Ophthalmology

1. DISEASES OF THE EYE LIDS
By RONALD MAMBOLEO

2. Eyelids & Conjunctiva

3. Content
• Congenital anomalies
• Edema of the lids
• Inflammatory disorders
• Anomalies of eye lashes
• Tumors
• Injuries

4. CONGENITAL ANOMALIES
• Congenital ptosis:
• Congenital coloboma:
• Distichiasis
• Microblepharon

5. CONGENITAL PTOSIS

6. INFLAMMATORY DISORDERS OF THE LIDS
• Blepharitis:
– Seborrheic/ squamous
– Staphylococcal blepharitis
– Mixed staphylocoaccal and seborrheic
– Posterior blepharitis
– Parasitic blepharitis

7. SEBORRHOEIC BLEPHARITIS
• Is similar to seborrhoeic inflammation of the
scalp
• Associated symptoms
– Discomfort
– Foreign body sensation
– tearing

8. SIGNS/TREATMENT
– Scales seen along the margin
– The lashes fall off easily
– Thickening of posterior margin
Treatment:
Lid hygiene
Antibiotics

9. ULCERATIVE/ STAPHYLOCOCCAL
BLEPHARTIS
• Is caused by staph infection of lid margin;
Also associated with chronic conjunctivitis and
dacryocystitis.

10. SYMPTOMS
– Irritation, Discharge, tearing
--Photophobia
– Chronic irritation
SIGNS
-discharge
-leave ucler which bleed easily
TREATMENT
-lid hygiene with warm compress
-antibiotics : drops, ointment and systemic

11. Posterior blepharitis
• Also known as meibomitis
• Is associated with dysfunction of meibomian
glands
• The openings become prominent with thick
secretions
• Treatment
– Massage with warm compress
– antibiotics

12. Lid/preseptal cellulitis
• Ant to orbital septum
• Causes
– Skin trauma,insect bites,
– spread from local infxn
styes, dacrocystitis
– URTI,ear infections
• Unilateral,tender, red &
periobital oedema
• Rx; Systemic antibiotics

13. STYE
• This is acute inlammation of zeis and moll
glands
• Associated with chronic rubbing of eyelids,
metabolic disorders like diabetes,
• Mainly caused by staph aureas

14. SYMPTOMS
– Acute swellling and photophobia
– Tearing
– Pain
Treatment
-antibiotics
-incision and drainage

16. CHALAZION
• It is a granuloma within the tarsal plate caused
by obstructed in the ducts of the meibomian
gland.
• It is painless swelling in the lid.
• Treatment- I & C, or simply wait for six months
for resolution.

17. CHALAZION

18. Treatment I/D

19. Internal hordeolum

20. INTERNAL HORDEOLUM
• Is suppurative inflammation of meibomian
gland.
• Is caused by staphylococcal infection
• Treatment is similar to stye

21. Molluscum Contagiosum
• 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
– Excision of the lid lesion.
– Cauterization, cryotherapy,laser

22. • Caused by varicellla zoster virus
• Typically occurs in elderly patients but can
occur earlier commonly in immunosupressed
patients
• Starts with pain in distribution of first division
of trigeminal nerve
• Maculopapular rash-vesicles-pustules-crusting
• Hutchison‘s sign
• Periorbital oedema
• Acute eye disease in HZO
– Acute epithelial keratitis
– Conjunctivitis
– Episcleritits
– Scleritis
– Uveitis
– Chronic disease
– Lid scaring,
– post herpetic neuralgia
HERPES ZOSTER OPHTHALMICA

23. • Oral acyclovir
• IV acyclovir indicated for encephalitis
• Oral valaciclovir, famciclovir
• Systemic steroids- in combination with
antivirals
• Acyclovir ointment and bacitracin ointment
Treatment options

24. ANOMALIES OF EYE LIDS
• Trichiasis
-is inward misdirection of cilia which rub against the
eyeball
-causes
-cicatrrising trachoma
-ulcerative blepharitis
-mechanical injuries
-operative scars
-healed membrenous conjunctivitis

25. • Symptoms
– Irritation, photophobia, pain
Signs
-examination reveal misdirected cilia
Complications
-corneal abrassion, opacity,vasculariazation, non
healing corneal ulcer

26. • Traetment
– Epilation
– Electrolysis
– Cryoepilation
– Surgical correction

27. Entropion
• Lashes abrade cornea causing pain, watering,
photophobia, ulceration and corneal scar
• Lid margin turned in
• Types
– Congental
– Cicatricial
– Spastic entropion
– Senile involution
– Mechanical entropion

28. • Treatment
– Surgical correction

29. Ectropion
• Is the outward turning or rolling of the eye lids
• Types
– Senile ectropion
– Paralytic ectropion
– Cicatricial ectropion
– Mechaincal ectropion
– Spastic ectropion
Treatment
- surgical

30. Ptosis
• Is abornal drooping of the upper eyelid
• Causes
– Congenital
– Acquired
• Neurogenic- 3rd nerve palsy
• Myogenic -LPS
• Aponeurotic –lavetor
• Mechanical ptosis

31. Tumors of the eyelids
• Arises in skin or conjuctiva
• Skin cancers are rare in Africans, but
conjunctival tumours are common
• More common in HIV positive patients

32. Squamous Cell carcinoma
• 5% eyelid tumours
• Squamous cell layer of
epidermis
• Ulcerative growth with
elevated indurated
margins or nodular
• Metastases to regional
LN, spreads to orbit,
brain, sinuses
• Common in elderly & ISS
• Rx: Surgical excision,
radiotherapy

33. Basal cell Carcinoma
• 90% of eyelid malignancies
• Elderly people
• Mostly lower eyelid – 50%
• Locally invasive, non-
metastasizing
• Pleuripotent basal cells of
epidermis
• Noduloulcerative/rodent
ulcer most common type
• Rx:
– sx excision, radiotherapy,
cryotherapy

34. Karposis sarcoma
• Human Herpes virus 8
(HHV-8) infects vascular
endothelioum-vascular
tumour
• AIDS – advanced disease
• Pink,red-violet,brown
lesions
• May ulcerate and bleed
• Rx: Radiotherapy,excision