Diseases of the Eyelids Flashcards
diseases of the eyelids (meekins)
Entropion vs Ectropion
• 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.
diseases of the eyelids (meekins)
Entropion
- clinical signs
- sequelae
• Clinical signs
– Pain and squinting (blepharospasm)
– Excessive tearing (epiphora)
• Corneal sequelae
– Ulceration
– Vascularization
– Pigmentation
– Fibrosis
diseases of the eyelids (meekins)
Entropion (Types)
-
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
diseases of the eyelids (meekins)
Temporary Entropion Correction
Eyelid tacking
– Young animals and spastic entropion
– Non-absorbable Lembert-type (interrupted) sutures
– Leave in for 3 weeks .…or longer
– Replace as necessary
diseases of the eyelids (meekins)
Permanent Entropion Correction
• Anatomic (in mature animals)
• Hotz-Celsus procedure
– How much skin to remove??
Hotz-Celsus with Lateral Wedge
Ectropion
- when to treat
- Conformation desirable in some breeds
- Correct if there is associated conjunctival or corneal disease
Eyelash/Cilia Disorders
- Trichiasis
- Distichiasis
- Ectopic cilia
diseases of the eyelids (meekins)
Trichiasis
– Normal facial hairs that contact the cornea/conjunctiva
– Ex. Entropion, Nasal folds, Medial caruncle
diseases of the eyelids (meekins)
Distichiasis
– Hairs emerge from Meibomian gland openings
– Sometimes cause problems
diseases of the eyelids (meekins)
Ectopic cilia
– Hairs emerge through the palpebral conjunctiva
– Very commonly cause problems (i.e., ulcers!)
diseases of the eyelids (meekins)
Trichiasis Treatment
- Nasal fold trichiasis
– Nasal fold excision - Medial canthal trichiasis or caruncular hair
– Medial canthoplasty or local cryotherapy - Entropion
– Temporary or permanent surgical correction
diseases of the eyelids (meekins)
Distichiasis Treatment
diseases of the eyelids (meekins)
Ectopic Cilia
- Treatment
en bloc excision +/- cryotherapy
diseases of the eyelids (meekins)
Inflammatory Diseases
- Hordeolum
- Chalazion
- 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
Treatment
- Hordeolum (Stye)
- Usually young dogs
- Hot compresses
- +/- culture of expressed material
- Topical and systemic antibiotics
• Sometimes requires curettage
Treatment
- Chalazion
- Any age
- Surgical incision and curettage
- Topical antibiotics
Inflammatory Diseases
• Blepharitis
inflammation of eyelids
– Focal or diffuse lid lesion
– May be associated with more extensive dermatitis
Blepharitis Causes
Juvenile Pyoderma/Cellulitis
Bacterial Blepharitis
• Adult dogs
• Staphylococci or Streptococci spp.
– Blepharoconjunctivitis
– Meibomianitis
• May be due to staphylococcal hypersensitivity
Blepharitis Work-Up
• Impression smear, skin scraping, and hair pluck
• Cytology +/- culture
• Biopsy and histopathology
– If medically unresponsive
Blepharitis Treatment
- 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
- Specific antimicrobial (antibiotic, antifungal, etc.)
- Systemic drugs are usually more effective than topical medications
- Eyelids are highly vascular
Eyelid Trauma
- Blunt or penetrating injury
- Complete ophthalmic exam necessary!
- Medical therapy for blunt injury
- Systemic anti-inflammatory is most important
- Surgical repair for penetrating injury
Eyelid Laceration Repair
- Minimal debridement
- 2 layer closure with figure-of-8 margin suture*
- Extensive tissue loss – advanced reconstructive sx
diseases of the eyelids (meekins)
Eyelid Neoplasia
- 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
diseases of the eyelids (meekins)
Eyelid Neoplasia
- Treatment: Debulk and Cryotherapy
diseases of the eyelids (meekins)
Eyelid Neoplasia
- Treatment: Excision
diseases of the eyelids (meekins)
Eyelid Neoplasia
- treatment
- when is benign neglect ok?
- what if malignant
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…
- 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)
