased distance between the two medial orbital wall causing an increase in the interanal distance as well as in the increase in the inter pupilary distance also dystopia canthorum is a type of tanus
• 31:30 - 32:00 which is specifically seen in type one Barden B syndrome and is characterized by the lateral displacement of the Lial punctum looking uh so this is the difference between the telan and hypotelorism and I hope now it is clear so that was all for the anatomy and congenital abnormalities of the lid and development of eyelid once again thank you for the
• 32:00 - 32:30 opportunity uh thank you Dr Gan for that comprehensive class on on the topic of anatomy that is the base for uh every speciality that we deal with so with that I will hand over the mic to our moderators Dr pal and Dr are there any questions that you want to
• 32:30 - 33:00 ask Dr gjan okay so I I think we have a few questions from the audience and I would encourage uh all of the people who are tuned in if you have any doubts in uh what we went through I would encourage you to put that uh your questions in the uh in the chat box here so we can ask them so um one of the questions gjan Dr prian shagal has asked how to differentiate between congenital entropion and an epicanthal fold yes so see a conal entropion as the
• 33:00 - 33:30 name is suggesting it's an entropion so there will be an inward turning of the lid margin means you would not be able to see the lid margin structures like the mobian glands which would be displaced inwards whereas an epicanthal fold basically is an extra skin fold which is present in the medial canthal region so these two are very different things you might have asked what is the difference between congenital [Laughter]
• 33:30 - 34:00 when in epon you find in tropon there is an inward turning of the eyelid mus so that's the difference between the two things I think uh one of the things that that we talk about is that uh as and like an epon is common in what you call the Eastern Asian uh Anatomy you see a lot of kids uh even if they're from the northeast or if you see East Asian kids the epon is quite common but the thing I
• 34:00 - 34:30 think that one of the things that also differentiates it and Gan please correct me if I'm wrong is that as you grow children usually tend to grow out of the epon so you don't just operate that's not an indication surgery as soon as you see it entrop on you'll probably need to operate at some point the most of the times epiplon it is going to have a self- resoling of course it will have a self resolve it will self-resolve by itself but sometimes if there is rubbing of the cornea with the eyelashes you
• 34:30 - 35:00 need to operate them early and the surgery is also quite simple for the same but just be aware of the ectropion do not cut the existant too much uh all right so we have we have another question Dr sankla Anita is asking can you please uh explain I think this disan is what she's written you was speaking about the
• 35:00 - 35:30 wardenburg syndrome so can you can you so basically dystopia canthorum is a type of T cancers which is specifically found in Wen wenberg syndrome wenberg Syndrome has a lot of other features also including a white F lock of hair heterochromia itis and dystopia canthorum is one of the feature of the same where you find that there is an increase in the interanal distance as well as there is a lateral displacement of the Lal punct so when you draw a line
• 35:30 - 36:00 as you can see I had put the picture also if you draw the line if you draw a line the picture again GJ if you have the PowerPoint actually I've logged in from my that's okay I don't have my presentation so basically if you draw a line from the medial one3 of the lid you'll find that the Lal punct it is displaced uh bit laterally so that was very evident from the picture also
• 36:00 - 36:30 um what else uh do they want to ask something about it I think they just wanted you to explain dystopia canum again and I think we basically it is a typ of can specific feature of Wen that's it with like lateral displacement of theal PCT that's the specific thing
• 36:30 - 37:00 we got a got it ma'am also so I think you explained it really well uh any all the I mean every everyone who's attending any anything else this is the right time to get all your questions answered we have the wizard of anatomy with us Dr gjan uh is uh really I mean she's probably one of the best teachers you can get for anatomy so uh feel free to ask your questions here if not um you
• 37:00 - 37:30 know there's a YouTube link you can always leave your comments and we will try to uh answer those in in you know in the comment section and everything but uh if any other questions here we would be happy to answer them I think sometimes sometimes we get lost in technical terms uh it is more important to understand the concepts uh so like gjan said that for all practical purposes uh the term is just
• 37:30 - 38:00 tanus that term is just tanus speciic to A syndrome uh so stick to the basics U it's a very well presented session and lots to take away and I think a lot of short questions and all those things can also be answered gjan Val explained it very well I think it's very well done thank you gjan for that extensive lecture and thank thank you Dr palvi and Dr Punit for being with us so with that
• 38:00 - 38:30 we come to an end to our first class of Dos postgraduate education program and uh we'll be having classes every uh every Monday and Thursday as you're aware and the details of the class must have already uh reached you in your inboxes and um the next class we'll be having uh Dr pivi would you like to introduce the next class so the next class uh is on the basically
• 38:30 - 39:00 on the workup of eyelid uh of cases of oculoplastic cases and the presentation is by uh Dr P so the next lecture is by Dr akriti Desai and she'll be talking about how to work up an oculoplastic case and diseases of eyet disorders so uh looking forward to your active participation in the next class as well and we'll have classes every Monday and Thursday at 7:30 p.m. and the link for the classes
• 39:00 - 39:30 will be coming on to your inboxes mail um in your in your email inboxes so uh keep a track of the same so thank you everyone for your presence and good night and uh just just a reminder to everyone that for people who could not register the YouTube link is available and uh you can always you know sort of have your questions over there and so make sure to please uh spread the word amongst your friends and send them the
• 39:30 - 40:00 YouTube link because I think you cannot register for for the we can further register we can register further after the class is over the registration link will reopen and you can register further for the uh uh next classes excellent all right so please spread the word and uh like Dr pranita said how to work up an eyelid disorder by Dr akti on the 8th of August 7:30 p.m. Okay so