2-30 Lid disorders

Question 1

Describe entropion
- What is it?
- Causes?
- Other notes?

Answer 1

Inward turning of eyelid
- Scarring or age-related (Horizontal lid laxity, Vertical lid instability, and Preseptal orbicularis overiding tarsus)
- Usually lower lid due to upper lid tarsal plate stability is higher
- Problem is if from pseudo-trichiasis (lower lash scratching cornea)

Question 2

Describe ectropion
- What is it?
- Causes?
- Symptoms?
- Types? Describe them.

Answer 2

Eyelid pulled away from globe
- Due to laxity of muscles

• Early stages can be asymptomatic
• Starts w/ ocular irritation from tear film stabilility
• Most have epiphoria
• Exposure keratopathy/corneal ulceration if severe.

Either
Involutional (age-related)l:
- Due to laxity of horizontal lids or lateral/medial canthal tendons
- Asymptomatic if mild
Parlytic:
- CNVII (facial nerve) palsy
- Check for corneal exposure, lagophtalmos, and brow ptosis
Mechanical:
- Tumour/mass near lid

Question 3

Describe ptosis overall
- What is it?
- Causes?

Answer 3

Abnormally low lid position in primary gaze (mostly sup. lid)
- Congenital or aquired
if aquired, either:
- Neurogenic
- Aponeuoritc (due to age)
- Mechanical
- Myogenic

Question 4

Describe congenital ptosis

Answer 4

Abnormal levator muscle development
- Unilateral or bilateral, can be from birth trauma
- Abscent lid crease possible
- Compensatory chin elevation possible
- Amblyopia possible from sensory deprivation
- Can associate w/ Sturge-Weber (nerves + skin) or Foetal Alcohol syndrome

Marcus Gunn Jaw-Winking syndrome
- Jaw movement removes ptosis
- 5% of congenital cases are this, often unilateral.
- Maybe due to misdirected CNV (trigeminal) to levator muscle (CNIII)

Question 5

Describe aponeurotic vs myopathic vs neuropathic vs mechanical ptosis

Answer 5

Aponeurosis is part that connects levator palpebrae muscle to tarsal plate. In aponeurotic ptosis, this gets more lax meaning levator has to use up more energy to life the lids back to normal. Levator eventually tires out so ptosis occurs.

Myopathic = Muscle itself has problem e.g. muscular drystrophy, myasthenia gravis, or chronic progressive external ophthalmoplegia

Innervation defect e.g. CNIII palsy, or Horner’s syndrome

Impaired upper lid mobility due to mass like tumour, scar tissue, oedema…

Question 6

Describe distichiasis?

Answer 6

Lash grows posterior to meibomian glands (rubs cornea)
- Can be congenitial or acquired.
- If acquired, could be chronic inflamm/irritation, penphigoid, or chemical injury.

Question 7

Describe trichiasis?

Answer 7

Acquired misdirection of lashes (turns inwards)
Can result from many things like:
- Chronic blepharitis
- Trachoma
- HZO
- Trauma
- Surgery

Question 8

Describe epiblepharon

Answer 8

Skin + muscle ride over lid margin, which means lashes are closer to globe (not same as entropion)

Question 9

Describe madarosis

Answer 9

Loss of lashes
- Many causes.

Question 10

Describe anterior blepharitis
- Commonly due to…
- Signs?

Answer 10

Affects base of eyelashes
- Commonly due to bacteria or dandruff at scalp + eyebrows
- If staphylococcal, either acute or chronic.
Signs:
- Lid swell
- Erythema
- Collarattes (solidified exudates) at lash base
- Notchign of lid margin
- Dry eye secondary
- Associated w/ recurrent hordeola (red bump due to gland infection)

Question 11

Describe seborrheic dermatitis

Answer 11

Common non-contagious condition of skin areas rich w/ oil glands
- Associated w/ pityrosporum ovale yeast
- Flaky, red, itchy skin w/ variable severity
- Can affect lids.

Question 12

Describe posterior blepharitis
- Caused by…
- Signs?

Answer 12

• MGD causes it
  Signs:
• Lid margin notch
• Tear foaming
• Hyperaemia + telangiectasia of lid margin
• MG loss
  -> dry eye
• Corneal changes possible
• Associated w/ other skin conditions

Question 13

Describe angular blepharitis
- What is it?
- What else can be seen?
- Caused by?
- Associated w/…

Answer 13

• Crusted skin at lateral or medial canthus
• localized injection of conj. BVs possible
• Staph. Or Moraxella infection
• Associated w/ herpetic or candida infection

Question 14

Chronic blepharitis sequelae?

Answer 14

• Madarosis
• Folliculitis
• Inflammed, irregular lids
• Trichiasis
• Secondary corneal ulcer

Question 15

Describe pediculosis/phthiriasis?
- What is it?
- Signs/symptoms?

Answer 15

Infestation of lid by lice
- Eyelash itself less likely infested
- Redness
- Itchy, FB sensation
- Conj. injection
- Hard to treat, uncommon in NZ

Question 16

Describe external hordeolum
- What is it?
- Appearance?

Answer 16

A.K.A. Stye, acute lash follicle infection
- Lesion faces outward away from globe
- Staphyloccocal abscesses
- Multiple lesions possible
- Pain, hot, swollen, red bump at lids
- Associated w/ blepharitis possible.

Question 17

Describe internal hordeolum
- What is it?
- Appearance?

Answer 17

Meibomian gland infection
- Lesion faces inward towards globe
- Small abscess
- Can rupture and drain through conj.
- Red, swollen, tender eyelid
- Can lead to chalazion

Question 18

Hordeolum pathophysiology

Answer 18

• Associated post. Blepharitis or meibomianitis
• Stasis at gland secretion -> secondary infection
• Focal collections of polymorphonuclear leukocytes + necrotic debri

Question 19

Describe chalazion
- What is it?
- Clinical appearance?
- Timescale?
- Effects?

Answer 19

Sterile granulomatous inflammed meibomian gland
- Focal hard painless nodule in lid
- Can get bigger
- Prior history of painful lid infection possible
- Recurrent if co-existing blepharitis
- Large enough to astigmatise eye = blur
- Surrounded by fibrous tissue
- Spontaneous resolution possible