Lid Disorders Flashcards
Blepharitis - Definition
Inflammation of the eyelid
Posterior - inflammation of the inner portion of the eyelid
Anterior - inflammation at the base of the eyelid
Blepharitis - Etiology
- allergic conjunctivitis
- cigarette smoking
- contact lens
- retinoid use
- may be due to bacterial or fungal infection
Posterior Blepharitis - Epi and Pathophysiology
- Roseacea
- seborrheic dermititis
Chronic Infection
- coagulase-negative staph
- corynebacterium
- cutibacterium acnes
Path: hyperkeritinization of the meibomian gland ductal epithelium which alters secretions and makes a bacteria-friendly environment
Anterior Blepharitis - Epi and Path
- inflammation at the base of the eyelashes
- Three types:
- bacterial - scales and crusts (S. aureus and coag-negative staph)
- parasitic - demodex mite
- seborrheic - scales
Blepharitis - Symptoms
- Red, swollen, itchy eyes
- gritty burning sensation
- excessive tearing
- crusting of lashes
- light sensitivity
Blepharitis - Signs
- Anterior Bacterial - adherent material around lashes and colarettes
- Anterior Mite - adherent material around lashes and sleeves
- Anterior Seborrheic - greasy flakes
- Posterior - enlargement of meibomian gland opening and plugging
- All Forms - conjunctival injection and tear break-up time increased (which increases evaporative loss) - more likely in posterior
Blepharitis - Treatment
Mild to Moderate: Lid Hygiene Regimen
- warm compress
- lid massage
- lid washing
- artificial tears
Moderate to Severe:
- topical abx, bacitracin ointment, erythromycin ointment
- demodex - tea tree oil ophthalmic solution
- ivermectin PO (anti-parasite)
Blepharitis - Patient Education
- Lid hygiene routine
- limit triggers (smoking)
- dispose of old cosmetics and applicators
Chalazion - Definition
Inflammation and obstruction of the sebaceous glands of the eyelids
Chalazion - Signs and Symptoms
- eyelid swelling and erythema followed by
- a slow growing, rubbery, painless lesion
- visible on inversion of lid
Chalazion - Treatment
- time
- lid hygiene routine may work
- may need intralesional steriod injections to shrink lesion
Hordeolum - Definition
- acute purulent inflammation of the eyelid
Hordoleum - Epi and Path
Epi - usually Staph bacteria
Internal - meibomian gland
External - “stye” - eyelash follicle or Zeis gland
May develop into chalazion
May become cellulitis
Hordoleum - Signs and Symptoms
- painful (Hordoleum HURTS)
- warm
- swollen lump on eyelid (usually near margin)
- red
Entropion - Epi
- more common in elderly
- can be caused by spasms of the orbicularis oculi muscle
Entropion - Definition
- inward turning of the lower lidthat causes lashes to rub on the cornea causing irritation and scarring
Entropion - Clinical Presentation
- injection
- corneal abrasion/ulceration
- erythma of lower lid
- tearing
- Increased sensitivity
Entropion - Rx
- botox as a bridge to surgery
- surgical repair
Ectropion - Definition
- outward turning of the lower lid that can lead to ocular dryness
Ectropion - Epi
- common in the elderly
- due to weakness of canthal ligaments and orbicularis oculi muscle
Ectropion - Signs and Symptoms
- irritated red eye
- tearing
- constantly wiping eyes
Xanthelasma - Definition
- cholesterol-filled, soft, yellow plaques on the medial aspects of the eyelids
Xanthelasma - Epi
- 1/2 of patients have hypercholesterolemia
- 3/4 older patients with familial hypercholesterolemia
- middle-aged and older adults
Xanthelasma - Treatment
- cosmetic - they are harmless
- check lipid panel in all patients with these lesions
Basal Cell Carcinoma - Definition
- malignant tumor of the eyelid
Basal Cell Carcinoma - Epi
- most common malignancy of the eyelid
- fair skinned people
- hx of sun exposure
Basal Cell Carcinoma - Clinical Presentation
- small
- slow-growing
- firm
- painless
- pearly color
- indurated
- telangiectasia (maybe)
Basal Cell Carcinoma - Rx
- surgical excision
- Moh’s chemosurgery or excision with frozen section
Squamous Cell Carcinoma - Definition
- Less common malignancy of the lid, but faster growing than basal cell
Squamous Cell Carcinoma - Path
- Can be new lesion
- can be transformation of actinic keratosis
Squamous Cell Carcinoma - Presentation
- lower lid margin nodule or plaque
- everted edges
- crusting
Squamous Cell Carcinoma - Rx
- confirm with biopsy
- surgical excision is effective
- radiation can be used as an alternative
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Melanoma - Epi
- 1% of all eyelid malignancies
- 2/3 of tumor-related deaths
- excessive sun exposure
- genetic factors
- caucasian race
- changing skin nevi
Melanoma - Clinical Presentation
- irregular borders
- discoloration (usually dark)
- several varieties - nodular most common
Melanoma - Rx
- wide surgical excision
- regional lymph node dissection if extension is suspected
Hordoleum - RX
Lid Hygiene
Ectropion - Rx
Artificial tears and surgical repair
