Eyelid Disorders Flashcards
What is blepharitis
Inflammatory condition of the eyelid margin
Risk factors for blepharitis
Dry eyes, dermatological conditions - rosacae and demodex infestation
Cause of blepharitis
Staph blepharitis and meibomian gland dysfunction are most common causes
Symptoms of blepharitis
Redness
Burning sensation
Irritation
Tearing
Eyelid crusting and sticking
Visual problems such as photophobia and blurred vision
What time of day is blepharitis typically worse
In the morning
Signs of blepharitis
Meibomian glands may appear capped with oil
Dilated, visibly obstructed
Erythema, oedema
May exhibit eyelash loss and/or misdirection
Management of blepharitis
Warm compresses, eyelid massage, eyelid scrubs, topical Abx, oral Abx, lubricating eye drops, artificial tears, short courses of topical steroids
Oral Abx which could be used in blepharitis
Tetracycline and doxycycline
When are oral Abx used in patients with blepharitis
Those with meibomian gland dysfunction or patients associated with rosacea
Options for lubricating eyedrops in patients with blepharitis
Hypromellose, polyvinyl alcohol, carbomer
What can blepharitis lead to
Styes and chalazions
When can short courses of topical steroids be used in blepharitis
Beneficial for symptomatic relief in cases with significantly ocular inflammation
What is a stye
Tender red lump along the eyelid that may contain pus
What is hordeolum externum
Infection of the glands of Zeis or glands of Moll
What is hordeolum internum
Infection in the Meibomian glands
What are the glands of Moll
Sweat glands at the base of the eyelashes
What are the glands of Zeis
Sebaceous glands at the base of the eyelashes
Treatment of a stye
Hot compresses and analgesia. Consider topical antibiotics (chloramphenicol) if it associated with conjunctivitis or if persistent
What is chalazion
Chronic sterile lipogranuloma in the eyelid that originates from an obstructed meibomian gland of the tarsal plates
Risk factors for chalazion
Blepharitis, rosacea, prior chalazion, dermodicosis
Symptoms of chalazion
Gradually enlarging eyelid nodule, eyelid discomfort, even painful swelling if secondary infection occurs, history of similar eyelid swelling in the past
Signs of chalazion
Nodule on an eyelid, affects upper eyelids more (due to their being more meibomian glands)
Investigations into chalazion
Recurrent or atypical chalazia should be sent for pathologic evaluation, microscopy of the materials from a chalazion shows a lipogranulomatous
Management if chalazion small and asymptomatic
Left untreated, lid massage, warm compression, Abx steroid eye drops or ointments
Management of chalazion is associated with inflammatory conditions
Topical Abx eyedrops
When is surgical treatment involved in chalazion
Unresolved or large and symptomatic. Incision and curettage
What is entropion
Eyelid turns inwards with the lashes against the eyeball.
What is ectropion
Eyelid turns outwards with the inner aspect of the eyelid exposed, usually affects the bottom lid
What is the end result of entropion
Results in pain and can result in corneal damagae and ulceration
What is the end result of ectropion
Result in exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected
Management of entropion
Taping the eyelid down to prevent it turning inwards. Definitive management is with surgical intervention, also using regular eye drops
Management of ectropion
mild cases require no treatment, regular lubricating eye drops are used to protect the surface of the eye, more significant require surgery
What is trichiasis
Inward growth of eyelashes, this results in pain and can result in corneal damage and ulceration
Management of trichiasis
Specialist to remove the eyelash, recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent lash regrowing
What is blepharoptosis
Abnormal low lying upper eyelid margin with the eye in primary gaze.
Symptoms of blepharoptosis
Usually present with eye being small, tired appearance, limited field of vision and headache
Investigations into blepharoptosis
Visual acuity, pupillary reflexes, ocular motility, marginal reflex distance, levator functions, proptosis, enopthalmos, logophthalmos, presence of Bell phenomenon
Medical therapy of patients with blepharoptosis
Patients with myasthenia gravis may improve with medical therapy such as sympathomimetic topical eye drops
Eg of sympathomimetic topical eye drops
apraclonidine and phenylephrine
When is early surgical intervention required
If there is a risk of the patient developing ambylopia or significant abnormal head position to develop
What is the main treatment for ptosis
Surgical - levator resection (good levator function) or frontalis suspension (poor levator function). Mullerectomy in mild ptosis
Causes of acquired ptosis
Aponeurotic or involutional ptosis may result from stretching, disinsertion of the levator aponeurosis. Myogenic ptosis, neurogenic ptosis, mechanical ptosis.
Myogenic causes of ptosis
Myasthenia gravis
Neurogenic causes of ptosis
3rd nerve palsy or Horner’s syndrome
Mechanical causes of ptosis
Result from presence of eyelid mass, such as neurofibroma or haemangioma
