Eyelid/Eyelashes

Question 1

Hordeolum

Answer 1

Lid Cleaning
Warm compresses 15 mins BID-TID
Maxitorl ung TID x 7 days
If severe, consider Doxycycline 100mg qd or BID
OR Augmentin 500mg BID x 7 days

frequent follow ups are rarely necessary

Question 2

Chalazion

Answer 2

Lid cleaning
Warm compresses
AB/Steroid combination drops or ointment
Doxycycline 100mg qd-bid
Incision and curettage
Intralesional steroid injection if needed
Photoiomodulation

Frequent follow ups are rarely necessary

Question 3

Preseptal Cellulitis

Answer 3

Augmentin 875/125 mg bid

Bactrim 160/800 mg bid

Doxycycline 100mg bid

Every couple of days for reassessment

Question 4

Blepharitis

Answer 4

Lid hygiene

Antibiotic/AB-Steroid combination drop/ointment

Oral Doxycycline 100mg bid

Azithromycin (Z-Pack)

Follow up: 2-4 weeks

Question 5

Contact Dermatitis

Answer 5

Avoid irritating agents
artificial tears
Cool compresses
Steroid ointment/cream

Follow up: 1 week

Question 6

Basal Cell Carcinoma

Answer 6

UV Protection
Biopsy
Surgical excision (Mohs Technique) is the gold standard

Follow up: 6-12 months

“Think BASAcally a rodent chewed ulcer”

Tumor usually in the lower lid or medial cants. Most common malignant eyelid tumor.

Sometimes referred to as “rodent ulcer”

Question 7

Squamous Cell Carcinoma

Answer 7

UV protection
Biopsy
Surgical excision (Mohs Technique)
Chemotherapy
Radiation
Cryotherapy

Follow up: 6 months, sometimes sooner

“Think Squamous = Swollen nodule’
Much higher change of malignancy compared to BCC

Question 8

Myokymia

Answer 8

“Eyelid Twitch”

Avoid precipitating factors such as fatigue, excess caffeine and stress or inadequate sleep.

Follow up is not necessary unless symptoms greatly worsen

Question 9

Blepharospasm

Answer 9

Lid twitch/contractions

Observation
Botox injection into orbicularis muscle
In rare cases, myectomy may be considered.

Frequent follow up is not necessary unless symptoms greatly worsen.

Question 10

Floppy Eyelid Syndrome

Answer 10

See Blepharospasm

Usually caused by sleep apnea machines.

Question 11

Molluscum Contagiosum

Answer 11

Umbilicated, dome-shaped nodule on eyelid or in the periorbital region. Often multiple lesions *DNA virus spread by contact

Observation
Topical chemical removal
Cauterization
Surgical excision

Follow up: Every 2-4 weeks

**If severe, consider testing for HIV

Question 12

Papilloma

Answer 12

Outward growth, usually pedunculate but sometimes sessile

Observation or surgical removal with biopsy

Frequent follow up is not necessary unless noticeable change in shape or size occurs

Question 13

Ectropion

Answer 13

Outward lid turn/ conj injection and keratinization/corneal keratopathy

Topical lubrication
Topical AB or AB/steroid combo
Eyelid surgery

Follow up: Every 1-2 weeks during topical rx.
PRN based on symptoms.

Question 14

Entropion

Answer 14

Inward lid turn; conj injection; corneal keratopathy; possible corneal scarring

Topical lubrication
Topical antibiotic
Botox injection
Eyelid surgery

Follow up: every 1-2 weeks during topical treatment
PRN based on symptoms

Question 15

Ptosis

Answer 15

Upper eyelid droop

Observation
Spectacle eyelid crutch
Eyelid taping
**Upneeq Rx
Eyelid Surgery

Follow up: If benign, frequent follow up is not necessary

Question 16

Trichiasis

Answer 16

Misdirected eyelashes/SPK

Observation
Topical lubrication
Epilation
Radiofrequency

Follow up: PRN based on symptoms

Question 17

Madarosis

Answer 17

Eyelash and/or brow loss

Observation
Address underlying etiology
Hair transplant

Follow up according to underlying etiology and severity

Question 18

Dermatochalasis

Answer 18

Redundant loos lid tissue causing vision reduction and possible irritation

Observation
Refer for blepharoplasty

Follow ups not required.
1-2 weeks following blepharoplasty

Question 19

Ocular Rosacea

Answer 19

Eyelid and facial erythema/Telangiectasia causing dryness, irritation, burning sensation

Eyelid hygiene, intense pulsed light
Doxycycline 50mg qd
Omega-3 supplementation

Follow up: depends on severity
Significant symptoms follow up ever 4-6 months

Question 20

Eyelid Coloboma

Answer 20

Missing eyelid tissue/Keratopathy
Often asymptomatic/Possible irritation

Observation
Topical lubrication
Eyelid reconstruction

Follow up: PRN based on symptoms

Question 21

Poliosis

Answer 21

Whitening of hair (due to decrease in melanin)

Observation
Hair coloring for cosmesis

Follow up: frequent follow ups are not necessary

Question 22

Seborrheic Keratosis

Answer 22

Waxy, scaly lesion. Usually dark with a “stuck on” appearance. Asymptomatic/possible irritation

Benign; looks like a multi-lobed mole

Observation
Biopsy
Excision

Follow up: frequent follow ups are rarely necessary

Question 23

Xanthelasma

Answer 23

Yellowish lipid plaques usually near the upper, inner lid. Asymptomatic but possible irritation.

Evaluate patient for hypercholesterolemia.

Observation
Excision

Follow up: Not usually necessary unless significant increase.

Question 24

Keratocanthoma

Answer 24

Dome shaped lesion, rolled edges, central plug
Asymptomatic but could cause irritation

Observation
Excision
Biopsy
Radiation therapy

Rule out squamous cell carcinoma

Follow Up: if definitive dx is made, follow ups not necessary

**Previously thought to be benign but considered by some to be a form of SCC

Question 25

Demodex

Answer 25

Cylindrical sleeve/collarettes around lash follicle
Often asymptomatic, could cause irritation

Observation
Tea tree oil
Cliradex
Zocular

Follow up: Every 2-3 weeks during treatment
PRN if insignificant signs/symptoms