This document provides information on various disorders, pathologies, and diseases that can affect the anterior structures of the eye. It discusses conditions such as: - Disorders of the eyelashes including trichiasis, distichiasis, and madarosis. - Benign eyelid lesions including chalazions, molluscum contagiosum, and xanthelasma. - Malignant eyelid tumors such as basal cell carcinoma, squamous cell carcinoma, and melanoma. - Conjunctival disorders including bacterial and viral conjunctivitis, vernal conjunctivitis, and pterygium. - Corneal pathologies such as infectious keratitis

1. EyeAnteriorStructuresPathlogiesandDisordersFielmannOptometristIrinaJagiloviche-mail: irina.jagilovica@gmail.com

2. DISORDERS OF LASHES1. Trichiasis2. Metaplastic lashes3. Distichiasis4. Phthiriasispalpebrarum5. Madarosis6. Poliosis

3. MadarosisDecrease in number or complete loss of lashesLocal causes Chronic anterior lid margin diseaseInfiltrating tumours

4. Burns, radiotherapy or cryotherapy

5. PoliosisPremature localized whitening of hairOcular associations Chronic anterior blepharitis Sympathetic ophthalmitisSystemic associationsVogt-Koyanagi-Harada syndromeWaardenburg syndrome

6. DistichiasisSecond row of lashes arising from meibomian gland orifices

7. CongenitalTrichiasisMost frequently affects lower lidof normal lashes Most frequently affects lower lidInferior punctateepitheliopathy

8. Phthiriasispalpebrarum Infestation of lashes by pubic crab louse and its ova (nits) Typically affects children in poor hygenic conditions

9. Staphylococcal blepharitisChronic irritation worse in morningsHyperaemia and telangiectasia of anterior lid marginScarring and hypertrophy if longstandingScales around base of lashes (collarettes)

10. Complications of staphylococcal blepharitispoliosismadarosistrichiasisRecurrent styesMarginal keratitisTear film instability

11. SeborrhoeicblepharitisShiny anterior lid margin Greasy scales Hyperaemia of lid marginLashes stuck together

12. Meibomianitis Inflamed and blockedmeibomiangland orificesMeibomian cyst formation

13. MeibomianseborrhoeaOil globules over meibomian gland orificesOily and foamy tear film

14. Herpes simplexSignsCrops of small vesicles

15. Rupture and crust

16. Heal without scarring after 7 daysComplicationsFollicular conjunctivitis

17. KeratitisTreatment - topicalantivirals

18. BENIGN EYELID LESIONS1. NodulesChalazion

19. Acute hordeolaMolluscumcontagiosumXanthelasma2. Cysts Cyst of Moll

20. Cyst of Zeiss

21. Sebaceous cyst

22. Hidrocystoma3. TumoursViral wart

23. Keratoacanthoma

24. Naevi

25. Capillary haemangioma

26. Port-wine stain

27. Pyogenicgranuloma

28. Cutaneous hornSigns of chalazion (meibomian cyst)Painless, roundish, firm lesion within tarsal plateMay rupture through conjunctiva and cause granuloma

29. MolluscumcontagiosumPainless, waxy, umbilicated noduleMay be multiple in AIDS patientsChronic follicular conjunctivitisOccasionally superficial keratitis

30. XanthelasmaCommon in elderly or those withhypercholesterolaemiaYellowish, subcutaneous plaques containing cholesterol and lipidUsually bilateral and located medially

31. Eyelid cystsCyst of MollTranslucentOn anterior lid marginCyst of ZeisOpaqueOn anterior lid margin

32. Viral wart (squamous cell papilloma)Most common benign lid tumourRaspberry-like surface

33. KeratosesSeborrhoeicActinicCommon in elderlyAffects elderly, fair-skinned individualsDiscrete, greasy, brown lesionMost common pre-malignant skin lesionFlat ‘stuck-on’ appearanceRare on eyelidsFlat, scaly, hyperkeratotic lesion

34. KeratoacanthomaUncommon, fast growing noduleAcquires rolled edges and keratin-filled craterInvolutes spontaneously within 1 year

35. Naevi ElevatedFlat, well-circumscribedHas both intradermal and junctional components May be non-pigmented Pigmented No malignant potential Low malignant potential

36. MALIGNANT EYELID TUMOURS1. Basal cell carcinoma2. Squamous cell carcinoma3. Meibomian gland carcinoma4. Melanoma5. Kaposi sarcoma

37. Basal Cell Carcinoma - Important Facts1. Most common human malignancy2. Usually affects the elderly3. Slow-growing, locally invasive4. Does not metastasize5. 90% occur on head and neck6. Of these 10% involve eyelids7. Accounts for 90% of eyelid malignancies

38. Nodular basal cell carcinoma Shiny, indurated nodule Slow progression Surface vascularization May destroy large portion of eyelid

39. Ulcerative basal cell carcinoma(rodent ulcer)Chronic ulceration

40. Sclerosing basal cell carcinomaIndurated plaque with loss of lashesSpreads radially beneath normal epidermisMay mimic chronic blepharitis

41. Squamous cell carcinomaNodularUlcerativeLess common but more aggressive than BCCNo surface vascularization

42. Meibomian gland carcinomaHard nodule; maymimic chalazionVery large tumourDiffuse thickening of lid margin and loss of lashesConjunctival invasion; maymimic chronic conjunctivitis

43. MelanomaPlaque with irregular outlineBlue-black nodule withnormal surrounding skinMay be non-pigmentedVariable pigmentation

44. Kaposi sarcomaVascular tumour occurring in patients with AIDSUsually associated with advanced diseaseVery sensitive to radiotherapy

45. Entropion & ectropion

46. Horner syndromeCaused by oculosympatheticpalsyUsually unilateral mildptosis and miosis, anisocoriaNormal pupillary reactions

47. Important causes of Horner syndromeCentral(first order neurone)Posterior hypothalamusBrainstem disease (vascular, demyelination) Spinal cord disease (syringomyelia, tumours)Pre-ganglionic(second order neurone)Superior cervicalganglionIntrathoracic lesions (Pancoasttumour, aneurysm) Neck lesions (glands, trauma)Post-ganglionic (third order neurone) Internal carotid artery diseaseCiliospinal centre of Budge( C8 - T2 ) Cavernous sinus massSimple bacterial conjunctivitisSubacute onset of mucopurulentdischargeCrusted eyelids and conjunctivalinjection

48. Signs of conjunctivitisUsually bilateral, acute waterydischarge and folliclesSubconjunctivalhaemorrhages andpseudomembranes if severe

49. Signs of keratitisFocal, subepithelialkeratitisFocal, epithelial keratitisMay persist for monthsTransient

50. Progression of vernal conjunctivitis Diffuse papillary hypertrophy, most marked on superior tarsus Formation of cobblestone papillae

51. Limbal vernalTrantas dotsMucoid nodule

52. CONJUNCTIVAL TUMOURS1. BenignNaevus

53. Papilloma

54. Epibulbardermoid

55. Lipodermoid2. Pre-malignant Primary acquired melanosis ( PAM )

56. Intraepithelial neoplasia (carcinoma in situ)3. Malignant Melanoma

57. Squamous cell carcinoma

58. Kaposi sarcoma

59. LymphomaNaevusMost frequently juxtalimbalPresents in first two decadesSharply demarcated and slightly elevated30% are almost non-pigmented

60. Melanoma

61. PapillomaPedunculatedSessile Presents in middle age

62. Presents in childhood or early adulthood

63. Not caused by infection

64. Infection with papilloma virus

65. Single and unilateral

66. May be multiple and bilateralEpibulbardermoidSignsAssociation Presents in childhood

67. Occasionally Goldenhar syndrome Smooth, soft mass

68. Usually juxtalimbalLipodermoidPresents in adulthood

69. Soft, movable, subconjunctival mass

70. Most frequently at outer canthusIntraepithelial neoplasia(carcinoma in situ)SignsProgression May become vascular and extend onto corneaPresents in late adulthood

71. Juxtalimbal fleshy avascular mass

72. Malignant transformation is uncommonPrimary acquired melanosis (PAM)SignsTypesPAM without atypia is benignPresents in late adulthoodUnilateral, irregular areas of flat, brown pigmentationPAM with atypia is pre-malignant May involve any part of conjunctiva

73. Conjunctival melanomaFrom naevusPrimaryFrom PAM with atypiaVery rareMost common typeSolitary noduleSudden appearance of nodules in PAMFrequently juxtalimbal but may be anywhereSudden increase in size or pigmentation

74. Squamous cell carcinomaProgressionSignsArises from intraepithelialneoplasia or de novo Slow-growing

75. May spread extensively

76. Presents in late adulthood

77. Rarely metastasizes

78. Frequently juxtalimbalKaposi sarcoma Affects patients with AIDS

79. Vascular, slow-growing tumour of low malignancy

80. Very sensitive to radiotherapy

81. Most frequently in inferior fornixLymphoma Usually presents in adulthood

82. Benign or malignant

83. Salmon-coloured, subconjunctival infiltratePERIPHERAL CORNEAL INFLAMMATION1. Marginal keratitis2. Rosaceakeratitis3. Phlyctenulosis4. Acute stromalkeratitis

84. Marginal keratitisProgressionSubepithelial infiltrate separated by clear zoneVascularizationfollowed by resolutionCircumferential spread

85. RosaceakeratitisAffects 5% of patients with acne rosaeca

86. Bilateral and chronicProgressionPeripheral inferiorvascularizationSubepithelial infiltrationThinning and perforationif severe

87. Phlyctenulosis Uncommon, unilateral - typically affects children

88. Severe photophobia, lacrimation and blepharospasmConjunctivalphlyctenCorneal phlycten Small pinkish-white nodule near limbus Usually transient and resolves spontaneously Starts astride limbus

89. Resolves spontaneously or extends onto cornea

90. Acute stromalkeratitis Uncommon, usually unilateral

91. Associated with non-necrotizing scleritisProgressionSuperficial or mid-stromal infiltrationOpacification and vascularization

92. CORNEAL INFECTIONS1. Bacterial keratitis2. Fungal keratitis3. Acanthamoebakeratitis4. Infectious crystalline keratitisHerpes simplex keratitis-Epithelial -Disciform6. Herpes zoster keratitis

93. Bacterial keratitis Contact lens wear

94. Chronic ocular surface disease

95. Corneal hypoaesthesiaExpanding oval, yellow-white, dense stromal infiltrateStromal suppuration and hypopyon

96. Fungal keratitisFrequently preceded by ocular trauma with organic matterGreyish-white ulcer which may be surrounded by feathery infiltrates Slow progression and occasionally hypopyon

97. Acanthamoebakeratitis Contact lens wearers at particular risk

98. Symptoms worse than signsPerineuralinfiltrates (radial keratoneuritis) Small, patchy Anteriorstromalinfiltrates Ulceration, ring abscess& small, satellite lesionsStromalopacificationTreatment

99. Infectious crystalline keratitis Very rare, indolent infection (Strep. viridans)

100. Usually associated with long-term topical steroid use

101. Particularly following penetrating keratoplasty White, branching, anterior stromal crystalline deposits

102. Herpes simplex epithelial keratitisDendritic ulcer with terminal bulbs May enlarge to become geographic Stains with fluoresceinHerpes simplex disciformkeratitisSignsAssociationsCentral epithelial and stromaloedemaOccasionally surrounded by WesselyringFolds in Descemet membraneSmall keratic precipitates

103. Herpes zoster keratitisNummular keratitisAcute epithelial keratitisDevelops in about 50% within 2 days of rashDevelops in about 30% within 10 days of rashSmall, dendritic or stellateepithelial lesionsMultiple, fine, granular deposits just beneath Bowman membraneTapered ends without bulbsHalo of stromal hazeMay become chronicResolves within a few days

104. CORNEAL DEGENERATIONS1. Age-relatedArcussenilis

105. Vogt white limbal girdle

106. Crocodile shagreen

107. Cornea guttata2. Lipid keratopathy Primary

108. Secondary3. Band keratopathy4. Spheroidal degeneration5. Salzmann nodular degeneration

109. Arcussenilis Innocuous and extremely common in elderly

110. Occasionally associated with hyperlipoproteinaemia

111. Peripheral border separated from limbus by clear zone Bilateral, circumferential bands of lipid depositsDiffuse central and sharp peripheral border Clear zone may be thinned ( senile furrow)

112. Vogt white limbal girdleInnocuous and very common in elderlyBilateralWhite, crescentic line along nasal and temporal limbusType 1 - separated from limbus by clear zoneType 2 - not separated by clear zone

113. Crocodile shagreen Uncommon and innocuous

114. Usually bilateralPolygonal stromal opacities separated by clear space Most frequently involve anterior stroma (anterior crocodile shagreen)Occasionally involve posterior stroma (posterior crocodile shagreen)

115. Cornea guttata Common, bilateral and usually innocuous

116. Rarely progression to Fuchs dystrophyTiny dark spots on central endothelium

117. Lipid keratopathyPrimarySecondaryCommon, secondary to previous disciformkeratitisRare, occurs spontaneously in avascular corneaUnilateral stromal deposits with vascularizationUsually unilateral stromal deposits without vascularization

118. Band keratopathy Common, unilateral or bilateral depending on cause

119. Subepithelial calcificationProgressionCentral spread of calcificationInterpalpebrallimbalopacificationSmall holes within calcified area Separated by clear zone

120. CORNEAL DYSTROPHIES1. Anterior Cogan microcystic.. Reis-Bucklers

121. Meesmann