Eye lid disorders
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BLEPHARITIS Blepharitis is a chronic inflammation of the lid margins. Etiology 1. It follows chronic conjunctivitis due to Staphyloccocus in debilitated children usually who are living in poor hygienic conditions. 2. Parasites such as Demodex folliculorum, Phthiriasis palpebrarum, crab louse, head louse also cause blepharitis. A stye is an infection (abcess) of one of the small oil producing glands lining the eyelid, usually caused by the bacteria that are normally found along the eyelids. A stye can occur on either the upper or lower eyelid. There are two types of styes, internal and external hordeola. An internal hordeolum (stye) is a bacterial infection of the meibomian glands inside the eyelids. Internal styes tend to be more severe and occur a little less often than an external hordeolum. An external hordeolum (stye) is a bacterial infection of the Glands of Zeis and/or Glands of Moll inside the eyelids. This type of stye is more superficial and tends to heal more readily. It is a chronic lipogranulomatous inflammatory lesion caused by blockage of meibomian gland orifices and stagnation of sebaceous secretion. Patient with acne rosacea or seborhoeic dermatitis are at increased risk of chalazion formation which may be multiple or recurrent. If it is recurrent, one should think of sebaceous gland carcinoma
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Eye lid disorders
- 3. There are short curved hair, the eyelashes situated on their free edges. The layers of tissue which form the eyelids are: β’ A thin covering of skin. β’ A thin sheet of areolar tissue. β’ Three musclesβthe orbicularis oculi, levator palpebrae superioris and Mullerβs muscle. β’ A thin sheet of dense connective tissue, the tarsal plate, larger in the upper than in the lower eyelid. It supports the other structures. β’ A lining of palpebral conjunctiva. 05/27/19 3αααα ααααα
- 4. β’It is about 2 mm broad and is divided into two parts by the punctum (divided into rounded anterior and sharp posterior borders by the grey line. β’The eyelashes originate anterior to the grey line and ducts of the meibomian glands are located posterior to the grey line. β’Grey line is important in operations where the lid is split as it indicates the position of loose fibrous tissue between the orbicularis muscle and the tarsus. 05/27/19 4αααα ααααα
- 5. Meibomian Glands (Tarsal Glands)Meibomian Glands (Tarsal Glands) These are modified sebaceous glands about β’20 -30 in number embedded in the tarsal plate. β’They are directed vertically and open on the lid margin. Therefore vertical incision is given while incising the chalazion. 05/27/19 5αααα ααααα
- 11. 1. Clinical features SQUAMOUS BLEPHARITIS ULCERATIVE BLEPHARITIS i. Scales White, fine and dry Yellowing, coarse, and sticky ii. Ulceration Absent Present iii. Bleeding Absent Present iv. Loss of eyelashes Few and temporary Permanent and almost all lashes are involved 2. Course 3. Complications Mild Occasional Progressive Usual and serious 05/27/19 11αααα ααααα
- 13. SymptomsSymptoms redness, soreness, lacrimation,photophobia Irritation Burning Itching of the lid margins SignsSigns β’Scales on lid margin(hard or soft/both β’Eye lid margin ulceration and redness 05/27/19 13αααα ααααα
- 14. Depending on the severity of the disease, one or multiple therapeutic treatments are utilized; pharmacologic agents and mechanical treatments are often required. such as lid hygiene warm compress Antibiotics 1. Lid hygiene is essential at least twice daily and Crust removal and lid margin cleaning with the help of cotton buds dipped in the dilute baby shampoo or solution of 3% sodium bicarbonate. 05/27/19 14αααα ααααα
- 15. Applied to the lids for 5β10 minutes to soften the crusts,can increase oil production and melt the oil in the meibomian glands. β’ While warm compresses are universally accepted as a therapeutic management modality, there is no universal recommendation regarding how to apply warm compresses 05/27/19 15αααα ααααα
- 16. Several types of topical antibiotics: drops and ointments, some of the commonly prescribed are: οΌAzithromycin , usually prescribe as one drop at bed time for one week or more. οΌBacitracin ophthalmic ointment: apply to base of eyelids one or more times a day for several days. οΌErythromycin ophthalmic ointment: apply to base of eyelids one or more times a day for several days. οΌCiprofloxacine 0.3% eye drop four times per a day 05/27/19 16αααα ααααα
- 17. β’ ZOXAN D eye drop four times per a day β’ Phenidix eye suspension three times per a day can be prescribed 05/27/19 17αααα ααααα
- 18. β’A stye is an infection (abcess) of one of the small oil producing glands lining the eyelid, usually caused by the bacteria that are normally found along the eyelids. β’A stye can occur on either the upper or lower eyelid. β’There are two types of styes, internal and external hordeola. β’An internal hordeolum (stye) is a bacterial infection of the meibomian glands inside the eyelids. Internal styes tend to be more severe and occur a little less often than an external hordeolum. β’An external hordeolum (stye) is a bacterial infection of the Glands of Zeis and/or Glands of Moll inside the eyelids. This type of stye is more superficial and tends to heal more readily.05/27/19 18αααα ααααα
- 19. β’ A well defined lump or bump on either upper or lower eyelid β’ Localized swelling of the eyelid β’ Mild pain in the eyelid β’ Sensitive to touch β’ Redness of the affected eyelid β’ Crusting of the eyelid margins β’ Burning in the eye β’ Eyelid may appear full or droopy β’ Mucous or watery discharge in the eye β’ Irritation of the eye 05/27/19 19αααα ααααα
- 20. A red, tender, swollen bump on the edge of the eyelid. You may be able to see the infected gland on the eyelid or it may be under the skin. The infection may quickly become quite large and painful. The eyes are teary. 05/27/19 20αααα ααααα
- 21. β’ It is an acute suppurative inflammation of lash follicle and its associated glands of Zeis or Moll. 05/27/19 21αααα ααααα
- 22. 1. Predisposing factors are as below: β’ Age. It is more common in children and young adults (though no age is bar) and in patients with eye strain due to muscle imbalance or refractive errors. β’Habitual rubbing of the eyes or fingering of the lids and nose, chronic blepharitis and diabetes mellitus are usually associated with recurrent styes. β’Metabolic factors, chronic debility, excessive intake of carbohydrates and alcohol also act as predisposing factors. 2. Causative organism commonly involved is staphylococcus aureus. 05/27/19 22αααα ααααα
- 23. Symptoms include acute pain associated with swelling of lid, mild watering and photophobia. Signs are as follows: β’ Stage of cellulitis is characterised by localised, firm, red, tender swelling at the lid margin associated with marked oedema . Usually, there is one stye, but occasionally, these may be multiple. β’Stage of abscess formation is characterised by a visible pus point on the lid margin in relation to the affected cilia. 05/27/19 23αααα ααααα
- 24. β’Hot compresses 2β3 times a day are very useful especially in cellulitis stage. β’Evacuation of the pus should be done by epilating the involved cilia, when the pus point is formed. β’Surgical incision is required rarely for a large abscess. β’Antibiotic eye drops (3β4 times a day) and eye ointment (at bed time) should be applied to control the infection. 05/27/19 24αααα ααααα
- 26. It is a suppurative inflammation of the meibomian gland associated with blockage of the duct. Etiology Predisposing factors are similar to hordeolum externum Causative mechanism. Hordeolum internum may occur as: β’Primary Staphylococcal infection of the meibomian gland or due to β’ Secondary infection in a chalazion (infected chalazion) 05/27/19 26αααα ααααα
- 27. Symptoms include acute pain associated with swelling of the lid, mild watering and photophobia. Thus, the symptoms are similar to hordeolum externum, except that pain is more intense, due to the swelling being embedded deeply in the dense fibrous tissue. SignsSigns A localized, firm, red, tender swelling of the lid associated with marked oedema. On examination, hordeolum internum can be differentiated from hordeolum externum by the fact that in it, the point of maximum tenderness and swelling is away from the lid margin and that pus usually points on the tarsal conjunctiva (seen as yellowish area on everting the lid) and not on the root of cilia. 05/27/19 27αααα ααααα
- 28. β’ It is similar to hordeolum externum, except that, when pus is formed, it should be drained by a vertical incision from the tarsal conjunctiva. 05/27/19 28αααα ααααα
- 29. Meibomian Cyst (Chalazion) β’It is a chronic lipogranulomatous inflammatory lesion caused by blockage of meibomian gland orifices and stagnation of sebaceous secretion. β’Patient with acne rosacea or seborhoeic dermatitis are at increased risk of chalazion formation which may be multiple or recurrent. β’If it is recurrent, one should think of sebaceous gland carcinoma 05/27/19 29αααα ααααα
- 30. 1. It is probably due to chronic irritation caused by an organism of low virulence. The glandular tissue is replaced by granulation tissue containing giant cells predominantly. 2. It is often multiple in number occurring in crops. 3. It is more common in adults than in children. 05/27/19 30αααα ααααα
- 33. Includes non pharmachological Pharmachological Surgical 05/27/19 33αααα ααααα
- 35. Refferences β’ Comprhensive ophthalmology sixth edition β’ Basic ophthalmology fourth edition β’ https://emedicine.medscape.com 05/27/19 αααα ααααα 35