eyelid inflammation & tumors
TRANSCRIPT
EYELID INFLAMMATION & TUMORS
July 7, 2012
LID INFLAMMATION
• Blepharitis
DEFINITION
• It is the inflammation of the lid margin
blepharitis
• Inflammation of the lid margin (crusting/redness of lids)
• Causes ‘gritty’/foreign body sensation, often concomitant with other ocular surface disease
• Associated with recurrent hordeolum (styes) or chalazia
• Improvement with warm compresses/lid hygeine, artificial tears, tetracycline
Types
1. Anterior a. Squamous b. Ulcerative
2. Posterior a. Meibomian seborrhoea b. Meibomianitis
ANTERIOR BLEPHARITIS
• It involves the outer parts of the eyelid• It is commonly caused by bacteria
SEBORRHEIC/SQUAMOUS
• It is characterized by the deposition of scales• Eyelashes fall• Hyperemic lid margin• Absence of ulcers
Squamous Blepharitis
Symptoms
• Burning, deposits / crusting along lid margins, grittiness , redness of lid margins, photophobia
• Symptoms are worse in the morning
ULCERATIVE
• It is characterized by the presence of infective materials such as yellow crusts or scales
• There is matting of the lashes• Presence of ulcers
Symptoms
• Redness of lid margins, burning, itching, watering and photophobia
• Signs: – Small ulcers at lid margins on removal of
discharge, this features differentiate it from conjunctivitis
Ulcerative Blepharitis
14- Ulcerative blepharitis
15- Ulcerative blepharitis
POSTERIOR BLEPHARITIS
• It involves the inner parts of the eyelids• It is due to problems in the oil glands
LID LUMPS
STYE
• It is a tender, painful red bump located at the base of an eyelash or inside the eyelid
• It is due to infection of the oil glands of the eyelid or from an infected hair follicle at the base of an eyelash
- It is an abscess in eyelash follicle.
painful -Most cases are
self limiting .
-Treatment requires the removal of the associated eyelash and application of hot compresses.
Internal hordeolum
an abscess in meibomian gland.
-Painful.
-May respond to topical antibiotics but incision by be necessary.
Hordeolum Internum
Chalazion -It is a granuloma
within the tarsal plate caused by obstructed meibomian gland.
-Painless.
-Symptoms are unsightly lid swelling which resolve within six months if the lesion persist we remove it surgically
Chalazion
-Is a viral infection of the skin or the mucous membranes, caused by pox virus.
-Can be presented with umbilicated lesion found on the lid margin.
-Cause irritation, redness, follicular conjuctivitis(small elevation of lymphoid tissue found on tarsal conjunctiva)
-Treatment requires excision of the lid lesion.
Molluscum contagiosum
• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis• May be multiple in AIDS patients • Occasionally superficial keratitis
Signs Complications
Histology of molluscum contagiosum
• Lobules of hyperplastic epithelium
• Circumscribed lesion• Surface covered by normal epithelium except in centre
• Intracytoplasmic (Henderson-Patterson) inclusion bodies• Deep within lesion bodies are small and eosinophilic• Near surface bodies are larger and basophilic
- Lipid containing bilateral lesions.
- Usually associated with hyperlipidemia .
- Removed for cosmetic reasons.
Xanthelasma
• Usually bilateral and located medially
• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid
Adenoma of Meibomian Gland
• Blepharitis– Anterior– Posterior– Staphylococcal– Seborrhoeic– Meibomianitis
• Treatment– Lid hygiene– Tears– Antibiotics– Warm compresses
Eyelids inflammation
• Allergy– Acute allergic
blepharoconjuctivitis– Allergic
dermatoblepharitis
Eyelids inflammation
• Chalazion– Focal inflammation of the eye
lids which result from obstruction of the meibomian glands
– Chronic lipogranulomatous inflammatory changes
– Treatment• Warm compresses• Local antibiotic• Excision
Eyelids inflammation
EYELID CYST
CYST OF MOLL
CYST OF ZEIS
SEBACEOUS CYST
HIDROCYSTOMA
BENIGN TUMORS
VIRAL WART
ACTINIC KERATOSIS
NAEVI
KERATOACANTHOMA
PYOGENIC GRANULOMA
HEMANGIOMA
• Basal cell carcinoma• Squamous cell carcinoma• Meibomian gland carcinoma• Melanoma• Kaposi sarcoma• Merkel cell carcinoma
Malignant eyelid tumors
Basal cell carcinoma• Most common malignancy(90%)
of the eyelid• Usually located on the lower lid
and medial canthus• Pearly nodules which ulcerate
and have telangiectasias• Treatment
– Surgical excision– Cryotherapy– Radiation therapy
Squamous cell carcinoma
• Less common than BCC• May arise de-novo or
from pre-existing actinic keratosis
• May metastasize
BENIGN EYELID LESIONS1. Nodules
• Chalazion • Acute hordeola
2. Cysts
•
• Cyst of Moll• Cyst of Zeiss• Sebaceous cyst• Hidrocystoma
3. Tumours
Xanthelasma
• Viral wart• Keratoacanthoma• Naevi• Capillary haemangioma• Port-wine stain• Pyogenic granuloma• Cutaneous horn
Molluscum contagiosum•
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 and curettage
Acute hordeola
• Staph. abscess of meibomian glands• Tender swelling within tarsal plate• May discharge through skin or conjunctiva
• Staph. abscess of lash follicle and associated gland of Zeis or Moll
• Tender swelling at lid margin
• May discharge through skin
Internal hordeolum ( acute chalazion )
External hordeolum (stye)
Viral wart (squamous cell papilloma)• Most common benign lid tumour• Raspberry-like surface
Pedunculated
Sessile
Histology of viral wart
Finger-like projections of fibrovascular connective tissue
Epidermis shows acanthosis (increased thickness) and hyperkeratosis
Rete ridges are elongated and bent inwards
Seborrhoeic
• Common in elderly• Discrete, greasy, brown lesion• Friable verrucous surface• Flat ‘stuck-on’ appearance
Actinic
• Most common pre-malignant skin lesion• Rare on eyelids
• Affects elderly, fair-skinned individuals
• Flat, scaly, hyperkeratotic lesion
Keratoses
Keratoacanthoma
• Uncommon, fast growing nodule• Acquires rolled edges and keratin-filled crater• Involutes spontaneously within 1 year
• Lesion above surface epithelium
• Central keratin-filled crater
• Chronic inflammatory cellular infiltration of dermis
Naevi• Appearance and classification determined by location within skin
• Tend to become more pigmented at puberty
• Elevated
Intradermal
• May be non-pigmented
• No malignant potential
• Flat, well-circumscribed
• Low malignant potential
Junctional
• Has both intradermal and junctional components
Compound
• Pigmented
Capillary haemangioma
• Rare tumour which presents soon after birth
• Starts as small, red lesion, most frequently on upper lid
• Blanches with pressure and swells on crying
• Grows quickly during first year
• May be associated with intraorbital extension
• Begins to involute spontaneously during second year
Periocular haemangioma
• Steroid injection in most cases• Surgical resection in selected cases
• High-out heart failure
Treatment options
Occasional systemic associations
• Kasabach-Merritt syndrome - thrombocytopenia, anaemia and reduced coagulant factors
• Maffuci syndrome - skin haemangiomas, endrochondromas and bowing of long bones
Histology of capillary haemangioma
Lobules of capillaries Fine fibrous septae Lobules under high magnification
Port-wine stain (naevus flammeus)
• Rare, congenital subcutaneous lesion
• Segmental and usually unilateral
• Does not blanch with pressure
• Ipsilateral glaucoma in 30%
• Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5%
Associations
Pyogenic granuloma
• Usually antedated by surgery or trauma• Fast-growing pinkish, pedunculated or sessile mass
• Bleeds easily
Cutaneous horn
• Uncommon, horn-like lesion protruding through skin• May be associated with underlying actinic keratosis or squamous cell carcinoma
PATHOLOGY OF THE LACRIMAL APPARATUS
CANALICULITIS
DACRYOCYSTITIS
DACRYOCYSTITIS
DACRYOADENITIS
NASOLACRIMAL DUCT OBSTRUCTION
• Translucent• On anterior lid margin
Cyst of Moll
• Similar to cyst of Moll • Not confined to lid margin
Eyelid cysts
• Opaque• On anterior lid margin
Cyst of Zeis
Eccrine sweat gland hidrocystoma
Sebaceous cyst
• Cheesy contents • Frequently at inner canthus