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Eyelid Pathologies Flashcards

(65 cards)

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1
Q

Squamous Cell Carcinoma: Aetiology (1)

A

Malignant lesion from sebaceous glands (like meibomian glands, glands of zeis, and glands in caruncle

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2
Q

Squamous Cell Carcinoma: Predisposing Factors (5)

A

Most common between 60-80

Immunosuppressed patients

Female

Fair skin

UV exposer

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3
Q

Squamous Cell Carcinoma: Signs (5)

A

Firm red nodule

Scaly crust but pretty flat

Irregular borders

May occasionally bleed

Increases in size rapidly

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4
Q

Squamous Cell Carcinoma: Symptoms (3)

A

Itchy

Irritable

Can be asymptomatic

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5
Q

Squamous Cell Carcinoma: Differential Diagnosis (1)

A

Basal cell carcinoma

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6
Q

Squamous Cell Carcinoma: Management (2)

A

Recommend sun protection as a prevention

Referral

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7
Q

Squamous Cell Carcinoma: Referral (1)

A

Urgent - emphasis importance to patient to ensure attendance of appointment

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8
Q

Basal Cell Carcinoma: Aetiology (4)

A

Most common malignant lesion in light skin tones

Most common form in adnexa

Rarely metastasises

Slow growing localised lesion

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9
Q

Basal Cell Carcinoma: Predisposing Factors (5)

A

Most common between 60-70

Immunosuppressed patients

Male

Fair skinned

UV exposure

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10
Q

Basal Cell Carcinoma: Signs (4)

A

Lesion with crusted centre

Inwardly rolled borders

Slow growth

May bleed

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11
Q

Basal Cell Carcinoma: Symptoms (3)

A

Itchy

Irritable

Sometimes asymptomatic

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12
Q

Basal Cell Carcinoma: Differential Diagnosis (1)

A

Squamous cell carcinoma

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13
Q

Basal Cell Carcinoma: Management (3)

A

Sun protection as prevention

Take photos to regularly review

Referral

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14
Q

Basal Cell Carcinoma: Referral (2)

A

Routine if confident it is basal cell

If unsure - refer as urgent to be safe

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15
Q

Anterior Blepharitis: Aetiology (1)

A

Chronic inflammation of eyelids

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16
Q

Anterior Blepharitis: Types (3)

A

Staphylococcal

Seborrheic

Demodex

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17
Q

Anterior Blepharitis: Staphylococcal (1)

A

Direct infection or exotoxin response/allergic reaction

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18
Q

Anterior Blepharitis: Seborrheic (1)

A

Disorder of the sebaceous glands of Zeis

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19
Q

Anterior Blepharitis: Demodex (1)

A

Infestation of demodex follicularum mite in lash follicles

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20
Q

Anterior Blepharitis: Predisposing Factors (4)

A

Contact lens wear

Demodex infection

Hygiene

Dermatitis - seborrheic

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21
Q

Anterior Blepharitis: Signs (2)

A

Lid margin becomes hyperaemic

Conjunctival hyperaemia

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22
Q

Anterior Blepharitis: Signs (Staphylococcal) (6)

A

Lid margin thickening/swelling

Crusting of lid margin

Loss of lashes

Lash misalignment

Reoccurring styes

Can involve inferior cornea in severe cases (keratitis/scarring/neovasc)

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23
Q

Anterior Blepharitis: Signs (Seborrheic) (1)

A

Oily/greasy appearance or deposits on lid margins

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24
Q

Anterior Blepharitis: Signs (Demodex) (2)

A

Collarettes on base of lashes

‘Eggs’ or mites

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25
Anterior Blepharitis: Symptoms (3)
Dry eye symptoms Contact lens intolerance (greasy deposits on reusable lenses) Discomfort (itchy/sore/gritty)
26
Anterior Blepharitis: Differential Diagnosis (6)
Posterior Blepharitis Dacryocystitis Cellulitis Medication related dermatitis Allergic eye disease Acute bacterial infection
27
Anterior Blepharitis: Management (3)
Lid hygiene - proprietary wipes best - tea tree based products for demodex treatment Explain it is chronic and likely to come back Switch to daily disposables if risk of secondary infection
28
Anterior Blepharitis: Referral (2)
Not usually required Routine if antibiotics required for persistent staphylococcal infections
29
Anterior Blepharitis: Contact Lens Implications (5)
Risk of secondary infection with staphylococcal blepharitis - Caution with reusable lenses - Do not fit with extended/continuous wear until treated - Consider daily disposable Greasy lens deposits may require more intense cleaning regime
30
Posterior Blepharitis (MGD): Aetiology (5)
Dysfunction disease of meibomian glands Bacteria affecting consistency of meibum secretions May be abnormal in patency, chemical or physical make up Tear film instability Osmolarity changes further disrupting lid margin homeostasis
31
Posterior Blepharitis (MGD): Predisposing Factors (4)
Contact lens wear Ocular rosacea Hygiene - make up debris on lid margin blocking glands Ongoing anterior blepharitis
32
Posterior Blepharitis (MGD): Signs (10)
Hyperaemic lid margin Conjunctival hyperaemia Thickening/swelling of lid margin Thick opaque secretions Poor patency of secretions with digital massage Blocked glands with a cap Notching of lid margins were glands pucker Can involve inferior cornea if severe Evaporative dry eye Meibography may identify blockage
33
Posterior Blepharitis (MGD): Symptoms (3)
Dry eye symptoms Contact lens intolerance (lipid deposits) Discomfort (itchy/sore/gritty)
34
Posterior Blepharitis (MGD): Differential Diagnosis (4)
Anterior blepharitis Meibomian gland carcinoma Preseptal cellulitis Dacryocystitis
35
Posterior Blepharitis (MGD): Management (4)
Lid hygiene - proprietary wipes best Warm compresses - heat bag retains heat better - lid massage following Intense pulsed light therapy - contentious treatment Explain chronic and likely to return
36
Posterior Blepharitis (MGD): Referral (2)
Routine Persistent cases can be referred for oral antibiotics
37
Posterior Blepharitis (MGD): Contact lens implications (2)
Oily deposits require more intense cleaning regime Will cause tear film quality challenges: - reduced wear time - reduced lens comfort - Poor stability/fitting challenges
38
Stye (Hordeolum Externum): Aetiology (1)
Localised bacterial infection of the glands of the cilia (eyelash) glands of Zeis and Moll
39
Stye (Hordeolum Externum): Predisposing Factors (2)
Hygiene Ongoing anterior blepharitis (esp staphylococcal)
40
Stye (Hordeolum Externum): Signs (3)
Small localised red lump (can be superior or inferior) Swollen surrounding lid Hyperaemia of surrounding tissue
41
Stye (Hordeolum Externum): Symptoms (2)
Intense localised discomfort (especially when pressure is applied) Epiphora
42
Stye (Hordeolum Externum): Differential Diagnosis (5)
Squamous cell carcinoma Basal cell carcinoma Preseptal cellulitis Internal hordeolum Dacryocystitis
43
Stye (Hordeolum Externum): Management (3)
Likely to self-resolve - reassure - Return if not Removal of lash may help resolve infected follicle discharge - care of secondary infection/hygiene Warm compresses
44
Stye (Hordeolum Externum): Contact Lens Implications (3)
Risk of secondary infection Reduce wear Avoid extended wear
45
Chalazion (Hordeolum Internum): Aetiology (2)
Infection/blockage of meibomian gland formed of a lipid type cyst (chalazion) Can become infected - hordeolum internum
46
Chalazion (Hordeolum Internum): Signs (3)
Moderate sized lump, centrally under the superior/inferior lid (less than 8mm) Pressure on cornea from lesion can cause astigmatic changes Swollen surrounding lid and hyperaemia of tissue (redness indicates infection)
47
Chalazion: Symptoms (3)
Asymptomatic Cosmetic concerns Blurred vision with induced pressure
48
Hordeolum Internum: Symptoms (2)
Tender Painful
49
Chalazion (Hordeolum Internum): Differential Diagnosis (5)
Preseptal cellulitis Internal hordeolum vs chalazion Dacryocystitis Dacryoadenitis depending on location Meibomian gland carcinoma
50
Chalazion (Hordeolum Internum): Management (1)
Possibly self-resolve with warm compresses and digital massage (over many weeks)
51
Chalazion (Hordeolum Internum): Referral (2)
Routine if causing vision distortion for removal (chalazion) Urgent if infected and needs antibiotics (may be remove when infection resolves)
52
Chalazion (Hordeolum Internum): Contact Lens Implications (4)
Poor lid position may interfere with contact lens stability Poor lid position may cause dry eye symptoms and lens intolerance Temporary astigmatic changes may occur Active infection should alert of secondary infection - proceed carefully with reusable/extended wear
53
Lid Wiper Epitheliopathy: Aetiology (3)
An area of increased abrasion and disruption to the epithelium of the lid wiper Abrasion is seen beyond the physiological 'line of marx' - best seen with lissamine green Hyperosmolarity may also be a factor
54
Lid Wiper Epitheliopathy: Predisposing Factors (7)
Contact lens wear (esp high modulus) Dry eye Advancing age Asian ethnicity (lid tone) Low humidity environment Incomplete blink reflex Eye rubbing
55
Lid Wiper Epitheliopathy: Signs (2)
Hperaemia around lid wiper margin With lissamine green: - enlarged width of line of marx - area of thickness indicates where it's occurring - grade severity by measuring length and width
56
Lid Wiper Epitheliopathy: Symptoms (4)
Asymptomatic Dry eye symptoms Contact lens intolerance General discomfort
57
Lid Wiper Epitheliopathy: Management (3)
Refit to lower modulus Manage other dry eye factors - lid hygiene - MGD - lubricant eye drops Avoid eye rubbing
58
Lid Wiper Epitheliopathy: Contact Lens Implications (3)
Lens product choice - low modulus lenses Check cleaning regime - lens surface deposits Consider hydrogel lenses depending on wear time
59
Xanthelasma: Aetiology (2)
Fatty deposits around external lid folds, especially nasally Likely due to atherosclerotic systemic concerns
60
Xanthelasma: Predisposing Factors (5)
Advancing age Female Atherosclerosis Hyperlipidaemia Diabetes
61
Xanthelasma: Signs (1)
Yellow mass like lesions collecting around palpebral sulci of the inferior and superior especially nasally
62
Xanthelasma: Symptoms (2)
Asymptomatic Cosmetic concerns only
63
Xanthelasma: Differential Diagnosis (1)
These lesions should never bleed, itch and the surface should be smooth and unbroken. If any of these occurs, carcinoma should be considered
64
Xanthelasma: Management (2)
Reassurance Send to the GP for cardiovascular work up
65
Xanthelasma: Contact Lens Implications (1)
None

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