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CLO > Eyelid Pathologies > Flashcards

Eyelid Pathologies Flashcards

1
Q

Squamous Cell Carcinoma: Aetiology (1)

A

Malignant lesion from sebaceous glands (like meibomian glands, glands of zeis, and glands in caruncle

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2
Q

Squamous Cell Carcinoma: Predisposing Factors (5)

A

Most common between 60-80

Immunosuppressed patients

Female

Fair skin

UV exposer

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3
Q

Squamous Cell Carcinoma: Signs (5)

A

Firm red nodule

Scaly crust but pretty flat

Irregular borders

May occasionally bleed

Increases in size rapidly

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4
Q

Squamous Cell Carcinoma: Symptoms (3)

A

Itchy

Irritable

Can be asymptomatic

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5
Q

Squamous Cell Carcinoma: Differential Diagnosis (1)

A

Basal cell carcinoma

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6
Q

Squamous Cell Carcinoma: Management (2)

A

Recommend sun protection as a prevention

Referral

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7
Q

Squamous Cell Carcinoma: Referral (1)

A

Urgent - emphasis importance to patient to ensure attendance of appointment

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8
Q

Basal Cell Carcinoma: Aetiology (4)

A

Most common malignant lesion in light skin tones

Most common form in adnexa

Rarely metastasises

Slow growing localised lesion

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9
Q

Basal Cell Carcinoma: Predisposing Factors (5)

A

Most common between 60-70

Immunosuppressed patients

Male

Fair skinned

UV exposure

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10
Q

Basal Cell Carcinoma: Signs (4)

A

Lesion with crusted centre

Inwardly rolled borders

Slow growth

May bleed

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11
Q

Basal Cell Carcinoma: Symptoms (3)

A

Itchy

Irritable

Sometimes asymptomatic

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12
Q

Basal Cell Carcinoma: Differential Diagnosis (1)

A

Squamous cell carcinoma

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13
Q

Basal Cell Carcinoma: Management (3)

A

Sun protection as prevention

Take photos to regularly review

Referral

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14
Q

Basal Cell Carcinoma: Referral (2)

A

Routine if confident it is basal cell

If unsure - refer as urgent to be safe

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15
Q

Anterior Blepharitis: Aetiology (1)

A

Chronic inflammation of eyelids

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16
Q

Anterior Blepharitis: Types (3)

A

Staphylococcal

Seborrheic

Demodex

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17
Q

Anterior Blepharitis: Staphylococcal (1)

A

Direct infection or exotoxin response/allergic reaction

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18
Q

Anterior Blepharitis: Seborrheic (1)

A

Disorder of the sebaceous glands of Zeis

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19
Q

Anterior Blepharitis: Demodex (1)

A

Infestation of demodex follicularum mite in lash follicles

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20
Q

Anterior Blepharitis: Predisposing Factors (4)

A

Contact lens wear

Demodex infection

Hygiene

Dermatitis - seborrheic

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21
Q

Anterior Blepharitis: Signs (2)

A

Lid margin becomes hyperaemic

Conjunctival hyperaemia

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22
Q

Anterior Blepharitis: Signs (Staphylococcal) (6)

A

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)

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23
Q

Anterior Blepharitis: Signs (Seborrheic) (1)

A

Oily/greasy appearance or deposits on lid margins

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24
Q

Anterior Blepharitis: Signs (Demodex) (2)

A

Collarettes on base of lashes

‘Eggs’ or mites

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25
Q

Anterior Blepharitis: Symptoms (3)

A

Dry eye symptoms

Contact lens intolerance (greasy deposits on reusable lenses)

Discomfort (itchy/sore/gritty)

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26
Q

Anterior Blepharitis: Differential Diagnosis (6)

A

Posterior Blepharitis

Dacryocystitis

Cellulitis

Medication related dermatitis

Allergic eye disease

Acute bacterial infection

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27
Q

Anterior Blepharitis: Management (3)

A

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

28
Q

Anterior Blepharitis: Referral (2)

A

Not usually required

Routine if antibiotics required for persistent staphylococcal infections

29
Q

Anterior Blepharitis: Contact Lens Implications (5)

A

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

30
Q

Posterior Blepharitis (MGD): Aetiology (5)

A

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

31
Q

Posterior Blepharitis (MGD): Predisposing Factors (4)

A

Contact lens wear

Ocular rosacea

Hygiene
- make up debris on lid margin blocking glands

Ongoing anterior blepharitis

32
Q

Posterior Blepharitis (MGD): Signs (10)

A

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

33
Q

Posterior Blepharitis (MGD): Symptoms (3)

A

Dry eye symptoms

Contact lens intolerance (lipid deposits)

Discomfort (itchy/sore/gritty)

34
Q

Posterior Blepharitis (MGD): Differential Diagnosis (4)

A

Anterior blepharitis

Meibomian gland carcinoma

Preseptal cellulitis

Dacryocystitis

35
Q

Posterior Blepharitis (MGD): Management (4)

A

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

36
Q

Posterior Blepharitis (MGD): Referral (2)

A

Routine

Persistent cases can be referred for oral antibiotics

37
Q

Posterior Blepharitis (MGD): Contact lens implications (2)

A

Oily deposits require more intense cleaning regime

Will cause tear film quality challenges:
- reduced wear time
- reduced lens comfort
- Poor stability/fitting challenges

38
Q

Stye (Hordeolum Externum): Aetiology (1)

A

Localised bacterial infection of the glands of the cilia (eyelash) glands of Zeis and Moll

39
Q

Stye (Hordeolum Externum): Predisposing Factors (2)

A

Hygiene

Ongoing anterior blepharitis (esp staphylococcal)

40
Q

Stye (Hordeolum Externum): Signs (3)

A

Small localised red lump (can be superior or inferior)

Swollen surrounding lid

Hyperaemia of surrounding tissue

41
Q

Stye (Hordeolum Externum): Symptoms (2)

A

Intense localised discomfort (especially when pressure is applied)

Epiphora

42
Q

Stye (Hordeolum Externum): Differential Diagnosis (5)

A

Squamous cell carcinoma

Basal cell carcinoma

Preseptal cellulitis

Internal hordeolum

Dacryocystitis

43
Q

Stye (Hordeolum Externum): Management (3)

A

Likely to self-resolve - reassure
- Return if not

Removal of lash may help resolve infected follicle discharge - care of secondary infection/hygiene

Warm compresses

44
Q

Stye (Hordeolum Externum): Contact Lens Implications (3)

A

Risk of secondary infection

Reduce wear

Avoid extended wear

45
Q

Chalazion (Hordeolum Internum): Aetiology (2)

A

Infection/blockage of meibomian gland formed of a lipid type cyst (chalazion)

Can become infected - hordeolum internum

46
Q

Chalazion (Hordeolum Internum): Signs (3)

A

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)

47
Q

Chalazion: Symptoms (3)

A

Asymptomatic

Cosmetic concerns

Blurred vision with induced pressure

48
Q

Hordeolum Internum: Symptoms (2)

A

Tender

Painful

49
Q

Chalazion (Hordeolum Internum): Differential Diagnosis (5)

A

Preseptal cellulitis

Internal hordeolum vs chalazion

Dacryocystitis

Dacryoadenitis depending on location

Meibomian gland carcinoma

50
Q

Chalazion (Hordeolum Internum): Management (1)

A

Possibly self-resolve with warm compresses and digital massage (over many weeks)

51
Q

Chalazion (Hordeolum Internum): Referral (2)

A

Routine if causing vision distortion for removal (chalazion)

Urgent if infected and needs antibiotics (may be remove when infection resolves)

52
Q

Chalazion (Hordeolum Internum): Contact Lens Implications (4)

A

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

53
Q

Lid Wiper Epitheliopathy: Aetiology (3)

A

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

54
Q

Lid Wiper Epitheliopathy: Predisposing Factors (7)

A

Contact lens wear (esp high modulus)

Dry eye

Advancing age

Asian ethnicity (lid tone)

Low humidity environment

Incomplete blink reflex

Eye rubbing

55
Q

Lid Wiper Epitheliopathy: Signs (2)

A

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

56
Q

Lid Wiper Epitheliopathy: Symptoms (4)

A

Asymptomatic

Dry eye symptoms

Contact lens intolerance

General discomfort

57
Q

Lid Wiper Epitheliopathy: Management (3)

A

Refit to lower modulus

Manage other dry eye factors
- lid hygiene
- MGD
- lubricant eye drops

Avoid eye rubbing

58
Q

Lid Wiper Epitheliopathy: Contact Lens Implications (3)

A

Lens product choice - low modulus lenses

Check cleaning regime - lens surface deposits

Consider hydrogel lenses depending on wear time

59
Q

Xanthelasma: Aetiology (2)

A

Fatty deposits around external lid folds, especially nasally

Likely due to atherosclerotic systemic concerns

60
Q

Xanthelasma: Predisposing Factors (5)

A

Advancing age

Female

Atherosclerosis

Hyperlipidaemia

Diabetes

61
Q

Xanthelasma: Signs (1)

A

Yellow mass like lesions collecting around palpebral sulci of the inferior and superior especially nasally

62
Q

Xanthelasma: Symptoms (2)

A

Asymptomatic

Cosmetic concerns only

63
Q

Xanthelasma: Differential Diagnosis (1)

A

These lesions should never bleed, itch and the surface should be smooth and unbroken. If any of these occurs, carcinoma should be considered

64
Q

Xanthelasma: Management (2)

A

Reassurance

Send to the GP for cardiovascular work up

65
Q

Xanthelasma: Contact Lens Implications (1)

A

None

CLO (13 decks)

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