Benign eyelid disorders

Question 1

Definition

Answer 1

Umbrella term for conditions of the skin and surrounding subcutaneous tissues of the eyelid.
- Not harmful but can cause significant acute or chronic issues to the individual, including risk of other sight-affecting complications

Question 2

Entropion

Answer 2

Def: Inversion of the eyelid
Epidemiology:
- Advanced age
- Cicratricial (due to scarring): SJS, trachoma, chemical burns or trauma
Signs:
- Inverted eyelide
- Eye irritation
- Excessive tearing
Tx:
- Temporary managed: tape or sutures
- Definitive: surgery

Question 3

Ectropion

Answer 3

Def: Eversion of the eyelid = horizontal lid laxity, exposing underlying conjunctiva
Epidemiology: Age-related degeneration and lid laxity
Signs:
- Everted eyelid
- Exposure of palpeberal conjunctiva
- Excessive tearing
- Conjunctival hyperaemia
Tx:
- conservative management with artificial tears
- definitive surgery

Question 4

Dermatocholasis

Answer 4

Excess and redundant eyelid skin, typically of the upper eyelid
Epidemiology:
- Advanced age
- Thyroid eye disease
Signs:
- Sagging eyelid skin
- Blepharoptosis: drooping upper eyelid
- Impaired visual field
Tx: Upper eyelid blepharoplasty (removal of the excess skin)

Question 5

Chalazion

Answer 5

Def: Meibobomian cyst = lump that forms on the eyelid due to a blockage of the meibomian glands.
Pathophys: Blockages typically occur due to localised inflammation, making blepharitis a key risk factor
Signs: painless (or occasionally painful) lump on eye lid
Treatment:
- Conservative: warm compresses encouraged for spontaneous discharge
- Surgical excision or intralesional corticosteroid injections

Question 6

Hordeolum

Answer 6

Def: Acute inflammation of the sebaceous or apocrine glands of the eyelid, usually secondary to infection.
Types:
- External (stye): usually caused by staphylococcus infection of the lash follicle
- Internal: Infection of the Meibomian glands, which may leave a chalazion behind
Signs:
- Tender lump in eyelid
- Excessive tearing
- Localised redness of the eye or eyelid
- Yellow spot in the centre
Tx:
- Hot compress and analgesia
- Topical antibiotics only indicated if there is associated conjunctivitis

Question 7

Dacryoadenitis

Answer 7

Def: Inflammation of the lacrimal gland (located laterally)
Aet:
- Infection (viral or gonococcal),
- Autoimmune causes (thyroid, eye disease, Sjogren’s syndrome and IgG4-related disease),
- Sarcoidosis
- Lymphoma
Key Clinical features include:
- Painful unilateral swelling in superolateral orbit
- Painful eye movements
- Erythematous eyelid
- Difficulty opening eye
- Excessive tearing
Management:
- Treat underlying cause
- Supportive management for viral infection
- Broad-spectrum Abx for bacterial infection
- Steroids for autoimmune

Question 8

Dacryocystitis

Answer 8

Inflammation of the lacrimal sac (located medially)
Aet: Bactieral infection usually secondary to blockage of the nasolactrimal duct
Epi: More common in neonates
Signs:
- Pain and redness in the inner corner of the eye
- Purulent discharge from the medial part of the eye
- Excessive tearing due to the obstructed drainage
Tx: immeadiate Abx required
Recurrent cases: dacryocystorhinostomy may be required
Complications: Spread to surrounding tissue becoming cellulitis