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My Own Deck > Eyelid Disorders > Flashcards

Eyelid Disorders Flashcards

1
Q

What is pilosabaceous unit?

A

Refers to arrangement consisting of hair shaft and follicles

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2
Q

What is the pilosabaceous unit associated with?

A

Sebaceous glands and muscle

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3
Q

How does the pilosabaceous become inflamed?

A

Due to infection (bacterial/fungal) or infestation (demodex mites)

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4
Q

What 2 forms can blepharitis come in?

A

Antetior and posterior

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5
Q

How can we differentiate between the 2 forms of blepharitis?

A

Bleph sxs= worse AM

Dry eye sxs= Worse PM

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6
Q

What ocular sxs may overlap with blepharitis and dry eye related deficiency?

A 
Ocular discomfort 
Dryness
Burning/stinging 
Grittiness
Photophobia
Blurred/fluctuating vision
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7
Q

What is anterior blepharitis associated with?

A

Excessive colonisation by BACTERIA, FUNGAL, DEMODEX MITES

Inflammation of lid margins and ocular surface…. inflamm signs associated with crusting/scaling of lashes

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8
Q

Where is posterior blepharitis often located?

A

Meibomian glands offices

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9
Q

What is the common cause of Posterior blepharitis or decline in MG function?

A

Age

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10
Q

How common is blepharitis?

A

40% of population and elderly

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11
Q

What are posterior eph associated with?

A

Inflamm of lid margin and ocular surface… inflamm not associated with crusting/scaling

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12
Q

What are the most common skin conditions associated with blepharitis?

A

Seborrheic dermatitis

Rosacca

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13
Q

What is the hallmark of blepharitis?

A

Chronic!

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14
Q

What other factors may cause inflammation on eyelids?

A

Environmental factors

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15
Q

What signs are associated with rosacea but not seborrheic dermatitis?

A

Telangiectasia- dilated/broken blood vessels
Puss filled pimple
Rhinophyma- red/purple nose enlargement

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16
Q

What sxs are common in both anterior and posterior blepharitis?

A 
Lids sxs- redness, lid swelling, crusting, sticky eyelids 
Irritation burning sensation 
Possible blurred vision 
Cls intolerance 
Photophobia 
Increased blinking
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17
Q

What do all sxs of blepharitis stem from?

A

Lid inflammation

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18
Q

What associated conditions are there with lid inflamm?

A

Conjunctivitis
Dry eye syndrome
Keratitis

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19
Q

What are the 3 key features in blepharitis?

A

Bilateral
Chronic
Asymptomatic

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20
Q

What signs are seen with ant and post blepharitis?

A 
Ant= lash related signs
Post= MGD Signs
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21
Q

What 8 signs are there in blepharitis?

A 
Lid swelling and redness
Posterior lid
Lash signs (scaling/crusting)
Bulbar and palpebral conjunctival hypereamia
Foaming tears
Debris floating 
Corneal signs
Superficial punctuate corneal erosion
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22
Q

What corneal signs could be presented in blepharitis?

A

Inferior punctuate erosion
Marginal infiltrates
Corneal vasc

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23
Q

What is the 1st line tx for blepharitis?

A

Cleaning
Heat tx c hot compress
Massage to promote movement of meibum through punctum
Lid hygiene using cotton pad, cooled boiled water/ tea tree oil
Advice pxs on inflamm conditions

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24
Q

If there is corneal involvement what action would be taken?

A

Ophthalmological opinion- urgent topical antibiotics/steroids

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25
Q

What are tx for blepharitis aimed to do?

A

Ant bleph= Reduce bacteria load
Post bleph= improving MG function
Attempt both!

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26
Q

What treatment methods can be used for seborrheic dermatitis?

A

Oral steroids/antibiotics

Anti fungal shampoo and OTX antifungal tx

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27
Q

What 2 types of benign lid bumps are there?

A

Chalazion and hordeolum

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28
Q

How does a chalazia arise?

A

Inspissation (thickening) of meibum lipid leading to obstruction of MG ducts. Backed up lipids lead to leakage into surrounding tissue

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29
Q

What is chalazia associated with?

A

Bleph and skin conditions

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30
Q

What signs and sxs maybe presented in a chalazia in mild/mod inflamed?

A

Swelling and mild hypereamia

Mild tenderness/pain

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31
Q

What the 1st line treatment for chalazia?

A

Hot compress daily twice 5 minutes/application

Lid massage and possibly lid hygiene if bleph associated

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32
Q

What is done treatment is unsuccessful?

A 
Unsuccessfull after 2 weeks= REFER
HES based options available-
- Intralesional steroid injection
- surgical incision 
- curretage
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33
Q

Where does hordeolum stem from?

A

Infected lash follicle spreads into glands

34
Q

What is the onset of hordeolum associated with?

A

Bleph, rosacea, trichiasis

… usually idiopathic onset

35
Q

Whats another term for hordeolum?

A

Stye

36
Q

Which 2 areas can hordeolums infect?

A 
Internal= Meibomian glands 
External= zeiss glands (anteriorly located)
37
Q

What sxs are associated with hordeolum?

A

Pain swelling burning sensation

38
Q

How is hordeolum treated?

A

Same as chalazia

39
Q

What is the hallmark for infection in hordeolum?

A

Pus!

40
Q

What is the natural lifespan of hordeolum?

A

2/52 approx and resolves spontaneously without intervention

41
Q

If the hordeolum persists after 2 weeks, what action is taken?

A

1st antibiotics

2nd surgical incision and curretage

42
Q

What complication can arise for hordeolum?

A

Cellulitis?

43
Q

Where is the orbital Septum located?

A

Anterior section of orbital bone to conjunctival tarsal plate

44
Q

Who are more at risk of cellulitis?

A

Children

45
Q

What are the key features of cellulitis?

A

Red, painful, swollen lids and unilateral

46
Q

If suspected, what action is taken?

A

Same day phone call consultation about need for emergency referral

47
Q

What is the cause of orbital cellulitis?

A

Spread from infective sinus disease especially with px with hx of upper respiratory tract infection i.e. pharyngitis, sinusitis, pneumonia

48
Q

What sxs and signs maybe presented in orbital cellulitis?

A

Red, swollen, tender eyelid
Pain on eye movements
Diplopia
Fever, unwell, lethargy

49
Q

How is preseptal cellulitis caused?

A

Local eyelid injury/defect- insect bite, hx of hordeolum

50
Q

How can periorbital and orbital ve differentiated?

A

CT scans

51
Q

How are both forms of cellulitis tx?

A 
Orbital= intravenous injection 
Preseptal= Oral
52
Q

What is a nodule?

A

Small swelling/ aggregation cells

53
Q

Which form of eyelid bumps are nodules more commonly seen in?

A

Chalazia

54
Q

What different types of BENIGN eyelid tumours are there?

A 
Epidermal inclusion cyst
Cysts of zeiss and moll
Xanthelasma
Molluscum contagiosum 
Seborrheic keratosis
Squamous papilloma
55
Q

Which is the most common form skin cysts?

A

Epidermal inclusion cysts

56
Q

What is the cause of epidermal inclusion cyst?

A

Hair follicle occlusion

57
Q

Which area of the body can epidermal inclusion cyst NOT be found?

A

Palm of hands

Soles of feet

58
Q

What are the signs of epidermal inclusion cyst?

A 
Elevated
round 
white lesion
Nodular 
Smooth surface 
Keratin filled
59
Q

How is epidermal inclusion cyst managed?

A

Non urgent referral- surgical excision IF sxs ONLY!

60
Q

Which benign eyelid tumours require a sxs surgery?

A

Epidermal inclusion cyst

Cysts of zeiss and moll

61
Q

Which benign eyelid tumours require a cosmesis surgery?

A

Xanthelasma
Seborrheic keratosis
Squamous papilloma

62
Q

What is the cause if Xanthelasma?

A

Hyperlipidemia (blood disorder= risk factor for CVD)

Can be idiopathic

63
Q

What are the signs of Xanthelasma?

A

Yellow slightly raised plaques
Bilateral
Asymmetric
Medially located

64
Q

What does a molliscum contagiosum look like?

A

Dome shaped
Pinkish
Isolation or clusters
Months to resolve spontaneously

65
Q

What presentations are seen in seborrheic keratosis?

A

Brownish

Wart like

66
Q

Whats another term for squamous papilloma?

A

Acrochordon or skin tag… finger like flesh

67
Q

What are the commonest forms of malignant eyelid tumours?

A

BCC

SCC

68
Q

What associated risk factors are there in BCC?

A

Sun exposure m/ sunny climates
Fair skin
Lower lid prevelant
AGE!

69
Q

What are the presentations seen in BCC?

A

Pearly margins
Ulcerated Centre
Not metastasize but invasive!

70
Q

What action isbtajen with malignant eyelid tumours?

A

Suspected? Urgent emergency referral to HES 2/52

71
Q

What 2 types of lower lid abnormalities are there?

A

Extropian

Entropian

72
Q

Which muscle is need to keep sufficient horizontal tension?

A

Lateral canthel tendon

73
Q

What sxs may a patient experience with the sagging of the eyelid?

A

Redness
Tearing
Epiphora
FB sensation

… all 2nd to inadequate tar film

74
Q

Due to the eyelid laxity what cornealn signs maybe presented?

A

Punctate corneal erosion syndrome…. if scarring then risk of permanent vision loss

75
Q

What treatment is the for ectropian?

A

Early stages- topical ocular lube

Oculoplastic surgery often needed

76
Q

What is ‘involutional entroian’?

A

When ectropian is caused by increase in hz eyelid laxity. Common cause in elderly

77
Q

What are the less common causes if ectropian?

A

Cicatricial ectropian- contraction caused by scarring

Paralytic ectropian- transient/permanent disruption to nervous supply i.e. bells palsy

78
Q

What 2 problems can occur with ectropian?

A

Anterior lid margin right angled

Lashes turn inwards

79
Q

What can cause entropian?

A

Involutional entropian- irregularities if lid skin tension

Cicatricial entropian- contraction caused by scarring of bulber conj

80
Q

How is entropian treated?

A

Lid surgery… initiated ASAP via GP seen in 2/52

Sxs severe?- HES discussion

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