DR. NAILA ALIAssistant Professor OPHTHALMOLOGY

Categories.

Congenital Anomalies Inflammations Disorders of position. Trauma Tumours

Inflammations/ Infections Stye Chalazion Lid cellulitis Preseptal orbital cellulitis Blephritis

AnteriorPosterior

Treatment Options for Trichiasis

1. Epilation - but recurrences within few weeks

2. Electrolysis - but frequently repeated treatments required

3. Cryotherapy - for many lashes

4. Laser ablation - for few scattered lashes

5. Surgery - for localized crop resistant to other methods

Stye (Common Boil)

Small abscess, staph infection of the eyelash, gland of Zeis or Moll

Tender, inflammed swelling in lid margin, single or multiple, may involve entire lid margin– preseptal cellulitis

Treat with hot compresses, removal of eyelash or systemic antibiotics in severe cases

Drain if puss points

Chalazion (Tarsal cyst or mebomian cyst)

Chronic inflammatory granuloma of mebomian gland—blockage and accumulation of secretions

One or more glands involved, mainly children and young adults involved

Swelling, heaviness, irritation blurring if large- induced

astigmatism

Chalazion (Tarsal cyst or mebomian cyst)

Small, cystic, hard swelling a little away from the lid margin, fixed to tarsus, non-tender

No signs of inflammation,no lymphadanopathy

Small may resolve, may remain the same, may burst on skin- fistula may infect- internal hordeolum.

treatment Surgery steroid injections Leave alone the small ones.

Signs of chalazion (meibomian cyst)

Painless, roundish, firm lesion within tarsal plate

May rupture through conjunctiva and cause granuloma

Histology of chalazion

Multiple, round spaces previously containing fat with surrounding granulomatous inflammation

Epithelioid Multinucleated cells giant cells

Treatment of chalazion

Injection of local anaesthetic Insertion of clamp Incision & curettage

Acute hordeola

• Staph. abscess of •Meibomian glands• Tender swelling • May discharge through skin or conjunctiva

• Staph. abscess of lash follicle and gland of Zeis or Moll• Tender swelling at lid margin

• May discharge through skin

Internal hordeolum ( acute chalazion )

External hordeolum (stye)

Lid cellulitis Etiology

Multiple styes Insect bites Trauma Clinical features

whole of the lid is involvedtender indurationmay lead to abscess formation/ skin necrosis

TreatmentSystemic antibioticsDrainage

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CHRONIC MARGINAL BLEPHARITIS

1. Anterior• Staphylococcal• Seborrhoeic

• Meibomianitis• Meibomian seborrhoea

2. Posterior

Blephritis

Usually chronic infection of the lid margin

Common external eye disease Causes—not clear but staph infection

and sebhorrea play a part Associated with tear film instability Anterior and posterior variety

Anterior blephritis—staph or ulcerative and Sebhorroeic or squamous

Staph Anterior Blephritis Chronic infection of the bases of the

lashes resulting in tiny intrafollicular abscesses

Secondary dermal and epidermal ulceration and tissue distruction

More common in children but may affect any age group

Females more affected than males Unhygienic conditions and dietary

factors involved

Staph Anterior Blephritis—Cont.

Symptoms:Sourness of lid marginLacrimation, itching and photophobia

Signs:Yellow crusts at the roots of the lidsOn removing the crusts, small ulcers may appearFall of the lashes—either not replaced or abnormal replacement

ComplicationsIf not treat may lead to

Poliosis, madarosis, trichiasis, tylosis

Treatment:General:

Improvement in general healthBalanced dietCorrection of refractive errors

Local:Broad spectrum antibiotic ointment, steroid ointment

Artificial tears. Treat the sequlae.

Staphylococcal blepharitis

• Hyperaemia and telangiectasia of anterior lid margin• Scarring and hypertrophy if longstanding

Scales around base of lashes (collarettes)

• Chronic irritation worse in mornings

Sebhorroeic Ant Blephritis Disorder of the glands of Zeis and

Moll Sebhorreoa may involve scalp,

eyebrows, nasolabial folds, retroauricular area and sternum.

Oily type and dry type (true seborrheoa)

Sebhorroeic Ant Blephritis Symptoms:

less severe, discomfort in the eyes, lacrimation, tear film instability (stinging)

Signs:Shiny, waxy appearance of the anterior lid margin, dandruff like desquamation lid epidermis (yellow, greasy scales)

Treatment:Lid hygiene— artificial tearsScalp treatment with antidandruff lotion

Seborrhoeic blepharitis

• Shiny anterior lid margin • Greasy scales • Lashes stuck together• Hyperaemia of lid margin

Posterior Blephritis

May present as:*Dysfunction of the mebomian glands.*Isolated mebomian seborrhoea and primary mebomenitis.*Combination of ant. Seb. Blephritis and meibominitis

Primary Mebominitis

Diffuse inflammation around glands Associated with acne rosacea (2/3rd) or Seb. Dermatitis (1/3rd)Signs:

*Pouting of gland orifices with dome of secretions—may become solid. (tooth-past like)*Obliteration of ducts—dilatation (thick, round, vascularised, notched Posterior border)*Secondary changes include papillary conjunctivitis, punctate epitheliopathy, and tear film instability (stinging)

Meibomianitis

Meibomian cyst formation Thickened posterior lid margin

Mebomian Seborrheoa

Dilated mebomian glands—easily expressed

Tear film is oily and foamy In severe cases—mebomian foam at

medial canthus.

Meibomian seborrhoea

Oil globules over meibomian gland orifices

Oily and foamy tear film

Treatment:A: Systemic antibiotics

Tetracycline, Doxocycline, Erythromycin

B: Others:Lid hygiene, topical steroids,

artificial tears.C: Local measures:

Warm compresses, mechanical expressions of secretions

Complications

Recurrent styes

Marginal keratitis Tear film instability

trichiasis, madarosis , poliosis

Trauma

Lid margin Lid tissue Loss of lid tissue

Eyelid haematoma

Orbital roof fracture if associated withsubconjunctival haemorrhage without visible posterior limit

Usually innocuous but exclude associated trauma to globe or orbit

Basal skull fracture - bilateral ring haematomas (‘panda eyes’)