External Eye

Question 1

What is an external stye? What is the infective organism?

What is the treatment?

Answer 1

Hordeolum externum is an abscess or infection in a lash follicle
May also involved the glands of Moll (sweat glands) and of Zeis (sebum glands attached to lash follicles)
They point outwards and may cause much inflammation.

Usually staphylococcal

Treat by applying warm compress 5-10 minutes several times each day.

Question 2

What is an internal stye?

Answer 2

Stye of internal (hordeolum internal - infection of the Meibomian glands.
Point inwards, opening onto conjunctiva, causing less local reaction but leave a residual swelling called a Meibomian cyst when they subside

Treated with hot compress
Vision may be impaired if corneal flattening occurs
Treat residual swelling by incision and curretage under local anaesthesia

Question 3

What is a chalazion?

Answer 3

Meibomian cyst
Retention cyst of the meibomian gland
Firm painless lump in eyelid

Question 4

What is blepharitis? Causes?
Presentation?
TReatment?

Answer 4

Inflammation of eyelid margins
May be due to Meibomian gland dysfunction (posterior blepharitis) or seborrhoeic dermatitis/staph infection (anterior blepharitis).

Bilateral symptoms
Grittiness, discomfort around margins,
Burningitchy red margins
Sticky in morning
Common styes and chalazions
Secondary conjunctivitis

Good eyelid hygiene
Cotton bud in warm water and baby shampoo to clean margins
Softening of lid margin with hot compress
Artificial tears for symptom relief in dry eyes

Question 5

What is the function of meibomian glands?

Answer 5

Meibomian glands secrete oil onto the eye surface to prevent rapid evaporation of the tear film.
Any problem affecting the Meibomian glands can cause drying of the eyes leading to irritation.

Question 6

What is pinguecula? Common patient?
Associations?
What is it called if invading the cornea?

Answer 6

Degenerative vascular yellow-grey nodules on the conjunctiva either side of the cornea
Adult male
Increased hair and skin pigment
Sun related skin damage

If inflamed - topical steroids

Invading cornea - pterygium

Question 7

What is entropion? What is it due to? Management?

Answer 7

Lid inturning
Degeneration of the lower lid fascial attachments and their muscles
Inturned eyelashes irritate the cornea

Taping lower lids to cheek or botulinum toxin infection gives temporary relief
Surgery

Question 8

What is ectropion? Association? Management?

Answer 8

Lower lid eversion

Causes eye irritation, watering and exposure keratitis (corneal inflammation)

Associated with old age, facial palsy

Managed with surgical correction, plastics

Question 9

What is lagophthalmos? Causes? Mx?

Answer 9

Difficulty in lid closure
Causes:
Exophthalmos
Mechanical impairment of lid movement
Leprosy

Rx:
Lubricate eyes with liquid paraffin ointment
Temporary tarsorrhaphy (stitching lids together) if corneal ulcers

Question 10

What is belpharospasm? Presentation? Causes?

Answer 10

Involuntary contraction of orbiculares oculists
In response to ocular pain
Repetitive belpharospasm can have serious impact on QOL
It is a facial dystonia

Starts unilaterally becoming bilateral
Patients may touch or pull eyelids to reduce it

Causes?
Neuroleptics
Parkinson's
Paraneoplastic
Progressive supra nuclear palsy

TReatment:
Botulinum neurotoxin - palliation is achieved with small doses injected into orbicular oculists - produced temporary flaccid paralysis.
Anticholinergics
Dopamine agonists