Eyelids

Question 1

What is blephiritis?

Answer 1

common disorder of the eyelids which can cause persistent and annoying symptoms of irritation, watering and redness.
2 main types; seborrheic and staphylococcal

Question 2

What does staphylococcal blepharitis look like?

Answer 2

infection of the lid margins by staphylococcal bacteria (aureus and epidermis). The lid margin is inflamed and coated with scales. The lashes are stuck together by crusts.

Question 3

What does seborrheic blepharitis look like?

Answer 3

This variant can occur is association with seborrheic dermatitis.
overproduction of sebum by glands at the lid margin. Bacteria metabolize the sebum into irritating free fatty acids.
The lids are less inflamed than in staphylococcal blepharitis, and there will be plugs of sebum seen in orifices

Question 4

What can lead on from blepharitis?

Answer 4

secondary conjunctivitis

punctate corneal epithelial erosions

Question 5

What are other assosciations with blepharitis?

Answer 5

dry eye 
corneal scarring and vascuralisation
eyelash abnormalities - inward growth and whitening and loss
stye
chalazion
acne rosacea

Question 6

Management of blepharitis:

Answer 6

Blepharitis. Treat with long term (for life!) daily lid hygiene (hot compresss and lid massage and then cleaning the lid margins with warm very dilute solution of baby shampoo and water).
Short term antibiotic ointment (fucithalmic) may help reduce staphylococcal load, remembering this is a hypersensitivity and not an infection. In more severe cases low dose systemic antibiotic (doxycycline 50mg od for 3/12) will reduce inflammation and promote healthier meibomian gland oil production.
There is no substitute for lid cleaning.
eye drops for comfort

Question 7

Explain contact dermatitis

Answer 7

This can be caused by contact with makeup, skin cleansers, shampoo etc.
Features include erythema, swelling and scales.

Question 8

What is a blackeye?

Answer 8

periorbital hematoma

Question 9

What does a full examination of a black eye look like?

Answer 9

Full examination of eye - vision, anterior segment, pupil responses, dilated fundal exam.
Need to rule out globe rupture.
Assess eye movements.
Palpation of orbital rim (fracture?),
Test sensation of infraorbital nerve – upper teeth / gum numbness most reliable sign of damage to the nerve.
CT scan of orbits if blowout fracture suspected (motility limited or gross enophthalmos).
In young patients, if unwell and vomiting may have a “greenstick” trapdoor blowout fracture and muscle entrapment. These can be ischaemic (hence the vomiting) and need urgent surgery. Adult bone is not as flexible, and the fractured segment does not flex back and trap structures, and surgery is often not required, or performed later if chronic motility problems or enophthalmos.

Question 10

What sx’s will a pt with proptosis be complaining of?

Answer 10

Prominent eyes/cosmesis. 
Decreased vision one/both eyes. 
Double vision. 
Foreign body sensation, pain, photophobia. 
Systemic symptoms of thyroid disease?

Question 11

how do chalazion arise?

Answer 11

Granulomatous reaction to retained meibomian secretions.

Question 12

treatment for chalazion?

Answer 12

Initial hot bathing and massage to encourage drainage from involved duct.
Oral antibiotics 10/7 if infection present.
If not resolving after 6 months, then incision and curettage (lid everted, internal approach).

Question 13

What is it called when the eye lids turn in and the eyelashes abrade the eyeball?

Answer 13

entropion

Question 14

what are the causes of entropion?

Answer 14

ageing
conjuctival scarring
spasm of orbicularis oculi muscle

Question 15

sx of entropion?

Answer 15

eye watering

foreign body sensation

Question 16

what is an ectropion?

Answer 16

turning out of the eyelid margin

Question 17

causes of ectropion?

Answer 17

ageing
facial nerve palsy
eyelid scarring
bulky eyelid tumours

Question 18

sx of ectropion

Answer 18

watering since normal collection of tears in punctum is impaired.

Question 19

What are the 3 signs of keratoconus?

Answer 19

(1) On downgaze, the cornea pushes the eyelid out in a V pattern (Munson’s sign).
(2) Abnormal non-uniform red reflex – like a “tear drop” in the centre – best viewed following dilation with tropicamide 1%).
(3) Gold standard is computed Corneal Topography, which can detect very early (forme fruste) keratoconus, even before it is symptomatic.

Question 20

What is the treatment of keratoconus?

Answer 20

Glasses for very early disease,
then rigid contact lenses once glasses no longer correct the astigmatism satisfactorily.
Surgery (corneal grafting) is reserved for very severe disease.

Question 21

What is the treatment of herpes simplex virus of the eye?

Answer 21

aciclovir 5xday, for 10 days, recurrences are common

Question 22

What is the difference between preseptal cellulitis and orbital cellulitis?

Answer 22

Careful history and examination - orbital cellulitis suggested by red eye, decreased vision, double vision, pain, fever, chemosis, proptosis, reduced ocular motility, and is usually secondary to concurrent sinusitis.
A preseptal infection leaves the eye unaffected which is white and moves and sees normally if the lid is lifted. The lid MUST be lifted to differentiate, best accomplished with two cotton buds. Treat with systemic antibiotics and careful review.