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Ophthalmology Rotation > Diseases of the Eyelids > Flashcards

Diseases of the Eyelids Flashcards

1
Q

diseases of the eyelids (meekins)

Entropion vs Ectropion

A

• Entropion – inversion of the eyelid margin
• Ectropion – eversion of the eyelid margin
• Combination of entropion and ectropion – “diamond eye”
– Bloodhound, Clumber Spaniel, St. Bernard, Great Dane, etc.

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2
Q

diseases of the eyelids (meekins)

Entropion

  • clinical signs
  • sequelae
A

• Clinical signs
– Pain and squinting (blepharospasm)
– Excessive tearing (epiphora)
• Corneal sequelae
– Ulceration
– Vascularization
– Pigmentation
– Fibrosis

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3
Q

diseases of the eyelids (meekins)

Entropion (Types)

A
  • Anatomic entropion
    • Young dogs
    • Breed-related
      • Shar Peis, Retrievers, Chow Chows
  • Spastic entropion
    • Lid spasm associated with pain (foreign body, corneal ulcer, etc.)
    • Vicious cycle!
    • *Evaluated by use of topical anesthetic
  • Cicatricial entropion
    • Less common
    • Associated with previous surgery, trauma, or chronic inflammation of eyelids
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4
Q

diseases of the eyelids (meekins)

Temporary Entropion Correction

A

Eyelid tacking

– Young animals and spastic entropion
– Non-absorbable Lembert-type (interrupted) sutures
– Leave in for 3 weeks .…or longer
– Replace as necessary

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5
Q

diseases of the eyelids (meekins)

Permanent Entropion Correction

A

• Anatomic (in mature animals)
• Hotz-Celsus procedure
– How much skin to remove??

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6
Q

Hotz-Celsus with Lateral Wedge

A
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7
Q

Ectropion

  • when to treat
A
  • Conformation desirable in some breeds
  • Correct if there is associated conjunctival or corneal disease
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8
Q

Eyelash/Cilia Disorders

A
  • Trichiasis
  • Distichiasis
  • Ectopic cilia
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9
Q

diseases of the eyelids (meekins)

Trichiasis

A

– Normal facial hairs that contact the cornea/conjunctiva
– Ex. Entropion, Nasal folds, Medial caruncle

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10
Q

diseases of the eyelids (meekins)

Distichiasis

A

– Hairs emerge from Meibomian gland openings
– Sometimes cause problems

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11
Q

diseases of the eyelids (meekins)

Ectopic cilia

A

– Hairs emerge through the palpebral conjunctiva
– Very commonly cause problems (i.e., ulcers!)

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12
Q

diseases of the eyelids (meekins)

Trichiasis Treatment

A
  • Nasal fold trichiasis
    – Nasal fold excision
  • Medial canthal trichiasis or caruncular hair
    – Medial canthoplasty or local cryotherapy
  • Entropion
    – Temporary or permanent surgical correction
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13
Q

diseases of the eyelids (meekins)

Distichiasis Treatment

A
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14
Q

diseases of the eyelids (meekins)

Ectopic Cilia

  • Treatment
A

en bloc excision +/- cryotherapy

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15
Q

diseases of the eyelids (meekins)

Inflammatory Diseases

  • Hordeolum
  • Chalazion
A
  • Hordeolum (stye) – painful suppurative infection of eyelid glands of Zeis or Moll
  • Chalazion – firm, non-painful swelling of Meibomian gland caused by accumulation of lipid secretions and granulomatous reaction
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16
Q

Treatment

  • Hordeolum (Stye)
A
  • Usually young dogs
  • Hot compresses
  • +/- culture of expressed material
  • Topical and systemic antibiotics

• Sometimes requires curettage

17
Q

Treatment

  • Chalazion
A
  • Any age
  • Surgical incision and curettage
  • Topical antibiotics
18
Q

Inflammatory Diseases
• Blepharitis

A

inflammation of eyelids
– Focal or diffuse lid lesion
– May be associated with more extensive dermatitis

19
Q

Blepharitis Causes

A
20
Q

Juvenile Pyoderma/Cellulitis

A
21
Q

Bacterial Blepharitis

A

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

22
Q

Blepharitis Work-Up

A

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

23
Q

Blepharitis Treatment

A
  • 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
24
Q

Eyelid Trauma

A
  • Blunt or penetrating injury
  • Complete ophthalmic exam necessary!
  • Medical therapy for blunt injury
    • Systemic anti-inflammatory is most important
  • Surgical repair for penetrating injury
25
Q

Eyelid Laceration Repair

A
  • Minimal debridement
  • 2 layer closure with figure-of-8 margin suture*
  • Extensive tissue loss – advanced reconstructive sx
26
Q

diseases of the eyelids (meekins)

Eyelid Neoplasia

A
  • More common in older animals
    • Canine – ~80% of eyelid tumors are benign
  • *• Meibomian gland adenoma most common**
    • Feline – most are malignant
  • *• SCC**
    • Equine – SCC most common, sarcoid second
    • Bovine – SCC
  • Therapeutic goal – destroy tumor while preserving eyelid function and cosmesis
27
Q

diseases of the eyelids (meekins)

Eyelid Neoplasia

  • Treatment: Debulk and Cryotherapy
A
28
Q

diseases of the eyelids (meekins)

Eyelid Neoplasia

  • Treatment: Excision
A
29
Q

diseases of the eyelids (meekins)

Eyelid Neoplasia

  • treatment
    • when is benign neglect ok?
    • what if malignant
A
30
Q

diseases of the eyelids (meekins)

Summary

  • Primary/anatomic entropion requires…
  • Spastic entropion should be treated with…
  • Entropion is the most important example of…
  • Distichiasis and ectopic cilium represent…
  • Dogs are most commonly affected by…
  • Eyelid tumors in cats are more often…
A
  • Primary/anatomic entropion requires permanent surgical correction in adult animals
  • Spastic entropion should be treated with temporary correction
  • Entropion is the most important example of trichiasis
  • *– Others include nasal fold, facial hair, lacrimal caruncle**
  • Distichiasis and ectopic cilium represent cilia abnormalities arising from the Meibomian glands
  • *– Ectopic cilia are more likely to lead to corneal ulceration**
  • Dogs are most commonly affected by benign Meibomian gland adenomas
  • Eyelid tumors in cats are more often malignant (squamous cell carcinoma)

Ophthalmology Rotation (20 decks)

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