Lid disorder

Question 1

What are the three clinically relevant eye lid glands ?

Answer 1

• Gland of Moll
• Zeiss Gland
• Meibomian Gland

Question 2

What is belpharitis ?

Answer 2

It is lid inflammation secondary to allergic conjunctivitis, cigarette smoking, contact lens use and retinoid use. It can also be infectious and the patients presents with irritated lid and eye. Mild cases can be treated by lid hygiene routine and severe cases needs to be treated with antibiotics or other agents.

Question 3

What is posterior belpharitis ?

Answer 3

Hyperkeritinization of meibomian gland ductal epithelium causes impaired secretory function which favours bacterial growth.

Question 4

What are the etiologies of posterior belpharitis ?

Answer 4

• Inflammatory conditions such as Rosacea, and Seborrheic dermatitis.
• Chronic infections of Coagulase-negative Staph, Corynebacterium sp, Cutibacterium acnes

Question 5

What is bacterial anterior belpharitis ?

Answer 5

Fibrinous scales and crust around eyelashes due to Staphylococcus aureus or Coagulase-negative
staphylococci.

Question 6

What is the causes of parsitic anterior belpharitis ?

Answer 6

Demodex folliculorum

Question 7

What is the presentation of seborrhic anterior belpharitis ?

Answer 7

Dandruff-like skin changes with Greasy scales of eyelids.

Question 8

What are the historical clues of belpharitis ?

Answer 8

• Red, swollen, itchy eyes
• Gritty burning sensation
• Excessive tearing
• Crusting of lashes
• Light sensitivity

Question 9

What are the PE findings on Anterior Bacterial and Demodex belpharitis ?

Answer 9

 Adherent material around lashes
 Collarettes (bacterial) or sleeves (Demodex)

Question 10

What is the PE finding in anterior Seborrhic belpharitis ?

Answer 10

Greasy flakes

Question 11

What are the PE findings in posterior belpharitis ?

Answer 11

 Enlargement of meibomian gland opening
 Meibomian gland plugging

Question 12

Tear breaking time is ___ in belpahritis ?

Answer 12

Increased due to increased evaporative loss.

Question 13

What is the 4 step process of mild to moderate belpharitis ?

Answer 13

• Step 1: Warm compresses - use washcloth that has been soaked in warm water; apply for 5-10 minutes at a time.
• Step 2: Lid massage - use washcloth from compress or fingers.
• Step 3: Lid washing - use water or very dilute baby shampoo
• Step 4: Apply artificial tears

Question 14

What is the Sever or Refractory belpharitis management ?

Answer 14

• Topical antibiotic ointment
• Bacitracin or erythromycin
• Applied to lid margins at bedtime
• Stop treatment once symptoms improve (~ 2 weeks) but continue lid hygiene routine
• Oral antibiotics
• Only after topical therapy has failed to resolve sx
• Doxycycline, tetracycline, or azithromycin
• Demodex
• Topical tea tree oil
• Ivermectin (PO)

Question 15

What is Hordeolum ?

Answer 15

Acute purulent inflammation of eyelid due to bacterial infection. Internal hordeolum affects meibomian gland. External hordeolum affects Zeis gland. It can progress to Chalizion or even to orbital cellulitis. The treatment is topical Abx.

Question 16

What is Chalizion ?

Answer 16

Slow growing, rubbery, painless lesion due to inflammation and obstruction of sebaceous glands of eyelids. Tx requires Lid hygiene and intralesional injection of glucocorticoids.

Question 17

What is Entropion ?

Answer 17

A senile condition that cause inward turning of the lower lid.

Question 18

What is Ectropion

Answer 18

A senile condition that cause outward turning of the lower lid.