Eyelid Pathologies Flashcards
Squamous Cell Carcinoma: Aetiology (1)
Malignant lesion from sebaceous glands (like meibomian glands, glands of zeis, and glands in caruncle
Squamous Cell Carcinoma: Predisposing Factors (5)
Most common between 60-80
Immunosuppressed patients
Female
Fair skin
UV exposer
Squamous Cell Carcinoma: Signs (5)
Firm red nodule
Scaly crust but pretty flat
Irregular borders
May occasionally bleed
Increases in size rapidly
Squamous Cell Carcinoma: Symptoms (3)
Itchy
Irritable
Can be asymptomatic
Squamous Cell Carcinoma: Differential Diagnosis (1)
Basal cell carcinoma
Squamous Cell Carcinoma: Management (2)
Recommend sun protection as a prevention
Referral
Squamous Cell Carcinoma: Referral (1)
Urgent - emphasis importance to patient to ensure attendance of appointment
Basal Cell Carcinoma: Aetiology (4)
Most common malignant lesion in light skin tones
Most common form in adnexa
Rarely metastasises
Slow growing localised lesion
Basal Cell Carcinoma: Predisposing Factors (5)
Most common between 60-70
Immunosuppressed patients
Male
Fair skinned
UV exposure
Basal Cell Carcinoma: Signs (4)
Lesion with crusted centre
Inwardly rolled borders
Slow growth
May bleed
Basal Cell Carcinoma: Symptoms (3)
Itchy
Irritable
Sometimes asymptomatic
Basal Cell Carcinoma: Differential Diagnosis (1)
Squamous cell carcinoma
Basal Cell Carcinoma: Management (3)
Sun protection as prevention
Take photos to regularly review
Referral
Basal Cell Carcinoma: Referral (2)
Routine if confident it is basal cell
If unsure - refer as urgent to be safe
Anterior Blepharitis: Aetiology (1)
Chronic inflammation of eyelids
Anterior Blepharitis: Types (3)
Staphylococcal
Seborrheic
Demodex
Anterior Blepharitis: Staphylococcal (1)
Direct infection or exotoxin response/allergic reaction
Anterior Blepharitis: Seborrheic (1)
Disorder of the sebaceous glands of Zeis
Anterior Blepharitis: Demodex (1)
Infestation of demodex follicularum mite in lash follicles
Anterior Blepharitis: Predisposing Factors (4)
Contact lens wear
Demodex infection
Hygiene
Dermatitis - seborrheic
Anterior Blepharitis: Signs (2)
Lid margin becomes hyperaemic
Conjunctival hyperaemia
Anterior Blepharitis: Signs (Staphylococcal) (6)
Lid margin thickening/swelling
Crusting of lid margin
Loss of lashes
Lash misalignment
Reoccurring styes
Can involve inferior cornea in severe cases (keratitis/scarring/neovasc)
Anterior Blepharitis: Signs (Seborrheic) (1)
Oily/greasy appearance or deposits on lid margins
Anterior Blepharitis: Signs (Demodex) (2)
Collarettes on base of lashes
‘Eggs’ or mites
Anterior Blepharitis: Symptoms (3)
Dry eye symptoms
Contact lens intolerance (greasy deposits on reusable lenses)
Discomfort (itchy/sore/gritty)
Anterior Blepharitis: Differential Diagnosis (6)
Posterior Blepharitis
Dacryocystitis
Cellulitis
Medication related dermatitis
Allergic eye disease
Acute bacterial infection
Anterior Blepharitis: Management (3)
Lid hygiene
- proprietary wipes best
- tea tree based products for demodex treatment
Explain it is chronic and likely to come back
Switch to daily disposables if risk of secondary infection
Anterior Blepharitis: Referral (2)
Not usually required
Routine if antibiotics required for persistent staphylococcal infections
Anterior Blepharitis: Contact Lens Implications (5)
Risk of secondary infection with staphylococcal blepharitis
- Caution with reusable lenses
- Do not fit with extended/continuous wear until treated
- Consider daily disposable
Greasy lens deposits may require more intense cleaning regime
Posterior Blepharitis (MGD): Aetiology (5)
Dysfunction disease of meibomian glands
Bacteria affecting consistency of meibum secretions
May be abnormal in patency, chemical or physical make up
Tear film instability
Osmolarity changes further disrupting lid margin homeostasis
Posterior Blepharitis (MGD): Predisposing Factors (4)
Contact lens wear
Ocular rosacea
Hygiene
- make up debris on lid margin blocking glands
Ongoing anterior blepharitis
Posterior Blepharitis (MGD): Signs (10)
Hyperaemic lid margin
Conjunctival hyperaemia
Thickening/swelling of lid margin
Thick opaque secretions
Poor patency of secretions with digital massage
Blocked glands with a cap
Notching of lid margins were glands pucker
Can involve inferior cornea if severe
Evaporative dry eye
Meibography may identify blockage
Posterior Blepharitis (MGD): Symptoms (3)
Dry eye symptoms
Contact lens intolerance (lipid deposits)
Discomfort (itchy/sore/gritty)
Posterior Blepharitis (MGD): Differential Diagnosis (4)
Anterior blepharitis
Meibomian gland carcinoma
Preseptal cellulitis
Dacryocystitis
Posterior Blepharitis (MGD): Management (4)
Lid hygiene
- proprietary wipes best
Warm compresses
- heat bag retains heat better
- lid massage following
Intense pulsed light therapy - contentious treatment
Explain chronic and likely to return
Posterior Blepharitis (MGD): Referral (2)
Routine
Persistent cases can be referred for oral antibiotics
Posterior Blepharitis (MGD): Contact lens implications (2)
Oily deposits require more intense cleaning regime
Will cause tear film quality challenges:
- reduced wear time
- reduced lens comfort
- Poor stability/fitting challenges
Stye (Hordeolum Externum): Aetiology (1)
Localised bacterial infection of the glands of the cilia (eyelash) glands of Zeis and Moll
Stye (Hordeolum Externum): Predisposing Factors (2)
Hygiene
Ongoing anterior blepharitis (esp staphylococcal)
Stye (Hordeolum Externum): Signs (3)
Small localised red lump (can be superior or inferior)
Swollen surrounding lid
Hyperaemia of surrounding tissue
Stye (Hordeolum Externum): Symptoms (2)
Intense localised discomfort (especially when pressure is applied)
Epiphora
Stye (Hordeolum Externum): Differential Diagnosis (5)
Squamous cell carcinoma
Basal cell carcinoma
Preseptal cellulitis
Internal hordeolum
Dacryocystitis
Stye (Hordeolum Externum): Management (3)
Likely to self-resolve - reassure
- Return if not
Removal of lash may help resolve infected follicle discharge - care of secondary infection/hygiene
Warm compresses
Stye (Hordeolum Externum): Contact Lens Implications (3)
Risk of secondary infection
Reduce wear
Avoid extended wear
Chalazion (Hordeolum Internum): Aetiology (2)
Infection/blockage of meibomian gland formed of a lipid type cyst (chalazion)
Can become infected - hordeolum internum
Chalazion (Hordeolum Internum): Signs (3)
Moderate sized lump, centrally under the superior/inferior lid (less than 8mm)
Pressure on cornea from lesion can cause astigmatic changes
Swollen surrounding lid and hyperaemia of tissue (redness indicates infection)
Chalazion: Symptoms (3)
Asymptomatic
Cosmetic concerns
Blurred vision with induced pressure
Hordeolum Internum: Symptoms (2)
Tender
Painful
Chalazion (Hordeolum Internum): Differential Diagnosis (5)
Preseptal cellulitis
Internal hordeolum vs chalazion
Dacryocystitis
Dacryoadenitis depending on location
Meibomian gland carcinoma
Chalazion (Hordeolum Internum): Management (1)
Possibly self-resolve with warm compresses and digital massage (over many weeks)
Chalazion (Hordeolum Internum): Referral (2)
Routine if causing vision distortion for removal (chalazion)
Urgent if infected and needs antibiotics (may be remove when infection resolves)
Chalazion (Hordeolum Internum): Contact Lens Implications (4)
Poor lid position may interfere with contact lens stability
Poor lid position may cause dry eye symptoms and lens intolerance
Temporary astigmatic changes may occur
Active infection should alert of secondary infection - proceed carefully with reusable/extended wear
Lid Wiper Epitheliopathy: Aetiology (3)
An area of increased abrasion and disruption to the epithelium of the lid wiper
Abrasion is seen beyond the physiological ‘line of marx’ - best seen with lissamine green
Hyperosmolarity may also be a factor
Lid Wiper Epitheliopathy: Predisposing Factors (7)
Contact lens wear (esp high modulus)
Dry eye
Advancing age
Asian ethnicity (lid tone)
Low humidity environment
Incomplete blink reflex
Eye rubbing
Lid Wiper Epitheliopathy: Signs (2)
Hperaemia around lid wiper margin
With lissamine green:
- enlarged width of line of marx
- area of thickness indicates where it’s occurring
- grade severity by measuring length and width
Lid Wiper Epitheliopathy: Symptoms (4)
Asymptomatic
Dry eye symptoms
Contact lens intolerance
General discomfort
Lid Wiper Epitheliopathy: Management (3)
Refit to lower modulus
Manage other dry eye factors
- lid hygiene
- MGD
- lubricant eye drops
Avoid eye rubbing
Lid Wiper Epitheliopathy: Contact Lens Implications (3)
Lens product choice - low modulus lenses
Check cleaning regime - lens surface deposits
Consider hydrogel lenses depending on wear time
Xanthelasma: Aetiology (2)
Fatty deposits around external lid folds, especially nasally
Likely due to atherosclerotic systemic concerns
Xanthelasma: Predisposing Factors (5)
Advancing age
Female
Atherosclerosis
Hyperlipidaemia
Diabetes
Xanthelasma: Signs (1)
Yellow mass like lesions collecting around palpebral sulci of the inferior and superior especially nasally
Xanthelasma: Symptoms (2)
Asymptomatic
Cosmetic concerns only
Xanthelasma: Differential Diagnosis (1)
These lesions should never bleed, itch and the surface should be smooth and unbroken. If any of these occurs, carcinoma should be considered
Xanthelasma: Management (2)
Reassurance
Send to the GP for cardiovascular work up
Xanthelasma: Contact Lens Implications (1)
None
