Eyelid Disorders

Question 1

Types of peri-ocular tumours

Answer 1

-90% basal cell carcinoma
-Squamous cell carcinoma
-Sebaceous cell Ca
-Melanoma
-Merkel cell

Question 2

Management of peri-ocular tumours

Answer 2

-Surgery
-Excisional biopsy preferred

Question 3

Describe basal cell carcinoma

Answer 3

-Pearly surface, flesh coloured papule with telangiectasia
-May later ulcerate leaving a central crater
-Lash loss
-Distorted lid architecture
-Loss of skin surface features (fine hairs and texture)

Question 4

Describe squamous cell carcinoma

Answer 4

-Risk factors: excessive exposure to sunlight, immunosuppression, smoking, actinic keratoses
-Rapidly expanding painless, ulcerate nodules/ may have a cauliflower-like appearance, areas of bleeding

Question 5

Describe keratoacanthoma

Answer 5

-Benign epithelial tumour
-Volcano or crater
=Initially a smooth dome-shaped papule
=Rapidly grows to become a crater centrally-filled with keratin
-Management: urgently excised as difficult to exclude squamous cell carcinoma

Question 6

Suspicious features of ciliary body melanoma

Answer 6

-Growth
-Thickness more than 2mm
-Lipofuscin
-Subretinal fluid

Question 7

Examples of life threatening oculoplastic emergencies

Answer 7

-Infection
-Necrotising fasciitis
-Orbital cellulitis

Question 8

Examples of sight threatening oculoplastic emergency

Answer 8

-Acute increase in orbital pressure
-Corneal exposure

Question 9

Describe orbital apex syndrome

Answer 9

-Compartment syndrome affecting the orbital contents
-Reduced vision + cranial nerve palsies III, IV, V, VI
-Dilated pupil
-Proptosis
-Conjunctival chemosis

Question 10

Describe orbital haemorrhage

Answer 10

-Blind, bulging, bashed
-Requires an urgent lateral canthotomy

Question 11

What to check for in 7th nerve weakness

Answer 11

-Lagophthalmos
-Bell’s phenomenon
-Corneal staining
-Corneal sensation

Question 12

Describe orbital cellulitis

Answer 12

-Infection affecting fat and muscles posterior to orbital septum
-Spreading upper respiratory tract infection from sinuses

-Redness and swelling around eye
-Severe ocular pain
-Visual disturbance
-RAPD?
-Proptosis
-Ophthalmoplegia/ pain with eye movements
-Eyelid oedema and ptosis
-Drowsiness/ nausea/ vomiting in meningeal involvement
-Chemosis

Question 13

What to do about orbital cellulitis

Answer 13

-Check pupils and vision
-Scan
-Admit for IV antibiotics
-May require drainage of orbital abscess

Question 14

Describe Preseptal cellulitis

Answer 14

-Less serious superficial infection anterior to orbital septum resulting from superficial tissue injury (chalazion, insect bite)

-Childhood, sinus infection, no Haem influenzae vaccination, recent eyelid infection, ear or facial infection

-Eye movement normal
-Vision normal
-No chemosis, proptosis, ophthalmoplegia/ pain with eye movements, reduced visual acuity

Question 15

Describe acute dacryocystitis

Answer 15

-Indicates a blocked nasolacrimal duct
-Often preceded by a watery sticky eye
-Treat with systemic antibiotics
-Refer to lacrimal clinic for dacryocystorhinostomy (DCR)

Question 16

Describe a stye

Answer 16

-Presentation: infection of the glands of the eyelids
=External: infection (staph) of sebum producing glands and sweat glands
=Internal: infection of Meibomian glands- can lead to chalazion (firm painless lump/ retention cyst)
-Management: hot compresses and analgesia, topical abs if associated conjunctivitis

Question 17

Investigations of orbital cellulitis

Answer 17

-FBC (WBC elevated, raised inflammatory markers)
-Clinical examination involving complete ophthalmological assessment – Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema.
-CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis.
-Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B