Eyelid Disorders

Question 1

What is blepharitis?

Answer 1

Inflammation of the eyelid margins

Question 2

What is the role of meibomian glands?

Answer 2

They secrete oil onto the surface of the eyes

Question 3

What is the management of blepharitis?

Answer 3

Hot compresses and gentle cleaning of the eyelid margins to remove debris using a cotton wool dipped in sterilised water and baby shampoo.
Lubricating eye drops can be used to relieve symptoms.

Question 4

Give examples of lubricating eye drops when it comes to blepharitis…

Answer 4

Hypromellose (least viscous, effects only last about ten minutes)
Polyvinyl alcohol (usually start with these)
Carbomer (lasts around 30-60 mins, most viscous)

Question 5

What is the other name for a stye?

Answer 5

Hordeolum

Question 6

What is hordeolum externum?

Answer 6

Stye= tender red lump along the eyelid which may contain pus

Hordeolum internum= infection of the meibomian glands, these are deeper and tend to be more painful and may point inwsrds towards the eyeball underneath the eyelid.

Hordeolum externum= infection of the sebaceous and sweat glands at the base of the eyelashes

Question 7

How are styes treated?

Answer 7

They are treated with hot compresses and analgesia

Consider topic antibiotics ie: chloramphenicol if it is associated with conjunctivitis or persistent

Question 8

What is a chalazion?

Answer 8

This occurs when a meibomian gland becomes blcoked and swells up, it is often called a meibomian cyst. It presents with a swelling in the eyelid which is typically not tender.

Question 9

What is the treatment of chalazion?

Answer 9

Hot compress and analgesia
Consider topical antibiotics- chloramphenicol if acutely inflamed
Rarely if conservative management fails then surgical drainage may be required.

Question 10

What is an entropion?

Answer 10

This is where the eyelid turns inwards with the lashes against the eyeball
It results in pain and can result in corneal damage and ulceration

Question 11

What is the management of entropion?

Answer 11

Initial management is by taping the eyelid down to prevent it from turning inwards
Definitive management is with surgical intervention
When the eyelid is taped down, it is essential to prevent the eye drying out by using regular lubricating eye drops
A same day referral to ophthalmology is required if there is a risk to sight.

Question 12

What is an ectropion?

Answer 12

This is where the eyelid turns outwards with the inner aspect of the eyelid exposed, it usually affects the bottom lid.

Question 13

What can an ectropion lead to?

Answer 13

Exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected

Mild cases- do not require treatment, regular lubricating eye drops are used to protect the surface of the eye, more significant cases may require surgery to correct the deficit

Same day referral to opthalmology is required if there is a risk to sight

Question 14

What is trichiasis?

Answer 14

This is inward growth of the eyelashes, it results in pain and can result in corneal damage and ulceration.

Question 15

What is the management of trichiasis?

Answer 15

Removing the eyelash- epilation
Electrolysis, cryotherapy or laser treatment if the lash is regrowing and recurring.

Again a same day referal is required if there is a risk to sight

Question 16

How does periorbital cellulitis present?

Answer 16

An eyelid and skin infection in front of the orbital septum (in front of the eye), it presents with swelling, redness and hot skin around the eyelids and the eye.

Question 17

How can you distinguish between periorbital and orbital cellulitis?

Answer 17

A CT scan

Question 18

How do you treat periorbital cellulitis?

Answer 18

Treatment is with systemic antibiotics (oral or IV), because of the risk of it developing into orbital, vulnerable patients ie: children or severe cases may require admission for observation whilst they are treated.

Question 19

What is orbital cellulitis?

Answer 19

Infection around the eyeball that involves tissues behind the orbital septum

Question 20

What are the key features which distinguish orbital cellulitis from peri orbital cellulitis?

Answer 20

In orbital cellulitis you will get pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and proptosis.

Question 21

What is the management of orbital cellulitis?

Answer 21

Admission and IV antibiotics

They may require surgical drainage if an abscess forms