Eyelid disorders Flashcards
1
Q
Define blepharitis
A
- Inflammation of eyelid margins/edges.
2
Q
Describe pathophysiology of blepharitis.
A
- staph, HSV, VZV infection.
- allergies/ skin reactions
3
Q
How does blepharitis present?
A
- gritty, itchy, dry eye.
- eyelids may look greasy, and inflamed.
- sticky discharge - stuck together in the morning.
- crusts develop at base of eyelashes.
- erythema.
- bilateral and chronic.
4
Q
How is blepharitis managed?
A
- hot compression and cleaning.
- massage of meibomian glands to push oily fluid out.
- avoid contact lens during flare up.
- lubricating eye drops - 1st line = Polyvinyl alcohol , 2nd line = hypromellose.
- Abx - doxycycline.
5
Q
Define hordeolum.
A
aka stye
- Bacterial infection of eyelid – causes a painful bump on inside or outside of eye.
- can be internal or external.
- staph aureus infection
6
Q
Pathophysiology of external hordeolum.
A
infection of glands of zeis OR glands of Moll.
- Infection in root of eyelash – starts as small red lump and develops into little abscess (yellow pus filled).
o Glands of Zeis = sebaceous glands at base of eyelashes.
o Glands of Molls = sweat glands at base of eyelashes.
7
Q
Pathophysiology of internal hordeolum.
A
- Infection of Meibomian glands.
- Swelling points towards inside of eyeball and is more painful.
8
Q
Risk factors for hordeolum.
A
itchy eyelid/ rub a lot - ext more likely.
- blepharitis.
9
Q
How does hordeolum present?
A
- Red, hot lump.
- Pain
- Local inflammation.
- Int style – dull aching in the eyelid and sometimes get sensation of a lump.
10
Q
How are hordeolum’s managed?
A
- hot compression and analgesia.
- Head/ point usually burst within 3-4 days, can take 1-2 wks to completely resolve.
- ext stye - epilation of eyelash
- int stye = surgical drainage
- Abx (i.e. chloramphenicol) if associated with conjunctivitis or persistent
11
Q
Define chalazion
A
- Blockage and swelling of meibomian gland.
- aka meibomian cyst.
12
Q
Pathophysiology of a chalazion?
A
- Meibomian glands – under inner surface of eyelid – make oily fluid called meibum to lubricate eye.
- If gland becomes blocked – meibum cannot escape into tears – causes gland to swell into cyst and leak into eyelid tissue – overtime inflammation causes lump to form in eyelid.
- Lump if firm and solid – called chalazion.
13
Q
Risk factor of chalazion?
A
- Blepharitis
- Eczema
o BECAUSE in both cases meibum is thicker – therefore more likely to block gland.
14
Q
How does chalazion present?
A
- eyelid swelling.
- mild pain and irritation.
- can become infected - red, swollen and painful.
- if too big - press on the eyeball and affect vision.
- most common on the upper eyelid and can have several on eyelid.
15
Q
Mx of a chalazion?
A
- lasts 2-6 months, if no symp no Tx needed.
- warm compression, hygeine, masage and analgesia.
- Abx if infected (chloramphenicol).
- surgical drainage.
16
Q
Define entropian.
A
- ## Eyelid (normally lower eyelid) rolls inwards so that eyelashes touch surface of eye (cornea).
17
Q
define trichiasis.
A
Eyelash turning in against eye
18
Q
Pathophysiology of entropion.
A
- Weakness of small muscles around eyelid.
- Trachoma (e.g chlamydia trachomatis) – infection that causes scaring and disruption of eyelid – makes it turn in.
- Injury - chemical burns.
19
Q
Risk factors for entropion.
A
- old age
- ocular irrtation
- past eye surgery,
20
Q
How does entropion present?
A
- Pain, irritation and watery eye.
- Foreign body sensation.
- If left untreated - Corneal damage and ulceration – blurry vision.
21
Q
Mx of entropion.
A
- tapping eyelid to cheek.
- botulinum toxin injecion to eyelid muscles.
- lubricating ointment, bandage contact lens, epilation of eyelash,
- same day referral to opthal if risk to sight.
- surgery
22
Q
Define ectropion.
A
- Eyelid (usually lower) turns outwards.
23
Q
Pathophysiology of ectropion.
A
- Age related weakness of muscles.
- Scaring +/ - contracture of skin and underlying tissues – trauma, burns, skin tumours, chronic blepharitis.
- Conditions causing weakness of facial nerve and muscles +/ - facial paralysis – e.g bells palsy, parotid tumour, stroke, head and neck malignancy.
24
Q
How does ectropion present?
A
- Sore, red eye.
- Watery eye – excessive tearing to protect cornea and keep eye lubricated.
- Usually affects one eye BUT AGE RELATED AFFECTS BOTH.
- Inner lining of eye that droops forwards – dry and sore.
- Punctum visible with slit lamp.
- Since eyelid doesn’t close properly – dry and sore cornea and cornea not protected – corneal ulcer and visual disturbances
25
Q
Mx of ectropion.
A
- avoid rubbing eye
- lubricating ointment
- tape lower and upper eyelid shut
- surgery to tighten skin and muscles around eyelid.
same day referral to opthal is=f risk to sight.
26
Q
Complication of ectropion?
A
- Exposure keratopathy (aka exposure keratitis) – damage to cornea due to dryness caused by incomplete closure of eyelid.
27
Q
Define peri-orbital cellulitis.
A
- Eyelid and skin infection in front of orbital septum.
28
Q
Risk factors for pre-orbital cellulitis.
A
- < 10 yrs
- trauma
- Sinusitis, dacryocystisis, hordeolum.
29
Q
How does peri-orbital cellulitis present?
A
- Swelling, redness, hot skin around eyelids and eye.
- Fever
30
Q
How do you distinguish between peri-orbital and orbital cellulitis? (signs, symp and Ix).
A
- Signs that suggest pre-orbit, rather than orbital C:
o No proptosis, normal eye movements, no chemosis, normal optic nerve function, no impaired vision. - CT orbit gold standard
31
Q
Mx of peri-orbital cellulitis?
A
- systemic Abx
- vulnerable groups - severe cases and children - admission and monitoring due to high risk of progression to orbital cellulitis.
32
Q
Define orbital cellulitis.
A
- Infection around eyelid involving tissues behind orbital septum.
33
Q
Risk factors for orbital cellulitis.
A
- Trauma
- Sinus disease – ethmoidal sinus infection spreads to eye
- Strep/ staph infection – can spread from resp tract.
- Dacrocystisis, dental abscess.
- peri-orbital cellulits
34
Q
How does orbital cellulitis present?
A
- Pain on eye movement, reduced eye movements, diplopia.
- Changes in vision.
- Proptosis.
- Fever and malaise.
- Chemosis.
35
Q
Diagnosis and Ix for oribital cellulitis.
A
- Blood tests: FBC, CRP to screen for raised inflammatory markers
- Swabs sent for microscopy, culture and sensitivity
- CT orbit is the gold standard investigation to distinguish orbital cellulitis from preseptal cellulitis
36
Q
Mx of orbital cellulitis?
A
MEDICAL EMERGENCY
- IV Abx
- surgical drainage if abcess forms.
