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EYELID INFLAMMATION &        TUMORS       July 7, 2012
LID INFLAMMATION• Blepharitis
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  co...
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•   Absenc...
Squamous Blepharitis
Symptoms• Burning, deposits / crusting along lid margins,  grittiness , redness of lid margins,  photophobia• Symptoms are...
ULCERATIVE• It is characterized by the presence of infective  materials such as yellow crusts or scales• There is matting ...
Symptoms• Redness of lid margins, burning, itching,  watering and photophobia• Signs:  – Small ulcers at lid margins on re...
Ulcerative Blepharitis
14- Ulcerative blepharitis
15- Ulcerative blepharitis
POSTERIOR BLEPHARITIS• It involves the inner parts of the eyelids• It is due to problems in the oil glands
LID LUMPS
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 ...
 - It is an abscess  in eyelash follicle. painful -Most cases are  self limiting .   -Treatment    requires the    rem...
Internal hordeolum   an abscess in    meibomian    gland.   -Painful.   -May respond    to topical    antibiotics but  ...
Hordeolum Internum
Chalazion   -It is a granuloma    within the tarsal    plate caused by    obstructed    meibomian gland.   -Painless.  ...
Chalazion
   -Is a viral infection of    the skin or the mucous    membranes, caused by    pox virus.   -Can be presented with    ...
Molluscum contagiosum            Signs                           Complications• Painless, waxy, umbilicated nodule• Chroni...
Histology of molluscum contagiosum                               • Lobules of hyperplastic epithelium                     ...
   - Lipid    containing    bilateral lesions.   - Usually    associated with    hyperlipidemia .   - Removed for    co...
Xanthelasma• Common in elderly or those with  hypercholesterolaemia• Yellowish, subcutaneous plaques  containing cholester...
Adenoma of Meibomian Gland
Eyelids inflammation• Blepharitis   –   Anterior   –   Posterior   –   Staphylococcal   –   Seborrhoeic   –   Meibomianiti...
Eyelids inflammation• Allergy   – Acute allergic     blepharoconjuctivitis   – Allergic     dermatoblepharitis
Eyelids inflammation• Chalazion   – Focal inflammation of the eye     lids which result from     obstruction of the meibom...
EYELID CYST
CYST OF MOLL
CYST OF ZEIS
SEBACEOUS CYST
HIDROCYSTOMA
BENIGN TUMORS
VIRAL WART
ACTINIC KERATOSIS
NAEVI
KERATOACANTHOMA
PYOGENIC GRANULOMA
HEMANGIOMA
Malignant eyelid tumors•   Basal cell carcinoma•   Squamous cell carcinoma•   Meibomian gland carcinoma•   Melanoma•   Kap...
Basal cell carcinoma•   Most common malignancy(90%)    of the eyelid•   Usually located on the lower lid    and medial can...
Squamous cell carcinoma• Less common than BCC• May arise de-novo or  from pre-existing actinic  keratosis• May metastasize
BENIGN EYELID LESIONS1. Nodules  • Chalazion  • Acute hordeola • Molluscum contagiosum • Xanthelasm   a 2. Cysts  • Cyst o...
Signs of chalazion (meibomian cyst)Painless, roundish, firm lesion   May rupture through conjunctivawithin tarsal plate   ...
Histology of chalazionMultiple, round spaces previously   Epithelioid   Multinuccontaining fat with surrounding     cells ...
Treatment of chalazionInjection of local anaesthetic Insertion of clamp   Incision and curettage
Acute hordeola   Internal hordeolum                 External hordeolum (stye)   ( acute chalazion )• Staph. abscess of mei...
Viral wart (squamous cell papilloma)    • Most common benign lid tumour   • Raspberry-like surfacePedunculate             ...
Histology of viral wartFinger-like projections of        Epidermis shows acanthosis (increasedfibrovascular connective tis...
Keratoses       Seborrhoeic                           Actinic• Common in elderly                • Affects elderly, fair-sk...
Keratoacanthoma• Uncommon, fast growing nodule          • Lesion above surface epithelium • Acquires rolled edges and kera...
Naevi           • Appearance and classification determined by location within ski         • Tend to become more pigmented ...
Capillary haemangioma• Rare tumour which presents soon after birth be associated with intraorbita                         ...
Periocular haemangioma              Treatment options               • Steroid injection in                 most cases     ...
Histology of capillary haemangiomaLobules of capillaries Fine fibrous septae   Lobules under high magnification
Port-wine stain (naevus flammeus)                • Rare, congenital subcutaneous lesi                • Segmental and usual...
Pyogenic granuloma                          Cutaneous horn  • Usually antedated by surgery or trauma•   Uncommon, horn-lik...
PATHOLOGY OF THE LACRIMAL       APPARATUS
CANALICULITIS
DACRYOCYSTITIS
DACRYOCYSTITIS
DACRYOADENITIS
NASOLACRIMAL DUCT OBSTRUCTION
Eyelid cysts                    Eccrine sweat gland  Cyst of Moll      hidrocystoma• Translucent       • Similar to cyst o...
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
Eyelid inflammation & tumors
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Eyelid inflammation & tumors

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Transcript of "Eyelid inflammation & tumors"

  1. 1. EYELID INFLAMMATION & TUMORS July 7, 2012
  2. 2. LID INFLAMMATION• Blepharitis
  3. 3. DEFINITION• It is the inflammation of the lid margin
  4. 4. 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
  5. 5. Types1. Anterior a. Squamous b. Ulcerative2. Posterior a. Meibomian seborrhoea b. Meibomianitis
  6. 6. ANTERIOR BLEPHARITIS• It involves the outer parts of the eyelid• It is commonly caused by bacteria
  7. 7. SEBORRHEIC/SQUAMOUS• It is characterized by the deposition of scales• Eyelashes fall• Hyperemic lid margin• Absence of ulcers
  8. 8. Squamous Blepharitis
  9. 9. Symptoms• Burning, deposits / crusting along lid margins, grittiness , redness of lid margins, photophobia• Symptoms are worse in the morning
  10. 10. ULCERATIVE• It is characterized by the presence of infective materials such as yellow crusts or scales• There is matting of the lashes• Presence of ulcers
  11. 11. Symptoms• Redness of lid margins, burning, itching, watering and photophobia• Signs: – Small ulcers at lid margins on removal of discharge, this features differentiate it from conjunctivitis
  12. 12. Ulcerative Blepharitis
  13. 13. 14- Ulcerative blepharitis
  14. 14. 15- Ulcerative blepharitis
  15. 15. POSTERIOR BLEPHARITIS• It involves the inner parts of the eyelids• It is due to problems in the oil glands
  16. 16. LID LUMPS
  17. 17. 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
  18. 18.  - 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.
  19. 19. Internal hordeolum an abscess in meibomian gland. -Painful. -May respond to topical antibiotics but incision by be necessary.
  20. 20. Hordeolum Internum
  21. 21. 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
  22. 22. Chalazion
  23. 23.  -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.
  24. 24. Molluscum contagiosum Signs Complications• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis• May be multiple in AIDS patients • Occasionally superficial keratitis
  25. 25. 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
  26. 26.  - Lipid containing bilateral lesions. - Usually associated with hyperlipidemia . - Removed for cosmetic reasons.
  27. 27. Xanthelasma• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid• Usually bilateral and located medially
  28. 28. Adenoma of Meibomian Gland
  29. 29. Eyelids inflammation• Blepharitis – Anterior – Posterior – Staphylococcal – Seborrhoeic – Meibomianitis• Treatment – Lid hygiene – Tears – Antibiotics – Warm compresses
  30. 30. Eyelids inflammation• Allergy – Acute allergic blepharoconjuctivitis – Allergic dermatoblepharitis
  31. 31. 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
  32. 32. EYELID CYST
  33. 33. CYST OF MOLL
  34. 34. CYST OF ZEIS
  35. 35. SEBACEOUS CYST
  36. 36. HIDROCYSTOMA
  37. 37. BENIGN TUMORS
  38. 38. VIRAL WART
  39. 39. ACTINIC KERATOSIS
  40. 40. NAEVI
  41. 41. KERATOACANTHOMA
  42. 42. PYOGENIC GRANULOMA
  43. 43. HEMANGIOMA
  44. 44. Malignant eyelid tumors• Basal cell carcinoma• Squamous cell carcinoma• Meibomian gland carcinoma• Melanoma• Kaposi sarcoma• Merkel cell carcinoma
  45. 45. 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
  46. 46. Squamous cell carcinoma• Less common than BCC• May arise de-novo or from pre-existing actinic keratosis• May metastasize
  47. 47. BENIGN EYELID LESIONS1. Nodules • Chalazion • Acute hordeola • Molluscum contagiosum • Xanthelasm a 2. Cysts • Cyst of Moll • Cyst of Zeiss • Sebaceous cyst • Hidrocystoma3. Tumours • Viral • wart • Keratoacanthoma • Capillary haemangioma Naevi • Port-wine stain • Pyogenic granuloma • Cutaneous horn
  48. 48. Signs of chalazion (meibomian cyst)Painless, roundish, firm lesion May rupture through conjunctivawithin tarsal plate and cause granuloma
  49. 49. Histology of chalazionMultiple, round spaces previously Epithelioid Multinuccontaining fat with surrounding cells giant celgranulomatous inflammation
  50. 50. Treatment of chalazionInjection of local anaesthetic Insertion of clamp Incision and curettage
  51. 51. 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
  52. 52. Viral wart (squamous cell papilloma) • Most common benign lid tumour • Raspberry-like surfacePedunculate Sessild e
  53. 53. Histology of viral wartFinger-like projections of Epidermis shows acanthosis (increasedfibrovascular connective tissue thickness) and hyperkeratosis Rete ridges are elongated and bent inw
  54. 54. 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
  55. 55. 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
  56. 56. 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
  57. 57. 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
  58. 58. 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
  59. 59. Histology of capillary haemangiomaLobules of capillaries Fine fibrous septae Lobules under high magnification
  60. 60. 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%
  61. 61. 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
  62. 62. PATHOLOGY OF THE LACRIMAL APPARATUS
  63. 63. CANALICULITIS
  64. 64. DACRYOCYSTITIS
  65. 65. DACRYOCYSTITIS
  66. 66. DACRYOADENITIS
  67. 67. NASOLACRIMAL DUCT OBSTRUCTION
  68. 68. 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
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