Lids, Lashes and Tears Flashcards
What is an ectropion?
The outward rotation of eyelid margin (usually lower), 70% bilateral, can be asymmetric
Name the 5 main causes of Ectropion
Involutional
Cicatricial
Paralytic
Mechanical
Congenital
What is involutional ectropion
Most common cause. Age related, can be caused by muscle weakness or increased lid laxity
What is cicatricial ectropion
Ectropion caused by scarring, which has contracted changing the shape of skin. May be from trauma, burn or surgery.
What is paralytic ectropion
Nerve issue usually after a facial palsy
What is mechanical ectropion
Something obstructing normal position of tissue, due to tumour in or near lid margin. May be caused by inflammation from injury (but this is acute and normally ectropion is chronic)
What is a pre-disposing factor of ectropion?
Age - as lid laxity increases
What are symptoms of ectropion?
Can see Punta pointing abnormally, Sore (pain/ discomfort/ grittiness), red eye, watery, symptoms vary depending on severity
What are the signs of ectropion?
Lower lid not opposed (in contact) with globe; punctual in abnormal position; Exposure keratopathy; Conjunctival hyperaemia; Epiphora
How can you test for ectropion?
Distraction test (if you can move lower lid >6mm away from globe it is called lax, indicated increased lid laxity)
Snap-back test (pull lower lid down, release it, should “snap back”, poor recovery indicated muscle weakness)
How to manage ectropion?
Depends on impact to px quality of life.
Mild cases = Offer reassurance about condition and advice, ocular lubricants, advise avoid rubbing eyes.
Manage exposure keratitis = tape lid closed when sleeping, ocular lubricants.
Moderate to severe cases: Consider for surgery if: recurrent infections, significant corneal involvement, still affects life after above measures.
What is floppy eyelid syndrome?
Spontaneous flipping of lid on side they sleep on, uncommon, symptoms worse in morning (dry, gritty eyes)
Who typically get floppy eyelid syndrome?
Middle aged men, obese, sometimes hx of sleep apnoea
What is Entropion?
Inward rotation of eyelid and lid margin (lashes in contact with ocular surface, cases irritation)
What are the causes of entropion (4)?
Involutional
Cicatricial
Spastic
Congenital
What are the predisposing factors?
Age
Severe cicatrising disease (affecting tarsal conjunctiva)
Entropion - Symptoms
Irritation (especially on blinking)
Foreign body sensation
Red
Watery
Blurred vision
Entropion - Signs
Inward rolling of lid margin
Associated irritation signs
Corneal/conjunctival disturbance (could be both)
Conjunctival hyperaemia
Lid laity (involutional entropion)
Conjunctival scarring (cicatricial entropion)
Absence of lower lid crease (congenital)
Distraction test
Snap-back test
Entropion - management
Taping lid to skin, epilation of lashes, ocular lubricants, therapeutic contact lens. Referral for surgery if persists after above
What is Trichiasis?
Inward misdirection of lashes towards cornea
What are the causes of trichiasis?
Congenital: Failure of epithelial germ cells to differentiate completely to Meibomian glands
Acquired: The result of another condition (entropion, abnormal growth following injury, Stevens-Johnson syndrome, or chronic blepharoconjunctivitis)
What are the predisposing factors of trichiasis?
- Staphylococcal blepharitis
- Cicatricial conditions (scarring conditions)
- HZO
What are the symptoms of trichiasis?
Discomfort, irritation
Foreign body sensation
Watery eye
Red eye
Won’t go away, tends to get worse as lashes grow
What are the signs of trichiasis?
Lash(es) in contact with ocular surface
Conjunctival hyperaemia
Corneal epithelium abrasion
Fluorescein staining of cornea/conjunctiva
Chronic, severe signs:
- Pannus (occurs in chronic conditions where there is constant irritation)
- Corneal ulcer
- Infective keratitis
Trichiasis - Management
Epilation of lashes; manage underlying cause; therapeutic contact lens; ocular lubricants; refer if significant corneal involvement
What is a chalazion?
Inflammatory & sterile lump. (not infectious) blockage of a secretory gland causing a lump or lesion, usually painless
What are the causes of a chalazion?
Spontaneous or Following acute infection - internal hordeolum
What are the risk factors of a chalazion?
Chronic blapharitis
Rosacea
Seborrhoeic dermatitis
Pregnancy
Diabetes mellitus
Chalazion - Symptoms
Painless lump(s)
Can be recurrent, may have had it before - especially if they have an underlying eyelid condition
Sometimes after infection - history may say had painful eye a few weeks ago
Gradual increase in size (over weeks/months)
Blurred vision (if larger can induce astigmatism)
Chalazion - Signs
- Well-defined solid nodule in tarsal plate
- Lid eversion (difficult with this) - may see external conjunctival granuloma
- Induced astigmatism/hyperopia
- May be associated blepharitis
What is a hordeolum?
Acute staphylococcal infection of the glands; usually tender and red
What is an internal hordeolum?
Infection of meibomian gland
What is an external hordeolum?
Infection of glands of Zeiss and moll
What is the predisposing factor of a hordeolum?
Chronic blepharitis
Hordeolum - Symptoms
Tender lump in eyelid
Sometimes painful
Epiphora/sticky discharge
Local redness of eye and lid
Hordeolum - Signs
Tender inflamed swollen area on lid/in tarsal plate
May involve entire eyelid in more severe cases
May point anteriorly through skin or posteriorly through conjunctiva (seen on eversion of lid)
