DEFINITION• It is the inflammation of the lid margin
blepharitis• Inflammation of the lid margin (crusting/redness of lids)• Causes ‘gritty’/foreign body sensation, often concomitant with other ocular surface disease• Associated with recurrent hordeolum (styes) or chalazia• Improvement with warm compresses/lid hygeine, artificial tears, tetracycline
Types1. Anterior a. Squamous b. Ulcerative2. Posterior a. Meibomian seborrhoea b. Meibomianitis
ANTERIOR BLEPHARITIS• It involves the outer parts of the eyelid• It is commonly caused by bacteria
SEBORRHEIC/SQUAMOUS• It is characterized by the deposition of scales• Eyelashes fall• Hyperemic lid margin• Absence of ulcers
STYE• It is a tender, painful red bump located at the base of an eyelash or inside the eyelid• It is due to infection of the oil glands of the eyelid or from an infected hair follicle at the base of an eyelash
- It is an abscess in eyelash follicle. painful -Most cases are self limiting . -Treatment requires the removal of the associated eyelash and application of hot compresses.
Internal hordeolum an abscess in meibomian gland. -Painful. -May respond to topical antibiotics but incision by be necessary.
Chalazion -It is a granuloma within the tarsal plate caused by obstructed meibomian gland. -Painless. -Symptoms are unsightly lid swelling which resolve within six months if the lesion persist we remove it surgically
-Is a viral infection of the skin or the mucous membranes, caused by pox virus. -Can be presented with umbilicated lesion found on the lid margin. -Cause irritation, redness, follicular conjuctivitis(small elevation of lymphoid tissue found on tarsal conjunctiva) -Treatment requires excision of the lid lesion.
Molluscum contagiosum Signs Complications• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis• May be multiple in AIDS patients • Occasionally superficial keratitis
Histology of molluscum contagiosum • Lobules of hyperplastic epithelium • Intracytoplasmic (Henderson-Patterson)• Circumscribed lesion inclusion bodies• Surface covered by normal • Deep within lesion bodies are small and epithelium except in centre eosinophilic • Near surface bodies are larger and basophilic
- Lipid containing bilateral lesions. - Usually associated with hyperlipidemia . - Removed for cosmetic reasons.
Xanthelasma• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid• Usually bilateral and located medially
Eyelids inflammation• Chalazion – Focal inflammation of the eye lids which result from obstruction of the meibomian glands – Chronic lipogranulomatous inflammatory changes – Treatment • Warm compresses • Local antibiotic • Excision
Basal cell carcinoma• Most common malignancy(90%) of the eyelid• Usually located on the lower lid and medial canthus• Pearly nodules which ulcerate and have telangiectasias• Treatment – Surgical excision – Cryotherapy – Radiation therapy
Squamous cell carcinoma• Less common than BCC• May arise de-novo or from pre-existing actinic keratosis• May metastasize
Signs of chalazion (meibomian cyst)Painless, roundish, firm lesion May rupture through conjunctivawithin tarsal plate and cause granuloma
Histology of chalazionMultiple, round spaces previously Epithelioid Multinuccontaining fat with surrounding cells giant celgranulomatous inflammation
Treatment of chalazionInjection of local anaesthetic Insertion of clamp Incision and curettage
Acute hordeola Internal hordeolum External hordeolum (stye) ( acute chalazion )• Staph. abscess of meibomian • Staph. abscess of lash follicle and glands associated gland of Zeis or Moll • Tender swelling at lid margin• Tender swelling within tarsal plate• May discharge through skin • May discharge through skin or conjunctiva
Viral wart (squamous cell papilloma) • Most common benign lid tumour • Raspberry-like surfacePedunculate Sessild e
Histology of viral wartFinger-like projections of Epidermis shows acanthosis (increasedfibrovascular connective tissue thickness) and hyperkeratosis Rete ridges are elongated and bent inw
Keratoses Seborrhoeic Actinic• Common in elderly • Affects elderly, fair-skinned individuals • Discrete, greasy, brown lesion • Most common pre-malignant skin lesion • Friable verrucous surface • Rare on eyelids• Flat ‘stuck-on’ appearance • Flat, scaly, hyperkeratotic lesion
Keratoacanthoma• Uncommon, fast growing nodule • Lesion above surface epithelium • Acquires rolled edges and keratin-filled crater • Central keratin-filled crater• Involutes spontaneously within 1 year• Chronic inflammatory cellular infiltrat of dermis
Naevi • Appearance and classification determined by location within ski • Tend to become more pigmented at puberty Intradermal Junctional Compound• Elevated • Flat, well-circumscribed • Has both intradermal and junctional• May be non-pigmented • Pigmented components• No malignant potential • Low malignant potential
Capillary haemangioma• Rare tumour which presents soon after birth be associated with intraorbita • May extension• Starts as small, red lesion, most frequently on upper lid • Grows quickly during first year • Begins to involute spontaneously• Blanches with pressure and swells on crying during second year
Periocular haemangioma Treatment options • Steroid injection in most cases • Surgical resection in selected cases Occasional systemic associations • High-out heart failure • Kasabach-Merritt syndrom thrombocytopenia, anaemi and reduced coagulant fact • Maffuci syndrome - skin haemangiomas, endrochondromas and bowing of long bones
Histology of capillary haemangiomaLobules of capillaries Fine fibrous septae Lobules under high magnification
Port-wine stain (naevus flammeus) • Rare, congenital subcutaneous lesi • Segmental and usually unilateral • Does not blanch with pressure Associations • Ipsilateral glaucoma in 30% • Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5%
Pyogenic granuloma Cutaneous horn • Usually antedated by surgery or trauma• Uncommon, horn-like lesion protrudi • Fast-growing pinkish, pedunculated or through skin sessile mass • May be associated with underlying ac• Bleeds easily keratosis or squamous cell carcinoma
Eyelid cysts Eccrine sweat gland Cyst of Moll hidrocystoma• Translucent • Similar to cyst of Moll• On anterior lid • Not confined to lid margin margin Cyst of Zeis Sebaceous cyst• Opaque • Cheesy contents• On anterior lid • Frequently at margin inner canthus