The Eyelid Flashcards
What is a stye?
Medical term is Hordeolum externum. This is simply a small abscess or infection from staphylococcal organisms usually in the lash follicle but can also be sweat gland or sebum glands. These point outwards and can involve large amounts of inflammation.
How should styes be treated?
Treat by applying warm compress for 5-10minutes several times a day until it resolves. Usually they only a last a couple of days
What are meibomian cysts?
This is a Hordeolum internum, an abscess of the meibomian glands. These points inwards onto the conjunctiva. There is less inflammation involved but can leave a residual swelling called a chalazion. Vision can rarely be affected if corneal flattening occurs.
How are meibomian cysts managed?
Treat residual swelling with incision and curettage under local anaesthetic. These last substantially longer than styes.
What is blepharitis?
Inflammation of the eyelid. More common in people with rosacea.
What causes blepharitis?
Meibomian gland dysfunction as they release oil to maintain a moist environment
Seborrheic dermatitis/Staphylococcal infection
What are the clinical features of blepharitis?
Bilateral erythematous and sometimes oedematous
Eyes have a burning, grittiness and itching red margin
Sticky eyes in the morning
Styes and chalazions are more common
Secondary conjunctivitis may occur
How is blepharitis managed?
Management
Softening of the lid margin with a hot compress twice a day
Treat with good eyelid hygiene. Use cotton wool bud and baby shampoo 1:10 diluted with warm water and clean along the lid twice a day.
In children with blepharokeratitis use erythromycin too.
What is entropion?
Interning of the eye lid, typically due to degeneration of the lower lid fascial attachments and their muscles. Rare in those under 40s. The interned eyelid irritates the cornea.
How can entropion be managed whilst awaiting surgery?
Taping the lower eyelids to the cheek or botulinum toxin injections can give temporary relief whilst waiting for surgery.
What is ectropion?
Lower lid eversions also cause eye irritation, watering and exposure keratitis. Usually in older patients, with fascial palsies.
How is ectopion managed?
Plastic surgery may correct the deformity, if facial palsy is the cause then surgical correction.
What is a pinguecula and how is it treated?
Degenerative vascular yellow-grey nodules appear on the conjunctiva, usually the nasal side. Typically, males with dark skin and a lot of sun exposure. Diagnosed using a slit lamp. If inflamed (pingueculitis) then give steroids. If it invades the cornea then this is called a pterygium and surgery involving allografting is required.
What is a blepharospasm?
Involuntary contraction of orbicularis oculi. Usually occurs in response to ocular pain but when it occurs inappropriately it is called a focal dystonia. It is more common in females and preceded by exaggerated blinking. Starts unilateral and becomes bilateral. Unknown cause, although sometimes related to comorbidities such as parkinson’s.
How is blepharospasm treated?
Botulinum neurotoxin as a palliation technique. Small regular injections into the orbicularis oculi. Other options include anticholinergics, dopamine agonists.
