Eyelid disorders

Question 1

Define blepharitis

Answer 1

• Inflammation of eyelid margins/edges.

Question 2

Describe pathophysiology of blepharitis.

Answer 2

• staph, HSV, VZV infection.
• allergies/ skin reactions

Question 3

How does blepharitis present?

Answer 3

• gritty, itchy, dry eye.
• eyelids may look greasy, and inflamed.
• sticky discharge - stuck together in the morning.
• crusts develop at base of eyelashes.
• erythema.
• bilateral and chronic.

Question 4

How is blepharitis managed?

Answer 4

• hot compression and cleaning.
• massage of meibomian glands to push oily fluid out.
• avoid contact lens during flare up.
• lubricating eye drops - 1st line = Polyvinyl alcohol , 2nd line = hypromellose.
• Abx - doxycycline.

Question 5

Define hordeolum.

Answer 5

aka stye

• Bacterial infection of eyelid – causes a painful bump on inside or outside of eye.
• can be internal or external.
• staph aureus infection

Question 6

Pathophysiology of external hordeolum.

Answer 6

infection of glands of zeis OR glands of Moll.

• Infection in root of eyelash – starts as small red lump and develops into little abscess (yellow pus filled).
  o Glands of Zeis = sebaceous glands at base of eyelashes.
  o Glands of Molls = sweat glands at base of eyelashes.

Question 7

Pathophysiology of internal hordeolum.

Answer 7

• Infection of Meibomian glands.
• Swelling points towards inside of eyeball and is more painful.

Question 8

Risk factors for hordeolum.

Answer 8

itchy eyelid/ rub a lot - ext more likely.
- blepharitis.

Question 9

How does hordeolum present?

Answer 9

• Red, hot lump.
• Pain
• Local inflammation.
• Int style – dull aching in the eyelid and sometimes get sensation of a lump.

Question 10

How are hordeolum’s managed?

Answer 10

• hot compression and analgesia.
• Head/ point usually burst within 3-4 days, can take 1-2 wks to completely resolve.
• ext stye - epilation of eyelash
• int stye = surgical drainage
• Abx (i.e. chloramphenicol) if associated with conjunctivitis or persistent

Question 11

Define chalazion

Answer 11

• Blockage and swelling of meibomian gland.
• aka meibomian cyst.

Question 12

Pathophysiology of a chalazion?

Answer 12

• Meibomian glands – under inner surface of eyelid – make oily fluid called meibum to lubricate eye.
• If gland becomes blocked – meibum cannot escape into tears – causes gland to swell into cyst and leak into eyelid tissue – overtime inflammation causes lump to form in eyelid.
• Lump if firm and solid – called chalazion.

Question 13

Risk factor of chalazion?

Answer 13

• Blepharitis
• Eczema
  o BECAUSE in both cases meibum is thicker – therefore more likely to block gland.

Question 14

How does chalazion present?

Answer 14

• eyelid swelling.
• mild pain and irritation.
• can become infected - red, swollen and painful.
• if too big - press on the eyeball and affect vision.
• most common on the upper eyelid and can have several on eyelid.

Question 15

Mx of a chalazion?

Answer 15

• lasts 2-6 months, if no symp no Tx needed.
• warm compression, hygeine, masage and analgesia.
• Abx if infected (chloramphenicol).
• surgical drainage.

Question 16

Define entropian.

Answer 16

• ## Eyelid (normally lower eyelid) rolls inwards so that eyelashes touch surface of eye (cornea).

Question 17

define trichiasis.

Answer 17

Eyelash turning in against eye

Question 18

Pathophysiology of entropion.

Answer 18

• Weakness of small muscles around eyelid.
• Trachoma (e.g chlamydia trachomatis) – infection that causes scaring and disruption of eyelid – makes it turn in.
• Injury - chemical burns.

Question 19

Risk factors for entropion.

Answer 19

• old age
• ocular irrtation
• past eye surgery,

Question 20

How does entropion present?

Answer 20

• Pain, irritation and watery eye.
• Foreign body sensation.
• If left untreated - Corneal damage and ulceration – blurry vision.

Question 21

Mx of entropion.

Answer 21

• tapping eyelid to cheek.
• botulinum toxin injecion to eyelid muscles.
• lubricating ointment, bandage contact lens, epilation of eyelash,
• same day referral to opthal if risk to sight.
• surgery

Question 22

Define ectropion.

Answer 22

• Eyelid (usually lower) turns outwards.

Question 23

Pathophysiology of ectropion.

Answer 23

• Age related weakness of muscles.
• Scaring +/ - contracture of skin and underlying tissues – trauma, burns, skin tumours, chronic blepharitis.
• Conditions causing weakness of facial nerve and muscles +/ - facial paralysis – e.g bells palsy, parotid tumour, stroke, head and neck malignancy.

Question 24

How does ectropion present?

Answer 24

• Sore, red eye.
• Watery eye – excessive tearing to protect cornea and keep eye lubricated.
• Usually affects one eye BUT AGE RELATED AFFECTS BOTH.
• Inner lining of eye that droops forwards – dry and sore.
• Punctum visible with slit lamp.
• Since eyelid doesn’t close properly – dry and sore cornea and cornea not protected – corneal ulcer and visual disturbances

Question 25

Mx of ectropion.

Answer 25

- avoid rubbing eye - lubricating ointment - tape lower and upper eyelid shut - surgery to tighten skin and muscles around eyelid. same day referral to opthal is=f risk to sight.

Question 26

Complication of ectropion?

Answer 26

- Exposure keratopathy (aka exposure keratitis) – damage to cornea due to dryness caused by incomplete closure of eyelid.

Question 27

Define peri-orbital cellulitis.

Answer 27

- Eyelid and skin infection in front of orbital septum.

Question 28

Risk factors for pre-orbital cellulitis.

Answer 28

- < 10 yrs - trauma - Sinusitis, dacryocystisis, hordeolum.

Question 29

How does peri-orbital cellulitis present?

Answer 29

- Swelling, redness, hot skin around eyelids and eye. - Fever

Question 30

How do you distinguish between peri-orbital and orbital cellulitis? (signs, symp and Ix).

Answer 30

- Signs that suggest pre-orbit, rather than orbital C: o No proptosis, normal eye movements, no chemosis, normal optic nerve function, no impaired vision. - CT orbit gold standard

Question 31

Mx of peri-orbital cellulitis?

Answer 31

- systemic Abx - vulnerable groups - severe cases and children - admission and monitoring due to high risk of progression to orbital cellulitis.

Question 32

Define orbital cellulitis.

Answer 32

- Infection around eyelid involving tissues behind orbital septum.

Question 33

Risk factors for orbital cellulitis.

Answer 33

- Trauma - Sinus disease – ethmoidal sinus infection spreads to eye - Strep/ staph infection – can spread from resp tract. - Dacrocystisis, dental abscess. - peri-orbital cellulits

Question 34

How does orbital cellulitis present?

Answer 34

- Pain on eye movement, reduced eye movements, diplopia. - Changes in vision. - Proptosis. - Fever and malaise. - Chemosis.

Question 35

Diagnosis and Ix for oribital cellulitis.

Answer 35

* Blood tests: FBC, CRP to screen for raised inflammatory markers * Swabs sent for microscopy, culture and sensitivity * CT orbit is the gold standard investigation to distinguish orbital cellulitis from preseptal cellulitis

Question 36

Mx of orbital cellulitis?

Answer 36

MEDICAL EMERGENCY - IV Abx - surgical drainage if abcess forms.