Eyelid Disorders

Question 1

What is blepharitis

Answer 1

Inflammatory condition of the eyelid margin

Question 2

Risk factors for blepharitis

Answer 2

Dry eyes, dermatological conditions - rosacae and demodex infestation

Question 3

Cause of blepharitis

Answer 3

Staph blepharitis and meibomian gland dysfunction are most common causes

Question 4

Symptoms of blepharitis

Answer 4

Redness
Burning sensation
Irritation
Tearing
Eyelid crusting and sticking
Visual problems such as photophobia and blurred vision

Question 5

What time of day is blepharitis typically worse

Answer 5

In the morning

Question 6

Signs of blepharitis

Answer 6

Meibomian glands may appear capped with oil
Dilated, visibly obstructed
Erythema, oedema
May exhibit eyelash loss and/or misdirection

Question 7

Management of blepharitis

Answer 7

Warm compresses, eyelid massage, eyelid scrubs, topical Abx, oral Abx, lubricating eye drops, artificial tears, short courses of topical steroids

Question 8

Oral Abx which could be used in blepharitis

Answer 8

Tetracycline and doxycycline

Question 9

When are oral Abx used in patients with blepharitis

Answer 9

Those with meibomian gland dysfunction or patients associated with rosacea

Question 10

Options for lubricating eyedrops in patients with blepharitis

Answer 10

Hypromellose, polyvinyl alcohol, carbomer

Question 11

What can blepharitis lead to

Answer 11

Styes and chalazions

Question 12

When can short courses of topical steroids be used in blepharitis

Answer 12

Beneficial for symptomatic relief in cases with significantly ocular inflammation

Question 13

What is a stye

Answer 13

Tender red lump along the eyelid that may contain pus

Question 14

What is hordeolum externum

Answer 14

Infection of the glands of Zeis or glands of Moll

Question 15

What is hordeolum internum

Answer 15

Infection in the Meibomian glands

Question 16

What are the glands of Moll

Answer 16

Sweat glands at the base of the eyelashes

Question 17

What are the glands of Zeis

Answer 17

Sebaceous glands at the base of the eyelashes

Question 18

Treatment of a stye

Answer 18

Hot compresses and analgesia. Consider topical antibiotics (chloramphenicol) if it associated with conjunctivitis or if persistent

Question 19

What is chalazion

Answer 19

Chronic sterile lipogranuloma in the eyelid that originates from an obstructed meibomian gland of the tarsal plates

Question 20

Risk factors for chalazion

Answer 20

Blepharitis, rosacea, prior chalazion, dermodicosis

Question 21

Symptoms of chalazion

Answer 21

Gradually enlarging eyelid nodule, eyelid discomfort, even painful swelling if secondary infection occurs, history of similar eyelid swelling in the past

Question 22

Signs of chalazion

Answer 22

Nodule on an eyelid, affects upper eyelids more (due to their being more meibomian glands)

Question 23

Investigations into chalazion

Answer 23

Recurrent or atypical chalazia should be sent for pathologic evaluation, microscopy of the materials from a chalazion shows a lipogranulomatous

Question 24

Management if chalazion small and asymptomatic

Answer 24

Left untreated, lid massage, warm compression, Abx steroid eye drops or ointments

Question 25

Management of chalazion is associated with inflammatory conditions

Answer 25

Topical Abx eyedrops

Question 26

When is surgical treatment involved in chalazion

Answer 26

Unresolved or large and symptomatic. Incision and curettage

Question 27

What is entropion

Answer 27

Eyelid turns inwards with the lashes against the eyeball.

Question 28

What is ectropion

Answer 28

Eyelid turns outwards with the inner aspect of the eyelid exposed, usually affects the bottom lid

Question 29

What is the end result of entropion

Answer 29

Results in pain and can result in corneal damagae and ulceration

Question 30

What is the end result of ectropion

Answer 30

Result in exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected

Question 31

Management of entropion

Answer 31

Taping the eyelid down to prevent it turning inwards. Definitive management is with surgical intervention, also using regular eye drops

Question 32

Management of ectropion

Answer 32

mild cases require no treatment, regular lubricating eye drops are used to protect the surface of the eye, more significant require surgery

Question 33

What is trichiasis

Answer 33

Inward growth of eyelashes, this results in pain and can result in corneal damage and ulceration

Question 34

Management of trichiasis

Answer 34

Specialist to remove the eyelash, recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent lash regrowing

Question 35

What is blepharoptosis

Answer 35

Abnormal low lying upper eyelid margin with the eye in primary gaze.

Question 36

Symptoms of blepharoptosis

Answer 36

Usually present with eye being small, tired appearance, limited field of vision and headache

Question 37

Investigations into blepharoptosis

Answer 37

Visual acuity, pupillary reflexes, ocular motility, marginal reflex distance, levator functions, proptosis, enopthalmos, logophthalmos, presence of Bell phenomenon

Question 38

Medical therapy of patients with blepharoptosis

Answer 38

Patients with myasthenia gravis may improve with medical therapy such as sympathomimetic topical eye drops

Question 39

Eg of sympathomimetic topical eye drops

Answer 39

apraclonidine and phenylephrine

Question 40

When is early surgical intervention required

Answer 40

If there is a risk of the patient developing ambylopia or significant abnormal head position to develop

Question 41

What is the main treatment for ptosis

Answer 41

Surgical - levator resection (good levator function) or frontalis suspension (poor levator function). Mullerectomy in mild ptosis

Question 42

Causes of acquired ptosis

Answer 42

Aponeurotic or involutional ptosis may result from stretching, disinsertion of the levator aponeurosis. Myogenic ptosis, neurogenic ptosis, mechanical ptosis.

Question 43

Myogenic causes of ptosis

Answer 43

Myasthenia gravis

Question 44

Neurogenic causes of ptosis

Answer 44

3rd nerve palsy or Horner's syndrome

Question 45

Mechanical causes of ptosis

Answer 45

Result from presence of eyelid mass, such as neurofibroma or haemangioma