Lesions of the eye lids

Question 1

List the non-malignant lesions of the eyelid

Answer 1

• Chalazion (meibomian cyst)
• Cyst of Zeis (obstructed sebaceous
  gland)
• Cyst of Moll (apocrine hidrocystoma)
• Sebaceous (Pilar) cyst
• Comedones (blackheads)
• Dermoid cyst
• Milia
• Epidermal inclusion cyst
• Eccrine hidrocystoma
• Xanthelasma
• Syringoma
• Congenital melanocytic naevus
• Acquired melanocytic naevus
• Capillary haemangioma
• Squamous cell papilloma
• Basal cell papilloma

Question 2

List the malignant lid lesions

Answer 2

Basal cell carcinoma
Squamous cell carcinoma
Keratoacanthoma
Sebaceous gland carcinoma
Melanoma
Kaposi sarcoma

Question 3

What is a chalazion and what are the risk factors

Answer 3

Granulomatous inflammatory lesion of the meibomian gland common in adults (30-50). It is PAINLESS

Risk factors
•Blepharitis
•Eyelid trauma
•Poor lid hygiene
•Sebborrheic dermatitis
•Rosacea
•High blood lipid concentration
•Bortezomib: proteasome inhibitor (multiple myeloma)

Question 4

How do you manage chalazion?

Answer 4

•Conservative: At least a third
resolve spontaneously
•Hot compress
•Steroid injection: Lesions close
to the lacrimal punctum
•Incision and curettage
•Recurrence: Send for pathologic
examination

Question 5

What is a stye and what are the risk factors?

Answer 5

Inflammation of eye lash follicle and its associated gland of Zeis. Staphylococcus aureus is the commonest cause.

Risk factors
•Chronic blepharitis
•Meibomian gland dysfunction
•Rosacea

Question 6

How would you treat a stye?

Answer 6

Treatment
•Antibiotics (topical / oral)
•Hot compress
•Epilation of associated lash
•Incision and drainage

Question 7

List the aetiology for Trichiasis

Answer 7

• Chronic blepharitis
• Steven Johnson syndrome
• Trachoma
• Vernal keratoconjunctivitis
• Trauma (mechanical or chemical)
• Surgery (incision and curettage of chalazion)

Question 8

What are the treatment options for trichiasis?

Answer 8

•Artificial tears
•Epilation
•Electrolysis / electrocautery
•Cryotherapy
•Laser ablation

Question 9

What is entropion and what is the classification?

Answer 9

This is the abnormal outward eversion of the lid.

Classification
- Involutional
- Cicatrical
- Mechanical
- Paralytic

Question 10

What are the clinical features of ectropion

Answer 10

•Epiphora
•Red eye
•Keratinization of the palpebral
conjunctival
•Ocular surface disease

Question 11

How will you manage a patient with ectropion

Answer 11

Treatment
Medical
a. Artificial tears / lubricants
b. Taping
Surgery

Question 12

What is an entropion and how would you classify it?

Answer 12

This is the Abnormal inversion or inward turning of the lid margin

Classification
1. Involutional (age-related): affects mainly lower lid

2. Cicatricial: scarring of the palpebral conjunctiva can rotate the upper / lower lid margin towards the globe
3. Congenital: developmental anomalies, usually lower lid
4. Acute spastic: ocular irritation (infectious, inflammatory, traumatic)

Question 13

What are the clinical features of entropion and how would you manage the condition?

Answer 13

Clinical presentation
•Epiphora
•Red eye
•Ocular surface disease

Treatment
Medical
a. Artificial tears / lubricants
b. Botulinium toxin (spastic entropion)
Surgery