Eyelid Disorders Flashcards
What is pilosabaceous unit?
Refers to arrangement consisting of hair shaft and follicles
What is the pilosabaceous unit associated with?
Sebaceous glands and muscle
How does the pilosabaceous become inflamed?
Due to infection (bacterial/fungal) or infestation (demodex mites)
What 2 forms can blepharitis come in?
Antetior and posterior
How can we differentiate between the 2 forms of blepharitis?
Bleph sxs= worse AM
Dry eye sxs= Worse PM
What ocular sxs may overlap with blepharitis and dry eye related deficiency?
Ocular discomfort Dryness Burning/stinging Grittiness Photophobia Blurred/fluctuating vision
What is anterior blepharitis associated with?
Excessive colonisation by BACTERIA, FUNGAL, DEMODEX MITES
Inflammation of lid margins and ocular surface…. inflamm signs associated with crusting/scaling of lashes
Where is posterior blepharitis often located?
Meibomian glands offices
What is the common cause of Posterior blepharitis or decline in MG function?
Age
How common is blepharitis?
40% of population and elderly
What are posterior eph associated with?
Inflamm of lid margin and ocular surface… inflamm not associated with crusting/scaling
What are the most common skin conditions associated with blepharitis?
Seborrheic dermatitis
Rosacca
What is the hallmark of blepharitis?
Chronic!
What other factors may cause inflammation on eyelids?
Environmental factors
What signs are associated with rosacea but not seborrheic dermatitis?
Telangiectasia- dilated/broken blood vessels
Puss filled pimple
Rhinophyma- red/purple nose enlargement
What sxs are common in both anterior and posterior blepharitis?
Lids sxs- redness, lid swelling, crusting, sticky eyelids Irritation burning sensation Possible blurred vision Cls intolerance Photophobia Increased blinking
What do all sxs of blepharitis stem from?
Lid inflammation
What associated conditions are there with lid inflamm?
Conjunctivitis
Dry eye syndrome
Keratitis
What are the 3 key features in blepharitis?
Bilateral
Chronic
Asymptomatic
What signs are seen with ant and post blepharitis?
Ant= lash related signs Post= MGD Signs
What 8 signs are there in blepharitis?
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
What corneal signs could be presented in blepharitis?
Inferior punctuate erosion
Marginal infiltrates
Corneal vasc
What is the 1st line tx for blepharitis?
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
If there is corneal involvement what action would be taken?
Ophthalmological opinion- urgent topical antibiotics/steroids
What are tx for blepharitis aimed to do?
Ant bleph= Reduce bacteria load
Post bleph= improving MG function
Attempt both!
What treatment methods can be used for seborrheic dermatitis?
Oral steroids/antibiotics
Anti fungal shampoo and OTX antifungal tx
What 2 types of benign lid bumps are there?
Chalazion and hordeolum
How does a chalazia arise?
Inspissation (thickening) of meibum lipid leading to obstruction of MG ducts. Backed up lipids lead to leakage into surrounding tissue
What is chalazia associated with?
Bleph and skin conditions
What signs and sxs maybe presented in a chalazia in mild/mod inflamed?
Swelling and mild hypereamia
Mild tenderness/pain
What the 1st line treatment for chalazia?
Hot compress daily twice 5 minutes/application
Lid massage and possibly lid hygiene if bleph associated
What is done treatment is unsuccessful?
Unsuccessfull after 2 weeks= REFER HES based options available- - Intralesional steroid injection - surgical incision - curretage
Where does hordeolum stem from?
Infected lash follicle spreads into glands
What is the onset of hordeolum associated with?
Bleph, rosacea, trichiasis
… usually idiopathic onset
Whats another term for hordeolum?
Stye
Which 2 areas can hordeolums infect?
Internal= Meibomian glands External= zeiss glands (anteriorly located)
What sxs are associated with hordeolum?
Pain swelling burning sensation
How is hordeolum treated?
Same as chalazia
What is the hallmark for infection in hordeolum?
Pus!
What is the natural lifespan of hordeolum?
2/52 approx and resolves spontaneously without intervention
If the hordeolum persists after 2 weeks, what action is taken?
1st antibiotics
2nd surgical incision and curretage
What complication can arise for hordeolum?
Cellulitis?
Where is the orbital Septum located?
Anterior section of orbital bone to conjunctival tarsal plate
Who are more at risk of cellulitis?
Children
What are the key features of cellulitis?
Red, painful, swollen lids and unilateral
If suspected, what action is taken?
Same day phone call consultation about need for emergency referral
What is the cause of orbital cellulitis?
Spread from infective sinus disease especially with px with hx of upper respiratory tract infection i.e. pharyngitis, sinusitis, pneumonia
What sxs and signs maybe presented in orbital cellulitis?
Red, swollen, tender eyelid
Pain on eye movements
Diplopia
Fever, unwell, lethargy
How is preseptal cellulitis caused?
Local eyelid injury/defect- insect bite, hx of hordeolum
How can periorbital and orbital ve differentiated?
CT scans
How are both forms of cellulitis tx?
Orbital= intravenous injection Preseptal= Oral
What is a nodule?
Small swelling/ aggregation cells
Which form of eyelid bumps are nodules more commonly seen in?
Chalazia
What different types of BENIGN eyelid tumours are there?
Epidermal inclusion cyst Cysts of zeiss and moll Xanthelasma Molluscum contagiosum Seborrheic keratosis Squamous papilloma
Which is the most common form skin cysts?
Epidermal inclusion cysts
What is the cause of epidermal inclusion cyst?
Hair follicle occlusion
Which area of the body can epidermal inclusion cyst NOT be found?
Palm of hands
Soles of feet
What are the signs of epidermal inclusion cyst?
Elevated round white lesion Nodular Smooth surface Keratin filled
How is epidermal inclusion cyst managed?
Non urgent referral- surgical excision IF sxs ONLY!
Which benign eyelid tumours require a sxs surgery?
Epidermal inclusion cyst
Cysts of zeiss and moll
Which benign eyelid tumours require a cosmesis surgery?
Xanthelasma
Seborrheic keratosis
Squamous papilloma
What is the cause if Xanthelasma?
Hyperlipidemia (blood disorder= risk factor for CVD)
Can be idiopathic
What are the signs of Xanthelasma?
Yellow slightly raised plaques
Bilateral
Asymmetric
Medially located
What does a molliscum contagiosum look like?
Dome shaped
Pinkish
Isolation or clusters
Months to resolve spontaneously
What presentations are seen in seborrheic keratosis?
Brownish
Wart like
Whats another term for squamous papilloma?
Acrochordon or skin tag… finger like flesh
What are the commonest forms of malignant eyelid tumours?
BCC
SCC
What associated risk factors are there in BCC?
Sun exposure m/ sunny climates
Fair skin
Lower lid prevelant
AGE!
What are the presentations seen in BCC?
Pearly margins
Ulcerated Centre
Not metastasize but invasive!
What action isbtajen with malignant eyelid tumours?
Suspected? Urgent emergency referral to HES 2/52
What 2 types of lower lid abnormalities are there?
Extropian
Entropian
Which muscle is need to keep sufficient horizontal tension?
Lateral canthel tendon
What sxs may a patient experience with the sagging of the eyelid?
Redness
Tearing
Epiphora
FB sensation
… all 2nd to inadequate tar film
Due to the eyelid laxity what cornealn signs maybe presented?
Punctate corneal erosion syndrome…. if scarring then risk of permanent vision loss
What treatment is the for ectropian?
Early stages- topical ocular lube
Oculoplastic surgery often needed
What is ‘involutional entroian’?
When ectropian is caused by increase in hz eyelid laxity. Common cause in elderly
What are the less common causes if ectropian?
Cicatricial ectropian- contraction caused by scarring
Paralytic ectropian- transient/permanent disruption to nervous supply i.e. bells palsy
What 2 problems can occur with ectropian?
Anterior lid margin right angled
Lashes turn inwards
What can cause entropian?
Involutional entropian- irregularities if lid skin tension
Cicatricial entropian- contraction caused by scarring of bulber conj
How is entropian treated?
Lid surgery… initiated ASAP via GP seen in 2/52
Sxs severe?- HES discussion
