Lids Flashcards
Xanthelasma
soft, yellowish plaques,
variable sizes,
often bilateral, upper and lower eyelid,
lipid and cholesterol deposits,
Squamous Cell Papilloma
Also known as viral wart
* Common in adults
* Sessile or pedunculated
* Histopathology: excessive convoluted
epithelium with central fibrovascular core
Basal Cell Papilloma
Seborrheic keratosis
* Very common (90% > 60 yrs)
* Smooth, waxy or warty surface
* Slow growing, not painful or tender
* Flat or raised plaque
* Skin coloured, yellow, grey, light brown,
dark brown or mixed colours
* Cosmetic removal
Dermatitis Papulosa Nigra (DPN)
- Multiple small diameter black or
dark brown papules - face and
neck - Dark skin colour
- Incidence and number increase
with age - Papules are identical to small
seborrheic keratoses
Skin Tags
- Very (most) common
- Small, soft, skin coloured growth
- Variable size, shape, colour and number
- Cause unclear - clusters of collagen and
blood vessels surrounded by skin - Harmless
Skin tags
SIO2001 Kate Doorduyn
Capillary Haemangioma
- Strawberry naevus: evident in
neonatal period - Grows in first year then usually
regresses by 5yrs - May be cutaneous, orbital or
mixed - Systemic associations
Vascular Malformation
- Port-wine stain
- Present at birth - may become
more prominent with time - Sturge-Weber syndrome (5%)
- 30% glaucoma
Retention Cysts
- Small, round, non-tender cysts
- Cyst of Zeis
- White cheesy (sebaceous)
material - Sebaceous cyst
- Similar to a cyst of Zeis
- Cyst of Moll
- Clear, fluid filled
- Cosmetic excision
Milia
- Tiny superficial white/yellow dome-
shaped cysts - Usually multiple - nose, chin & cheeks
- Any age - common in new born babies
(40%) - Trapped keratin
Naevi
- Congenital or acquired
- Pigmented or non-pigmented
- Flat or slightly raised
- +/- hairs, warty surface
- Malignant transformation is rare
Actinic Solar Keratosis
- Flat scaly lesions, rough skin
- Red, pink, brown or skin coloured
- Older age, h/o sun exposure
- May give rise to squamous cell
carcinoma - Occasionally papillomatous or
cutaneous horn
Actinic Keratosis
SIO2001 Kate Doorduyn
Cutaneous Horn
- Keratin projection
- Arise from benign, premalignant and
malignant lesions - 10% associated with squamous cell
carcinoma - Base is the point of interest
Keratacanthoma
- Rapidly enlarges (months)
- Regresses or evolves into squamous cell
carcinoma - Volcano shaped with keratin plug
- Visually, often difficult to distinguish
from BBC or SCC - Histopathology - arises from hair follicle
skin cells
Basal Cell Carcinoma (BCC)
- Most common periocular malignancy
- Slow growing, painless, often ulcerated
- Do not metastasise but invade locally
- Change in lid contour/lash redirection
Types - Nodular
- Ulcerative
- Sclerosing
Squamous Cell Carcinoma (SCC)
- May evoke inflammatory response
- Symptomatic - patient concern about lesion,
may irritate or itch, may bleed - Can look similar to BCC but more aggressive
- More likely to metastasise than BCC
Malignant Melanoma
- Very rare (of the eyelid)
- Can arise de novo or as a malignant
transformation of a naevus - Signs include itching, bleeding,
pigmentary changes, increase in size - 50% are non-pigmented
Ectropian
Outward rotation (eversion) of the
eyelid margin (usually lower)
* Occurs in ~4% of >50 yr olds
* 70% bilateral
Aetiology (causes)
* Age-related (involutional)
* most common cause
* Horizontal lid laxity
* Weakness of the orbicularis oculi and/or
canthal tendons
* Cicatricial: scarring +/- contracture of skin
and underlying tissue
* Paralytic (VII nerve palsy)
* Mechanical/Inflammatory
* Congenital
Entropian
Inward turning (inversion) of the tarsus
and lid margin
* Causes lashes to come into contact
with the ocular surface
* Affects ~2% of the elderly population
- Age-related (involutional)
- Commonest cause
- Degenerative changes result in horizontal
lid laxity - Cicatricial
- Scar tissue pulls the lid inwards
- Burns, surgery, rheumatoid arthritis
- Muscle Spasm
- Congenital (rare)
Ptosis
- Greek word ‘to fall’
- Drooping or abnormally low
position of the upper lid - Associated reduction in the
palpebral fissure height
Lid Retraction
- Suspected when eyelid margin is
above or level with the superior
limbus
Aetiology - TED – thyroid eye disease
- auto immune condition where
the eyes appear to bulge - Neurogenic
- e.g. Marcus Gunn Jaw Winking
- Mechanical
- e.g. surgical overcorrection of
a ptosis - Congenital
- e.g. Duane’s syndrome * Risk of exposure keratitis
Lagopthalmos
Inadequate eyelid closure
* Tear film disturbance
* Corneal desiccation
Symptoms
* Grittiness
* Burning
* Increased lacrimation
Associations
* CN VII (facial nerve) palsy
* Proptosis e.g. TED
* Night time (while sleeping)
incomplete eyelid closure
Lagophthalmos
Treatment of lagophthalmos
* Ocular lubricants
* Eyelid taping (esp. nocturnal)
* Surgery - depending on cause
Floppy Eyelid Syndrome
- Generalised laxity of eyelid tissues
- Can be unilateral or bilateral
- Lids spontaneous evert during sleep
- Symptoms - non-specific ocular irritation, redness
- Signs - SPK, easy distraction of lid from globe, easy upper lid eversion,
lower lid ectropion, ptosis, chronic papillary conjunctivitis, whitish
mucous discharge - Treatment - lubricants, eye shield for sleep, wedge excision, canthal
tendon repair - Associated with sleep apnoea (life threatening)
Facial Nerve Palsy (Bell’s palsy)
Partial or complete paralysis of the facial nerve (VII
cranial nerve)
* Facial nerve: Sensory, motor and
parasympathetic functions
* Bell’s palsy – idiopathic lower motor neurone
facial nerve dysfunction
Aetiology:
* Idiopathic
* Latent virus infection (HSV, herpes zoster)
* Others (infection, trauma, tumour)
Risk Factors:
* Pregnancy
* Diabetes
* HIV
Blepharospasm
Involuntary tonic, spasmodic, bilateral eyelid closure
* F>M
* More common in older individuals (60+ yrs)
* Causes - idiopathic, Parkinson’s disease, psychogenic drugs e.g.
psychotropics
* Treatment - botulinum toxin injections into orbicularis oculi
Obicularis Myokymia
*Involuntary contraction producing an annoying twitching
sensation
*Very common presentation in optometric practice
*Related to fatigue, stress and caffeine
*Rarely other associations:
* Hemifacial spasm
* Multiple sclerosis
*Treatment: rest and relaxation, warm compress and lid massage
Trichiasis
- Inward misdirection of eyelashes towards
the cornea
Aetiology - Chronic blepharitis = scarred lids
- Scar tissue from trauma, HZO
- CF: Distichiasis & Epiblepharon
Signs & Symptoms - Ocular discomfort, irritation and foreign
body sensation - Watering & red eye
- Corneal erosion
- Corneal ulcer/infective keratitis
Madorosis
Poliosis
Loss of lashes
Whitening of lashes
Blepharitis
- Inflammation of eyelid margins
- Extremely common
- Chronic/relapsing
- Typically bilateral
Predisposing/Risk factors - Seborrheic dermatitis (dandruff)
- Ocular rosacea
- Long term contact lens wear
- Topical eye medication (glaucoma)
- Demodex
Anterior Blepharitis
- Bacterial (Staphylococcal)
- Crusting/collarettes/scales
at base of lashes - Telangiectasia (dilated
blood vessels) - Lash misdirection/loss
- Seborrheic (gland of Zeis):
- Greasy deposits at base of lashes
- Demodex:
- Cylindrical deposits extending up lashes
- lash misdirection/loss, general redness
- itching
Posterior Blepharitis
- Thickened meibomian secretions
- Microliths
- Meibomianitis - passive retention of
secretions (chalazion, styes) - Foam in tear meniscus
- Unstable tear film - evaporative tear
deficiency
Hordeolum
- Acute bacterial infection (Staphylococcal) of an
eyelid gland - 24-48 hours red swelling
- Tender eyelid lump
- May spontaneously express itself with a
purulent material - Often associated with blepharitis
Two types - External hordeolum (stye)
- Lash follicle and associated gland of Zeis or
Moll - base of eyelash - Internal hordeolum
- Meibomian gland - tarsal plate
Treat as per blepharitis
Chalazion
- Common, chronic lid lump
Aetiology - Blockage of Meibomian gland duct
- Inflammatory response - stagnate
secretions and inflammatory cells - Spontaneous or follow hordeolum
- Typically less acute and occurs over a
period of weeks
Symptoms - Usually painless lid lump
- Single or multiple, may be recurrent
