Eyelid and lacrimal disorders - waldron Flashcards
what are the eyelids composed of
4 layers:
skin and subcutaneous tissue
striated muscle (orbicularis oculi)
tarsus
conjunctiva
what are the glands found within the eyelid
eccrine glands
lacrimal gland of Krause and Wolfring
apocrine gland of Moll
sebaceous gland - meibomian glands and gland of Zeiss
what is the tarsi
firm plates composed of dense connective tissue; meibomian glands are embedded in connective tissue of tarsal plates
what is the posterior eyelid surface
lined by palpebral conjunctiva composed of epithelium and subepithelial stroma - substantia propria
where are goblet cells found on the eyelid
epithelium of tarsi
what is the stroma composed of
fibrovascular connective tissue
what is hordeolum
sudden-onset localized swelling of eyelid initially causes eyelid hyperemia, edema, swelling and pain
usually caused by infection
remains painful and localized to eyelid margin
what is chalazion
sudden-onset localized swelling of eyelid initially causes eyelid hyperemia, edema, swelling and pain
non-infectious meibomian gland becomes small non-tender nodule in eyelid center
incision of intralesional corticosteroids may be used to hasten resolution
how are hordeolum and chalazions diagnosed
clinically
during first 2 days - they may be clinically indistinguishable
what is the treatment for hordeolum and chalazion
treatment primarily with hot compresses - both improve spontaneously
chalazion - incision or intra-lesional corticosteroids may be used
Hordeolum: systemic abx (dicloxacillin or erythromycin) indicated when cellulitis present
what is the clinical presentation of chalazion
eyelid diffusely swollen
102 days localized to body of the eyelid
usually small, nontender nodule or lump develops
usually drains through inner surface of eyelid or spontaneously absorbed over 2-8 weeks; rare to persist longer
depending on size and location - may indent cornea resulting in slightly blurred vision
what is the clinical presentation of Hordeolum (stye)
acute, localized swelling of eyelid that may be external or internal
EXTERNAL:1-2 days localized to eyelid margin
tearing, photophobia, FB sensation may be present. usually small yellow-ish pustule develops at base of eyelash
within 2-4 days, lesion ruptures and discharges material relieving pain and resolving lesion
INTERNAL: pain, redness, edema localized to posterior tarsal surface, inflam, recurrence is common (RARE)
What is Blepharitis
inflammation of eyelid margins, acute or chronic
itching and burning of eyelid margins with redness and edema
What is the etiology of acute blepharitis
usually bacterial infections (staph) of eyelid margin at origins of eyelashes - more crusting
may have viral source - usually more clear, serous discharge
what is acute non-ulcerative blepharitis
usually caused by allergic reactions involving same areas (intense itching, rubbing, rash)
what is the etiology of chronic blepharitis
non-infectious inflammation of unknown cause
what is the clinical presentation of blepharitis
itching and burning of eyelid margins
conjunctival irritation with lacrimation, photosensitivity, FB sensation
acute: small pustules, crusting
chronic: dilated swollen gland, exudate waxy, thick, yellowish
easily removable scales on eyelids
what is the workup/diagnostics used for Blepharitis
usually by slit-lamp examination (ophtho)
chronic blepharitis that does not response to treatment may require biopsy
what is the treatment of acute ulcerative blepharitis
abx ointment: bacitracin/polymyxin B, erythromycin, gentamicin QID x 7-10 days
what is the treatment of acute viral ulcerative belpharitis
acyclovir 400mg po TID x 7days
famciclovir 500mg po TID or valacyclovir 1gm po TID x 7days
what is the treatment of acute non-ulcerative belpharitis
avoiding offending action or substance
warm compresses over closed eyelid
if swelling persists > 24 hours, topical fluorometholone ophthalmic ointment x 7 days
what is the treatment of meibomian gland dysfunction chronic blepharitis
prevention of secondary keratoconjunctivitis sicca
warm compress and eyelid massage to extrude trapped secretions and coat ocular surface
what is the treatment of seborrheic chronic blepharitis
gentle cleansing of eyelid amrgin (lid scrubs) BID with cotton swab dropped in dilute solution of baby shampoo
topical abx ointment (erythromycin, bacitracin/polymyxin B or sulfacetamide) x 3 months
what can usually accompany chronic blepharitis
secondary keratoconjunctivitis sicca
What is entropion
inversion of an eyelid
caused by age-related tissue relaxation, post-infectious changes, post-traumatic changes or blepharospasm
eyelashes rub against eyeball and may lead to corneal ulceration and scarring
what is ectropion
eversion of lower eyelid
caused by age-related tissue relaxation, CN 7 palsy, post-traumatic or post-surgical changes
tearing (poor drainage of nasolacrimal system) and symptoms of dry eyes
what is the definitive treatment for entropion
surgery
what is the treatment for ectropion
symptomatic: tear supplements and at night ocular lubricants
definitive treatment: surgery
what is Dacryocystitis
infection of lacrimal sac that may lead to abscess formation
usually caused by (staph or strep species
what is acute dacryocycstitis
presents with pain, redness, edema around lacrimal sac
diagnosis based on s/sx and with pressure over lacrimal sac reflux of mucoid material through puncta
what is the treatment of acute dacryocycstitis
mild: warm compress/oral abx
severe: IV abx
abx usually 1st gen cephalosporin or penicillin
abscess may be drained, abx changed based on cx results
what is chronic dacryocycstitis
present with mass under medial canthal tendon and chronic conjunctivitis
what is the treatment of chronic dacryocycstitis
usually surgery: create passage between lacrimal sac and nasal cavity (dacryocycstorhinostomy)
what are the types of eyelid tumors
epithelial and melanocytic tumors
what is the most common malignant eyelid tumors
basal cell carcinomas in Caucasians
sebaceous gland carcinoma in asians
what are the benign eyelid tumors
squamous papilloma: m/c benign epithelial tumor of eyelid
seborrheic keratosis
keratoacanthoma
cutaneous horn (non-specific keratosis)
what are premalignant/malignant tumors
actinic keratosis - m/c precancerous lesion - may become SCC
xeroderma pigmentosum
BCC - m/c malignancy
SCC - UV light primary risk factor
what are benign malanocytic eyelid tumors
freckles (ephelis)
lentigo simplex
solar lentigo
eyelid nevi: congenital vs acquired
what are the cystic eyelid tumors
sweat gland tumors
hair follicle tumors
sebaceous gland tumors
stromal tumors
what is xanthelasma
common, benign deposit of yellow-white flat plaques of lpid material subcutaneous on upper and lower eyelids
about 1/3 have dyslipidemias, most do not
middle aged and elderly
dx: clinical
no treatment needed, removal for cosmetic
What are vascular eyelid tumors
capillary (infantile) hemangioma - m/c
nevus flammeus (port-wine stain)
kaposi’s sarcoma
what are neurogenic eyelid tumors
solitary neurofibroma - may resemble chalazion
