Diseases of the Eyelids

Question 1

What is Entropian? clinical signs? corneal sequelae?

Answer 1

• Inversion of the eyelid margin
• Clinical signs:
  
  • pain and squinting (blepharospasm)
  • Excessive tearing (epiphora)
• Corneal sequelae
  
  • Ulceration
  • Vascularization
  • Pigmentation
  • Fibrosis

Question 2

What are the different forms of Entropion?

Answer 2

• Anatomic entropion
  
  • young dogs
  • breed - related (Shar Peis, Retrievers, Chow Chows)
• Spastic entropion
  
  • Lid spasm associated w/ pain (foreign body, corneal ulcer, etc)
  • Vicious cycle
  • Evaluated by use of topical anesthetic
• Cicatricial entropion
  
  • Less common
  • Associated w/ previous surgery, trauma, or chronic inflammation of eyelids

Question 3

What is eyelid taking?

Answer 3

• Temporary Entropion Correction
• Young animals and spastic entropion
• Non-absorbable Lembert-type (interrupted) sutures
• Leave in for 3 weeks or longer
• Replace as necessary

Question 4

What is Hotz-Celsus procedure?

Answer 4

• Permanent entropion correction
• may be combined with a lateral wedge

Question 5

When should ectropion be corrected?

Answer 5

• If there is associated conjunctival or corneal disease

Question 6

What is Trichiasis?

Answer 6

• Normal facial hairs that contact with cornea/conjunctiva
• Ex. Entropion, nasal folds, medial caruncle

Question 7

What is Distichiasis?

Answer 7

• Hairs emerge from meibomian gland openings
• sometimes cause problems

Question 8

What is Ectopic cilia?

Answer 8

• Hairs emerge through the palpebral conjunctival
• Very commonly cause problems (i.e. ulcers)

Question 9

What is the treatment for Trichiasis?

Answer 9

• Address underlying cause:
  
  • Nasal fold trichiasis
    
    • nasal fold excision
  • Medial canthal trichiasis or caruncular hair
    
    • Medial canthoplasy or local cryotherapy
  • Entropion
    
    • temporary or permanent surgical correction

Question 10

How is Distichiasis treated?

Answer 10

• Benign neglect - if not causing a problem, leave them alone
• Manual epilation (i.e. plucking)
• Cryo-epilation

Question 11

What is the treatment for Ectopic Cilia?

Answer 11

• En bloc excision +/- cryotherapy

Question 12

What is Hordeolum?

Answer 12

• ‘Stye’
• Painful suppurative infection of eyelid glands of Zeis or Moll
• Usually in young dogs

Question 13

What is the Treatment for a Hordeolum?

Answer 13

• Hot compresses
• +/- culture of expressed material
• Topical and systemic antibiotics
• Sometimes requires curettage

Question 14

What is a Chalazion?

Answer 14

• Firm, non-painful swelling of Meibomian gland caused by accumulation of lipid secretions and granulomatous reaction
• Any age

Question 15

What is the treatment for a Chalazion?

Answer 15

• Surgical incision and curettage
• Topical antibiotics

Question 16

What is blepharitis?

Answer 16

• Inflammation of eyelids
• Focal or diffuse lid lesion
• May be associated with more extensive damage

Question 17

What are the causes of Blepharitis?

Answer 17

• Parasitic:
  
  • Dog: Demodex, Sarcoptes
  • Cat: Notoedres
  • Cuterebra spp.
• Bacterial:
  
  • juvenile pyoderma/cellulitis
  • Staphylococci and Streptococci spp.
• Mycotic
  
  • Microsporum and Trichophyton spp
• Immune-mediated
  
  • Allergies - contact allergens, drug/vaccine reactions, insect bites, etc.
  • Pemphigus disease complex
  • Uveodermatologic syndrome
• Traumatic:
  
  • lye, acids, fire
• Actinic - related to sunlight

Question 18

What is Juvenile Pyoderma/Celluitis?

Answer 18

• “Puppy strangles”
  
  • Young (<3mo)
  • Acute pyoderma of the head
  • Bacterial hypersensitivity (Staphylococci spp)
• Treatment
  
  • systemic antibiotics based on C&S if possible)
  • Systemic corticosteroids
    
    • Immunosuppressive dose
    • Rule-out parasitic disease

Question 19

What is Bacterial Blepharitis?

Answer 19

• Adult dogs
• Staphylococci or Streptococci spp.
  
  • Blepharoconjunctivitis
  • Meibomianitis
• May be due to staphylococcal hypersensitivity

Question 20

What is the diagnostic approach for Blepharitis?

Answer 20

• Impression smear, skin scraping, and hair pluck
• Cytology +/- culture
• Biopsy and histopathology
  
  • if medically unresponsive

Question 21

What is the treatment for Blepharitis?

Answer 21

• Treat underlying cause - if known
  
  • Specific antimicrobial (antibiotic, antifungal, etc)
    
    • often choose empiric cephalosporin or tetracycline
  • Immunosuppressive drugs for immune-mediated disease
    
    • Corticosteroids, azathioprine, cyclosporine
• Systemic drugs are usually more effective than topical medications
  
  • eyelids are highly vascular

Question 22

How should eyelid lacerations be repaired?

Answer 22

• Minimal debridement
• 2 layer closure with figure-of-8 margin suture
• Extensive tissue loss - advanced reconstructive surgery

Question 23

What are common eyelid neoplasias in animal medicine

Answer 23

• More common in older animals
• Canine ~80% of eyelid tumors are benign
  
  • Meibian gland adenoma most common
• Feline - most are malignant (Squamous Cell Carcinoma)
• Equine - SCC most common, Sarcoid tumor second
• Bovine - SCC
• Therapeutic goal - destroy tumor while preserving eyelid function and cosmesis

Question 24

What are the treatment options for eyelid neoplasia

Answer 24

• Debulk and Cryotherapy
  
  • incise conjunctival surface and debulk (curette tumor)
  • Freeze w/ two fast freeze/slow thaw cycles
• Excision
  
  • Wedge or “house” resection
• CO₂ laser ablation
• Benign neglect - small meibomian gland adenomas ONLY
• Reconstructive surgery - Large/Malignant tumors
  
  • H-Plasty
  • Lip-to lid procedure*
  • Pedicle flap, etc

Question 25

How is a wedge resection done on an eyelid?

Answer 25

• Width less than 25-30% lid length
• Height 2x excision width
• Removal: Jaeger eyelid plate, #15 blade, and tenotomy scissors
• 2 layer closure:
  
  • 6-0 absorbable (Vicryl) buried in deep layer
  • 6-0 absorbable (Vycryl) in skin
  • Figure-of-8 suture at eyelid margin then interrupted skin sutures