EYELID- INFECTION, INFLAMMATION, TUMORS AND DEFORMITIES

1. MEDICAL SURGICAL NURSING- II
UNIT – II
NURSING MANAGEMENT OF PATIENTS WITH
DISORDERS OF EYE
TOPIC : EYELID- INFECTION, INFLAMMATION,
TUMORS AND DEFORMITIES
PRESENTED BY
Mrs. SOUMYA SUBRAMANI, M.Sc.(N)
LECTURER, MSN DEPARTMENT
CON- SRIPMS, COIMBATORE.

2. Hordeolum (Stye):

3. INTRODUCTION
1. EYELIDS: Two movable folds with eyelashes.
 Layers present are skin, aerolar tissue; muscles- orbicularis
oculi, levator palpebrae superioris & Muller’s muscle; thin
sheet of dense connective tissue, tarsal plate; thin lining of
palpebrae conjunctiva.
2. EYELID MARGIN
 Covered with stratified squamous epithelium
 Anterior border is round, posterior is sharp & lies closely in
contact with the eyeball.
 Eyelashes originate anterior to the grey line and ducts of
meibomian are located posterior to the grey line.

4. 3. GLANDS OF EYELIDS
 Zeis’s Gland: Sebaceous gland situated on the margin of
the eyelid
 Moll’s Gland : Sweat glands & lie on the margin of eyelid.
 Meibomian Gland : Enormously developed sebaceous gland
embedded in tarsal plate, secretes oily secretion that
lubricates the eye
 Palpebral Fissure: Space between the two lids when the eye
is open
 Outer Canthus: Outer or lateral angle of palpebrae fissure
 Inner Canthus: Inner or medial angle of the palpebral fissure
 Blood supply: Opthalmic & lacrimal arteries & opthalmic vein
 Nerve supply: 7th , 3rd & 5th cranial nerve.

6. EYELID INFECTIONS, TUMORS AND DEFORMITIES

7. DEFINITION
An eyelid infection is any infectious condition that
effect eyelids.
Infection of an oil gland on the surface of the upper and
lower parts of eyelids ,hair follicle or sweat gland.

8. INFLAMMATIONS AND INFECTION
It includes
1. Blepharitis
2. Hordeolum (stye)
3. Chalazion (tarsal or meimobian cyst)

9. BLEPHARITIS
Is a common chronic bilateral inflammation of the eye lid
margins, in which they become red, irritated and
itching dandruff like scales form on the eyelashes.

10. 1. BLEPHARITIS
Squamous blepharitis
Ulcerative blepharitis
1. Squamous blepharitis
it is due to abnormal metabolism & seborrhea usually associated
with the dandruff of the scalp.
Numerous white coloured small scales accumulate among
the eyelashes.
2. ULCERATIVE BLEPHARITIS
it is an infective condition. The yellow crusts glue ( sticky) the lashes
together. On removing the crust there are small ulcers seen around the
bases of lashes.
Symptoms: itching, redness, soreness, lacrimation and
photophobia.

11. Treatment
 Local: -removal of scales , crusts & diseased lashes is
done by bathing lid margin with 3% of NaHCO3 ( sodium
bicarbonate ) lotion.
- antibiotics & ointment are applied.
 General : Improvement of general health & personal
hygiene.
- Dandruff of the scalp is to be adequately treated.

12. 2. Hordeolum / Stye: is a localized infection or inflammation of the
sebaceous glands (meibomian gland) in the eye lid margin involving
hair follicles of eyelashes.
 Etiology: Associated with staphylococci infection, .
Common in young adults & debilitated persons (very week person).
 Symptoms: Ac. Pain & tenderness over inflamed meibomian gland.
 Signs: Localized Pain, redness & edema near the lid margin.
 Treatment: Hot fomentation, ( to apply a warm compress on eye) Evacuation of pus,
 antibiotic eye drop = tobramycin
 & ointment & broad spectrum antibiotics is useful.
- Analgesics & anti-inflammatory drugs control pain & inflammation.

13. =3. Chalazion/ Meibomian cyst: is a cyst in the eyelid due to a blocked mei-bomian
gland in the eyelid.
 Etiology: due to chronic irritation due to organism of low virulence (The ability of bacteria
to cause disease) where the glandular tissue is replaced by granulation tissue containing
giant cells.
- more common in adults.
 Symptoms Signs: They are typically in the middle of the eyelid, red, and not painful.
 Treatment:
Warm moist compress
Topical antibiotic eye drops or ointment (e.g., chloramphenicol or fusidic acid)
Sx- removal of the lesion
Inject the lesion with corticosteroids

14. TUMORS
1. Benign Tumors
 Nevus
 Capillary Hemangioma
 Xanthelasma
 Neurofibroma
2. Malignant Tumors
 Squamous cell carcinoma
 Basal cell carcinoma

15. Nevus
• A nevus is a common, colored growth on or in the eyes.
• Sometimes called a freckle of the eye
• A nevus (a benign tumor) is commonly found on the
skin of other parts of the human body. A nevus can also
occur on the eyelid skin. These tumors are usually
pigmented and have thickness.
• Patients typically notice a dark spot on their eyelid that
is thickened.
Treatments
• Large eyelid nevi can be a cosmetic problem that can
be repaired by ophthalmic plastic surgery.

16. Capillary Hemangioma
is a non-cancerous (benign) tumor caused
by abnormal growth of blood vessels. May
be bright, superficial, strawberry- red
lesions or bluish or purplish deeper lesions.

17. Milia- are small, white, slightly
elevated cysts of the eyelid that
may occur in multiples.
Xanthelasma
are yellowish plaques that occur most commonly
near the inner canthus of the eyelid, more often
on the upper lid than the lower lid.
Occurs as a result of lipid disorders.

18. TREATMENT
• Rarely indicated when visual function is affected.
• Corticosteroid injection to the haemangioma lesion is effective.
• Surgical excision or electrocautery is primarily performed for
cosmetic reasons.

19. Malignant Tumors
Occurs more frequently among fair complexion people
who have a history of chronic exposure to the sun.
 Squamous cell carcinoma
 Basal cell carcinoma- most common
tumor of eyelid

20.  Squamous cell carcinoma
• Occurs less frequently but considered as the
2nd most common malignant tumor.
• May resemble the BCC
• It spreads slowly and tends to ulcerate and
invade the surrounding structures.
• Metastasis common

21.  Basal cell carcinoma
• It is most common seen in lower lid near the inner
canthus.
• Appears as a painless nodule that may ulcerate.
• The lesion spread to the surrounding tissues and
grows slowly.

22. ETIOLOGY
 Environmental toxins such as exposure to
radiation
Diet – deficiency of minerals and vitamins
Stress- excessive stress cause mutation in
the cells of their developing eyes
 Local trauma or injury- orbital trauma and
bleeding
 Inflammation or infection

23. CLINICAL MANIFESTATION
 Bulging of one eye (protrusion)
Complete and partial loss of sight
 Pain in or around the eye
Blurred vision
Change in the appearance of the eye
Edema
Redness
Itching
Burning

24. DIAGNOSIS
Ultrasound scans
CT SCAN
MRI
 They show the size , location ,and shape of
the tumors and also show the enlarged or
affected lymph node around the eye.

25. MEDICAL MAANAGEMENT
1.Identify the cause & eliminate the cause
2. control of symptoms
3. antibiotics and anti inflammatory drugs .
4.Maintain normal activity level ,including
exercise .
6, Prevention foreign particles enter in eye
 Use of sunglasses
 To keep the eye clan ,wipe away the drainage
from around the eye ‘moisten or wash with
warm water, from inner to the outer part the
eye.

26. MANAGMENT
• Chemotherapy
eye drops
• Mitomycin C –are used to treat different types of growths on the surface of
the eye
• fluorouracil- Is used treatment pre-cancerous and cancerous cell growth
• Radiation therapy
uses high energy x- rays to kill the cancer cell.
• Surgical management
Complete excision of carcinoma followed by reconstruction with skin grafting
if the surgical excision is extensive.

27. ANOMALIES & POSITION OF EYELIDS
It includes
1. Trichiasis
2. Entropion
3. Ectropion
4. Symblepharon
5. Ankyloblepharon
6. Able-pharon
7. Micropharon
8. Epicanthus
9. Distichiasis:
10.Lago-pthalamus,
11.Ptosis

28. ANOMALIES & POSITION OF EYELIDS
1. TRICHIASIS : abnormally positioned eyelashes Few lashes or
whole lid margin involved.
Etiology: Recurrent stye, Ulcerative blepharitis, Tight bandaging, Scars
of lid following burn, injury or operation.
Symptoms:
a) Foreign body sensation of photophobia due to corneal involvement
b) Irritation, pain & lacrimation
Treatment:
Trichiasis treatment involves removing the eyelash or
redirecting eyelash growth.

29. 2. ENTROPION: Conditions in which the lid margin
rolls inwards.
Etiology
a)Spastic entropion: Due to the spasm of orbicularis oculi muscle as may occur
after tight bandaging after operation of following irritative corneal condition
b)Cicatricial entropion :, ulcerative blepharitis, burns, operations, diphtheritic
membranous conjunctivitis.
Sign & symptoms : Same as for trichiasis
Treatment
A. Spastic
 Basic cause of blepharospasm is treated
 If due to prolonged & tight bandaging, discontinue it.
Antibiotics
Anti inflammatory - corticosteroids

30. 3. ECTROPION : It is a condition in which lid margin rolls
outwards
Symptom : Most common excessive watering of the eyes
Signs:
i) Conjunctiva become dry in appearance
ii) Chronic conjunctivitis & corneal ulcers.
TREATMENT:
Use of lubricating ointment or mild steroid several day and
weeks to ectropion repair corneal epithelium

31. 4. SYMBLEPHARON: It is a condition of the adhesions
between lids and the globe.
Etiology : burns, ulcers, diphtheria, operation
Symptoms:
1. Lagopthalamus: inability to close lids properly
2. Diplopia : double vision
Treatment: Lysis and removal of subconjunctival scar tissue

32. 5. ANKYLOBLEPHARON
It is a condition of the adhesion of the margins
of two eyelids.Adhesion may be partial or
complete,
Etiology
- Congenital or acquired due to chemical burn
i.e. acid, alkali.
Treatment
- Separation of lid margins along with mucus
membrane or conjunctival grafting is
recommended

33. 6. Able-pharon: Macrostomia syndrome Extremely rare,
the lid is not developed autosomal recessive
genetic disorder .
7. Micropharon: Rare, lids are abormally small

34. 8. Epicanthus : A vertical fold of skin on either side of the nose
sometime covering the inner canthus.
9. Distichiasis:
an additional row of lashers
occupies the position of meibomian glands. abnormal growth of lashers.

35. 10. LAGOPTHALAMOS
It is a condition of incomplete closure of palpebral aperture
Lagophthalmos is defined as the inability to close the eyelids
completely. Blinking covers the eye with a thin layer of tear fluid,
Etiology
Loss of function of the facial nerve inhibits eyelid closure as well as the
blinking reflex .
- Congenital deformity of lids, ectropion ,proptosis (abnormal protrusion
or displacement of an eye , paralysis , absence of reflex,
blinking in extremely ill patient’s
Treatment
1. Application of antibiotic eye ointment & bandage during sleep is
recommended.
2. Levofloxacin

36. 11. PTOSIS
It is a condition in which there is drooping of the upper lid below its normal
position .
Etiology
1. Congenital Ptosis: Occurs in 80 % cases, due to maldevelopment of
levator muscle; congenital weakness of superior rectus muscle.
2. Acquired Ptosis : a). Neurogenic : partial/ complete paralysis of 3rd nerve b)
Mechanical : Due to increased weight of upper lid as a result of edema,
hypertrophy or tumor formation.
c) Myogenic : Due to trauma of levator muscle, muscular dystrophy (increasing
weakening or breakdown of muscle) & myasthenia gravis. (neuromuscular
disease weakness of skeleton muscle)
Symptoms : Visual disturbance
visible drooping of the upper eyelid

37. TREATMENT
high doses of opioid drugs such
as morphine, Morphine is a narcotic pain reliever
used to treat moderate to severe pain. ... 0.05
mg/kg IM, IV, or subcutaneously every 4 to 8 hours
 oxycodone hydrochloride analgesic agents
 heroin, or hydrocodone can cause ptosis.
 Pregabalin (Lyrica), an anticonvulsant drug, has
also been known to cause mild ptosis.

38. THANKYOU