Benign Eyelid Disorder

Question 1

Blephritis

Answer 1

It causes a gritty, itchy, dry sensation in the eyes. It can be associated with dysfunction of the Meibomian glands, which are responsible for secreting oil onto the surface of the eye. It can lead to styes and chalazions.

Management is with hot compresses and gentle cleaning of the eyelid margins to remove debris using cotton wool dipped in sterilised water and baby shampoo.

Lubricating eye drops can be used to relieve symptoms:

Hypromellose is the least viscous. The effect lasts around10 minutes.
Polyvinyl alcohol is the middle viscous choice. It is worth starting with these.
Carbomer is the most viscous and lasts 30 – 60 minutes.

Question 2

Stye

Answer 2

Hordeolum externum is an infection of the glands of Zeis or glands of Moll. The glands of Moll are sweat glands at the base of the eyelashes. The glands of Zeis are sebaceous glands at the base of the eyelashes. A stye causes a tender red lump along the eyelid that may contain pus.

Hordeolum internum is infection of the Meibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.

Styes are treated with hot compresses and analgesia. Consider topic antibiotics (i.e. chloramphenicol) if it is associated with conjunctivitis or persistent.

Question 3

Entropian

Answer 3

Entropion is where the eyelid turns inwards with the lashes against the eyeball.

This results in pain and can result in corneal damage and ulceration.

Initial management is by taping the eyelid down to prevent it turning inwards. Definitive management is with surgical intervention. When the eyelid is taped down it is essential to prevent the eye drying out by using regular lubricating eye drops.

A same-day referral to ophthalmology is required if there is a risk to sight.

Question 4

Echtropian

Answer 4

Ectropion is where the eyelid turns outwards with the inner aspect of the eyelid exposed. It usually affects the bottom lid.

This can result in exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected.

Mild cases may not require treatment. Regular lubricating eye drops are used to protect the surface of the eye. More significant cases may require surgery to correct the defect.

A same-day referral to ophthalmology is required if there is a risk to sight.

Question 5

Periorbital Cellulitis

Answer 5

Periorbital cellulitis (also known as preorbital cellulitis) is an eyelid and skin infection in front of the orbital septum (in front of the eye). It presents with swelling, redness and hot skin around the eyelids and eye.

It is essential to differentiate it from orbital cellulitis, which is a sight and life threatening emergency. CT scan can help distinguish between the two.

Treatment is with systemic antibiotics (oral or IV). Preorbital cellulitis can develop into orbital cellulitis so vulnerable patients (e.g. children) or severe cases may require admission for observation while they are treated.

Question 6

Orbital Cellulitis

Answer 6

Orbital cellulitis is an infection around the eyeball that involves tissues behind the orbital septum.

Key features that differential this from periorbital celluitis is pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball (proptosis).

This is a medical emergency that requires admission and IV antibiotics. They may require surgical drainage if an abscess forms.