Pathology of eye lids and adnexa

1. OPTOM FASLU MUHAMMED
PATHOLOGY OF EYE LIDS
AND ADNEXA

2. LESIONS OF EYE LIDS AND ADNEXA ARE OF
FOLLOWING TYPES
 1.Cysts
 2.Inflamation /infections
 3.Metabolic changes and degenaration
 3.Tumorous conditions
 4.Tumours

3. CYSTS
 A cyst is a closed sac-like structure that is not a
normal part of the tissue where it is found
 Cysts are common and can occur anywhere in the
body in people of any age.
 The causes of a cyst
1. wear and tear" or simple obstructions to the flow of
fluid,
2. Infections,
3. Tumors,
4. chronic inflammatory conditions,
5. genetic (inherited) conditions, and
6. defects in developing organs in the embryo

4. CYSTS
 1.Inclusion cysts
 2.retention cysts
 3.develpmental/Dermoid cysts

5. INCLUSION CYSTS
 Inclusion cysts occur in any part of eyelid following
trauma or infection

6. RETENTION CYSTS
 Retention cysts are the result of blockade of ductal
opening of eccrine glands rarely the piloseceous
apparatus may show blockade at epidermal
opening .
 The cysts may contain clear or sebaceous material
based on the type gland involved .the so called
sebaceous cyst.

7. DERMOID CYSTS
 These cysts are encounterd in midline or fusion
lines .Dermoid cysts are frequently seen in infants
or adolescents .

8. INFLAMMATION / INFECTIONS
 1.blebharitis
 2.hordeolum
 3.chalazion
 Other infections/inflammations
 1.Bacterial or myobacterial
 2.Viral infections

9. BLEPHARITIS
 In this type of infection ,inflammation effecting the
eyelids
 Chronic inflammation of the lid margin
 Types: staphylococcal or seborrheic
 Symptoms: foreign-body sensation, burning,
mattering
 May predispose to chalazia, blepharoconjunctivitis,
loss of lashes

10. BLEPHARITIS TREATMENT
 Warm compresses
 Lid scrubs with 50/50 mixture of nonirritating
shampoo (Johnson and Johnson’s baby shampoo)
and water daily
 Antibiotic ointment at bedtime for 2-3 weeks
(Bacitracin or erythromycin)
 Resistant cases can be referred to the
ophthalmologist on a non-urgent basis

11. BLEPHARITIS: NOTE THE CRUSTING IN THE LASHES
AND THE THICKENED LID MARGIN

12. HORDEOLUM
 Hordeolum is a suppurative nonspecific
inflammation of eye lid adnexa
 On the basis of anatomical site of inflammation’ two
forms are recognised
 1. Hordeolum externum
 2. Hordeolum internum

13. HORDEOLUM
 Usually begins as diffuse swelling followed by
localization of a nodule to the lid margin
 Hordeolum – staphylococcal infection of the glands
of Zeis

14. INTERNAL HORDEOLUM EXTERNAL HORDEOLUM (STYE
•Staph. abscess of meibomian
glands
Tender swelling within
tarsal
•May discharge through
skin
or conjunctiva
• Staph. abscess of lash follicle
and
associated gland of Zeis or Moll
•Tender swelling at lid
margin
•May discharge through
skin

16. PATHOPHYSIOLOGY
 There is usually underlying meibomitis with
thickening and stasis of gland secretions
with resultant inspissation of the Zeis or
meibomian gland orifices.
 Stasis of the secretions leads to secondary
infection, usually by Staphylococcus aureus.
Histologically, hordeola represent focal
collections of polymorphonuclear leukocytes
and necrotic debris (ie, an abscess).
 Essentially, a hordeolum represents an
acute focal infectious process, while a
chalazion represents a chronic,
noninfectious granulomatous reaction.
However, chalazia often evolve from internal
hordeola

17. CHALAZION
 Chronic non specific inflammation of sebaceous
gland of lid with or with out granulomatous reaction
is called chalazion
 The zies gland inflammation is termed as external
chalazion
 The meibomian gland inflammation is termed as
internal chalazion

18. THE NODULE ON THE PATIENT’S RIGHT UPPER LID
IS A CHALAZION

19. PATHOPHYSIOLOGY
 A chalazion forms when the meibomian
gland becomes blocked and sebaceous
secretions accumulate. Reaction to the
material results in granulation tissue and
chronic inflammation.
 The large meibomian glands are
embedded in the tarsal plate of the eyelid;
therefore, edema usually is contained on
the conjunctival portion of the lid.
 Occasionally, the chalazion enlarges and
breaks through the tarsal plate to the
external portion of the eyelid. Blockage of
the Zeis glands may cause chalazia to
occur along the lid margin.

20. OTHER INFECTION AND INFLAMMATIONS
 Bacterial infections
 Viral infections

21. MOLL SCUM CONTAGIOSUM
 MC is a multiple nodular or papular lesion with
umbilicated centre .
 The enlargement and distension of of epidermal
cells with viral inclusions

22. VERUCOUS LESIONS
 These are due to papilloma group of viruses
 The lesions are characterized by exophytic
proliferative warty lesions and may be multiple

23. END OF PART ONE
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