There is a lesion in the lower eyelid that is nodular with an ulcerated center and pearly surface with telangiectasia. Potential diagnoses include squamous cell carcinoma, sebaceous cell carcinoma, or amelanotic melanoma. Excision is the treatment of choice, with techniques like frozen section or Mohs micrographic surgery to ensure clear margins while maximizing tissue retention. Careful examination is needed to assess lesion attachment, punctum involvement, eyelash loss, and skin laxity for reconstruction planning.

1. Dr. Riyad Banayot

3. Loss of caruncle, shallowing of the
lower, tear film is poor, cornea may
be opacified with neovascularization
Shallowing of the lower fornix and
symblepharon, entropion, ectropion
and trichiasis
Look for ulcers on the tongue or buccal mucosa, skin lesions

4.  Chemical burnt
 Steven-Johnson's syndrome
 Conjunctival malignancies

5.  Ocular lubricant with artificial tears and
ointments
 Topical steroid for acute inflammation
 Severe cases may need systemic steroid
and immunosuppressants such as
dapsone or cyclophosphamide
 Oculoplastic surgery for trichiasis and
entropion to reduce further damage to
the cornea.

6. • There is exposure of the underlying dark uveal tissue (usually covered by the
upper lid) with thinning of the surrounding sclera & conjunctiva. There are
large abnormal blood vessels crossing areas of scleral loss.
• Seen mainly in women with rheumatoid arthritis.
• Look for: signs of rheumatoid arthritis (symmetrical deformities of the hand
joints)
• Occasionally this condition is seen in Wegener's granulomatosis and relapsing
polychondritis.

7.  Anterior scleritis:
 Diffuse scleritis (most benign). 30% has underlying
connective tissue disease
 Nodular scleritis deep red to purple color, immobile
nodule
 Necrotizing scleritis (most destructive). 60% of affected
patients develop ocular and systemic complications.
40% suffer from loss of vision and 29% die within 5
years of onset due to complications from vasculitis.
 There are two types: With inflammation & Without
inflammation
 Posterior scleritis:
 least common, present with pain, proptosis, visual loss
and restricted motility.
 Can find: choroidal folds, exudative RD, papilloedema
and ACG from choroidal effusion

8. There is a round, raised, whitish lesion in the limbus. Pre-auricular skin tag
Further examination:
• Significant astigmatism is present due to distortion of the cornea
• The condition is associated with Goldenhar's syndrome.
• look for: Preauricular skin tag, Duane's syndrome and facial asymmetry (with
mandibular under-development which may be ipsilateral or contralateral, small
mouth

9. Treacher-Collins' syndrome:
 This is an autosomal dominant condition
 Malar hypoplasia
 Absent zygomatic arch
 Anti-mongoloid slant of the palpebral fissure
 Coloboma of the outer third of the lower
lids.
 In the lower face, there is hypoplasia of the
lower jaw with macrostomia and abnormal
dentition.
 The ears are usually malformed.

10. There is a lesion in the lower lid, nodular with an ulcerated
center. The surface is pearly and has telangiectasia.
Forms of lesion?

11. - Check if the lesion is attached to the underlying structure by gently moving the lesion
- Check if the punctum is involved (if present, there is a potential risk of orbital extension)
- Look for loss of eyelashes (this indicates of malignancy if the nature of lesion is uncertain)
- Assess the amount of skin laxity which would be important in reconstructive surgery
Further examination

12.  Squamous cell carcinoma
 Sebaceous cell carcinoma
 Amelanotic melanoma

13.  Cryotherapy
 Radiotherapy
 Excision. This is the treatment of choice.
Techniques:
 Frozen section techniques: After the tumor has been
excised. 1-2 mm wide strips of tissue is excised form
the adjacent tissue for frozen section examination.
Reconstruction is undertaken only when all margins
are found to be tumor free.
 Moh's micrographic surgery: Tissue is removed in
lamellar layers which provide a three-dimensional
mapping of the tumor excision. (it allows for
retention of the maximum amount of tissue)

14. • Always examine the undersurface of the UL if you find UL entropion and/or diffuse corneal
opacities. The inferior fornix is deep and there are no symblepharon (the presence of
symblepharon should make one consider ocular cicatricial pemphigoid, Steven-Johnson's
syndrome or chemical injury).
Other features that may suggest trachoma:
• Micropannus in the superior cornea
• Pits at the limbus (Herbert's pits which results from necrosis of the follicles)
On everting the eyelids, there is
subtarsal fibrosis
Diffuse corneal opacities (+/-
vascularization)

15. Trachoma
 Caused by Chlamydia
trachomatis
 Transmitted by flies
 Caused by serotypes
A, B, Ba or C.
 Commonly seen in
tropical countries
where sanitation is
poor
 Causes blindness
through corneal
scarring from keratitis
and entropion
Adult inclusion
conjunctivitis
 Caused by Chlamydia
trachomatis
 Transmitted sexually
 Caused by serotypes
D, E, F, G, H, I, J or K
 Common in developed
countries