eyelid problems

Question 1

what is blepharitis

Answer 1

associated with dysfunction of the Meibomian gland (which is responsible for secreting oil onto the surface of the eye) *can lead to styes and chalazions

Question 2

symptoms of blepharitis

Answer 2

gritty and itchy dry sensation in eyes

Question 3

management of blepharitis

Answer 3

hot compress
gentle cleaning of the eyelid margins
removal of debris using cotton wool dipped in sterilised water and baby shampoo

Lubricating eye drops can be used to relieve symptoms:

Hypromellose is the least viscous. The effect lasts around10 minutes.
Polyvinyl alcohol is the middle viscous choice. It is worth starting with these.
Carbomer is the most viscous and lasts 30 – 60 minutes.

Question 4

what is a stye

Answer 4

‘hordeolum externum’
infection of the glands of Zeis (sebaceous gland at base of eyelashes) or glands of Moll (sweat glands at base of eyelashes)

‘hordeolum internal’ is infection of the meibomian gland which is deeper, tender and more painful. may point inwards towards the eyeball underneath the eyelid.

Question 5

signs and symptoms of stye

Answer 5

tender red lump along the eyelid, may contain pus

Question 6

management of a stye

Answer 6

hot compress

consider topic antibiotics (chloramphenicol) if associated with conjunctivitis or if a persistent stye

Question 7

what is a chalazion

Answer 7

meibomian gland is blocked and swells up (meiboiam cyst)

swelling in the eyelid that is not tender but can be tender and red

tx: hot compress, analgesia, abx (chloramphenicol if inflammed)

drainage (Rare)

Question 8

what is an entropic?

Answer 8

when the eyelid turns inwards and the lashes are against the eye ball. this results in corneal damage and ulceration

Question 9

entropion management

Answer 9

tape eyelid down to prevent turning inwards

surgical intervention
lubricating eye drops

Question 10

what is an ectropion

Answer 10

eyelid turns outwards
inner aspect of the eye is exposed
usually effects the bottom lid

can result in exposure keratopathy (not llubricated and protected)

mx: regular lubricating eye drops, surgery, same day referral

Question 11

trichiasis

Answer 11

inward growth of the eyelasehs
pain and can cause corneal damage and ulceration

mx: epilation (remove eyelashes)

recurrent cases: electrolysis, cryotherapy, laser treatment (to prevent re-growth)

same day referral

Question 12

pre orbital cellulits

Answer 12

pre/peri
eyelid and skin infection in front of the orbital septum
temperature

swelling, redness, hot skin around the eyelids in the eye

• imoprtant to differentiate from orbital cellulitis (sight and life threatening emergency) (CT)
  tx: systemic abx oral/IV

Question 13

orbital cellulitis

Answer 13

infection arend eyeball which involves tissue behind the orbital septum

pain on eye movement
reduced eye movements
change in vision
abnormal pupil reactions
forward movement of the eye ball

medical emergency
IV abx
surgical drainage if abscess

Question 14

proptosis

Answer 14

proprtosis occurs in grave’s
proptosis is abnormal protrusion / displacement of the eye.

lid retraction, proptosis and ophthalmoplegia can be due to inflammation and infiltration of retro orbital tissues and extra ocular muscles. lid lag= excess thyroxine (tx beta blockers)

Question 15

convergent strabismus

Answer 15

childhood squint
usually due to poor eyesight of the affected eye

unialteral cover test
ask pt to focus on object
over the fixating eye
observe for movement of the other eye
deviation of eye can occur and eye might turn when fixating at distant objects near object or both