Other Eyelid and Lacrimal disorders

Question 1

Common features

Answer 1

There are several inflammatory disorders of the eyelid and lacrimal system that

• present as a ‘red and tender’ eye
• without involving the conjunctiva.

Any suspicious lesion should be referred.

Question 2

Stye

Question 3

Chalazion (meibomian cyst)

Answer 3

May resolve spont. or require incision.

Question 4

Dacryocystitis

Answer 4

Acute dacryocystitis is infection of the lacrimal sac

secondary to obstruction of the nasolacrimal duct at the junction of the lacrimal sac.

The problem may vary from being mild (as in infants) to severe with abscess formation.

Management

Local heat: steam or a hot, moist compress

Analgesics

Systemic antibiotics

• best guided by results of Gram stain and culture
• but initially use dicloxacillin or cephalexin (if sensitive to penicillin)

Measures to establish drainage are required eventually.

Recurrent attacks or symptomatic watering of the eye are indications for surgery such as dacryocystorhinostomy.

Question 5

Dacroadenitis

Answer 5

This is infection of the lacrimal gland

presenting as a tender swelling on upper outer margin of eyelid.

Many causes but usually viral (e.g. mumps).

Treat conservatively with warm compresses.

Antibiotics for a bacterial cause.

Question 6

Eyelashes: ingrowing (trichiasis)

Answer 6

Perform epilation using eyebrow tweezers

• available from chemists

Regular epilation may be necessary.

Severe cases: electrolysis of hair roots.

Question 7

Eyelid ‘twitching’ or ‘jumping’

Answer 7

Could be a nervous condition or a focal dystonia.

Advise that cause is usually stress or fatigue.

Reassure and counsel.

Consider prescribing clonazepam if severe.

Blepharospasm may be treated with:

• botulinum toxin injection into the orbicularis oculi muscle.