This document discusses various disorders of the eyelids and conditions that cause red eye. It describes several conditions including blepharitis, styes, chalazions, entropion, trichiasis, lagophthalmos, ptosis, dacryocystitis, orbital cellulitis, conjunctivitis, hemorrhagic conjunctivitis, allergic conjunctivitis, phlyctenular conjunctivitis, vernal conjunctivitis, pterygium, and corneal ulcers. Treatment options focus on antibiotic ointments, compress, referral for surgical correction if needed, and systemic antibiotics in more severe cases.

1. JBCHimalaya Eye Hospital, Pokhara JBC
Disorder of Lids and Red Eye
J.B.Chand DCEHJ.B.Chand DCEH
Himalaya Eye HospitalHimalaya Eye Hospital
Pokhara, NepalPokhara, Nepal

2. June 28, 2014 Disorder of Lids and Red Eye 2
JBCHimalaya Eye Hospital, Pokhara JBC
Blepharitis
• Chronic inflammation of eye lid margins usually caused by
staphylococcus
• Aetiology: Dryness of mucus membrane (Sicca) and
overactivity of the sebaceous glands, resulting in an excessive
amount of sebum (Seborrhae)
• Clinical features: Itching in eye lids, gritty and foreign body
sensation, dandruff, scalps in eye lid margin in squamos type and
pus point with sore in ulcerative type
• Complication: Thickened eye lid and loss of eye lashes
• Treatment: Control scalp dandruff when present, clean lashes
routinely, apply antibiotic ointment to lashes
• Lid hygiene and artificial tear

3. June 28, 2014 Disorder of Lids and Red Eye 3
JBCHimalaya Eye Hospital, Pokhara JBC
Blepharitis

4. June 28, 2014 Disorder of Lids and Red Eye 4
JBCHimalaya Eye Hospital, Pokhara JBC
Stye
• This is an acute inflammation of eyelash
follicle and Zeiss Gland in lid Margin. The
common causative organism is
staphylococci
• Clinical features: Pain, tendernes,
discharge and pus lump in lid margin
• Treatment: Hot compress, Apply antibiotic
eye ointment and systemic antibiotic if
necessary

5. June 28, 2014 Disorder of Lids and Red Eye 5
JBCHimalaya Eye Hospital, Pokhara JBC
Stye

6. June 28, 2014 Disorder of Lids and Red Eye 6
JBCHimalaya Eye Hospital, Pokhara JBC
Chalazion
• Non inflammatory granuloma of
mebomian gland
• Appears as painless lump or cyst in
mebomian gland
• Sometime disappears it self after hot
compress.
• Refer to eye hospital for I & C.

7. June 28, 2014 Disorder of Lids and Red Eye 7
JBCHimalaya Eye Hospital, Pokhara JBC
Chalazion

8. June 28, 2014 Disorder of Lids and Red Eye 8
JBCHimalaya Eye Hospital, Pokhara JBC
Trichiasis
• In turned eye lashes is triachiasis and leading
cause of corneal blindness
• This can be congenital, spastic, senile or due to
chronic inflammation like trachoma. It may
scratch cornea and cornea becomes un opaque
with and without infection
• Prevention: Epilation and apply antibiotic eye
ointment for trichiasis and refer to eye hospital
for surgical correction or further management

9. June 28, 2014 Disorder of Lids and Red Eye 9
JBCHimalaya Eye Hospital, Pokhara JBC
Entropion
• In turned lid is entropion
• This can be congenital, spastic, senile or due to
chronic inflammation like trachoma. It may
scratch cornea and cornea becomes un opaque
with and without infection
• Prevention: Apply antibiotic eye ointment and
refer to eye hospital for surgical correction or
further management

10. June 28, 2014 Disorder of Lids and Red Eye 10
JBCHimalaya Eye Hospital, Pokhara JBC
Triachisis / Entropion

11. June 28, 2014 Disorder of Lids and Red Eye 11
JBCHimalaya Eye Hospital, Pokhara JBC
Lagophthalmos
• Cannot close eye lids
• It is due to malfunctioning of orbicularis
occuli muscle supplied by 7th
cranial nerve
(Facial Nerve)
• Common in Leprosy patient and facial
nerve bel’s palsy
• Refer to eye hospital with Antibiotic
ointment and artificial tear to prevent
exposure keratitis

12. June 28, 2014 Disorder of Lids and Red Eye 12
JBCHimalaya Eye Hospital, Pokhara JBC
Lagophthalmos

13. June 28, 2014 Disorder of Lids and Red Eye 13
JBCHimalaya Eye Hospital, Pokhara JBC
Ptosis
• Drooping of eye lids (Can not open the
eye lids) This is usually due to congenital
defect or due to trauma in 3rd
cranial nerve
(Oculomoter) or aponeurosis supplying
levator muscle of eyelid.
• Complication: Loss of vision and
amblyopia.
• Treatment: Refer to eye hospital for
surgical correction

14. June 28, 2014 Disorder of Lids and Red Eye 14
JBCHimalaya Eye Hospital, Pokhara JBC
Ptosis

15. June 28, 2014 Disorder of Lids and Red Eye 15
JBCHimalaya Eye Hospital, Pokhara JBC
Dacryocystitis
• Infection of lacrimal sac secondary to obstruction
of lacrimal passage.
• Clinical features: Sudden onset of pain,
tenderness and epiphora
• Treatment: Systemic topical Antibiotic and
analgesic resolves the immediate problem.
Refer to Primary Eye Care Center/Eye Hospital
if condition does not improves.

16. June 28, 2014 Disorder of Lids and Red Eye 16
JBCHimalaya Eye Hospital, Pokhara JBC
Acute Dacryocystits

17. June 28, 2014 Disorder of Lids and Red Eye 17
JBCHimalaya Eye Hospital, Pokhara JBC
Orbital Cellulitis
• Bacterial infection of soft tissue behind
orbital septum:
• Clinical Features: Fever, chemosis
(conjunctival edema), proptosis, diplopia
(extraocular muscle involved), and lid
edema.
• Treatment: Refer immediately with
broad spectrum systemic Antibiotics. Be
aware: Could spread to cavernous
sinus.

18. June 28, 2014 Disorder of Lids and Red Eye 18
JBCHimalaya Eye Hospital, Pokhara JBC
Orbital Cellulitis

19. June 28, 2014 Disorder of Lids and Red Eye 19
JBCHimalaya Eye Hospital, Pokhara JBC
Red Eye

20. June 28, 2014 Disorder of Lids and Red Eye 20
JBCHimalaya Eye Hospital, Pokhara JBC
Ophthalmia Neonatorum
• The eye infection of infant age below 4 weeks. This is usually due
to the infection spread in to eye from mother’s infected vaginal
track while birth
• Can cause blind
• The common causative organisms are Chalamydia and Nisseria
Gonococi
• Type: Infective and chemical
• Clinical feature: Swelling of eye lid, watering, and purulent
discharge from eye
• Complication: Corneal involvement are frequent in Gonococi
type, which leads to corneal ulcer
• Frequent installation of broad spectrum antibiotic eye drop,
Tetracycline eye ointment and or Gentamycine/Tobramycine eye
drop.
• Refer parents for VDRL Check-ups

21. June 28, 2014 Disorder of Lids and Red Eye 21
JBCHimalaya Eye Hospital, Pokhara JBC
Ophthalmia Neonatorum

22. June 28, 2014 Disorder of Lids and Red Eye 22
JBCHimalaya Eye Hospital, Pokhara JBC
Conjunctivitis - Infective
• Inflammation of conjunctiva
• Usually communicable and easily transmits to other person from
contamination of ocular discharge
• Common causative organism, Bacteria, virus and Chalmydia
• It is important to prevent transmission. Do not share towel,
handkerchief and pillow of the infected patients. Wash hand properly
after cleaning and after contacting infected eyes
• Redness, Muco/purulent discharge, sticky eye, grittiness
• Frequent cleaning of eye and antibiotic usually Chloramphenicol 2
hrly for 5 days resolves the condition. In some types cornea may
involved
• Refer immediately to nearest eye hospital/center if patient have
photophobia, pain and loss of vision

23. June 28, 2014 Disorder of Lids and Red Eye 23
JBCHimalaya Eye Hospital, Pokhara JBC
Conjunctivitis - Infective

24. June 28, 2014 Disorder of Lids and Red Eye 24
JBCHimalaya Eye Hospital, Pokhara JBC
Haemorrhagic Conjunctivitis

25. June 28, 2014 Disorder of Lids and Red Eye 25
JBCHimalaya Eye Hospital, Pokhara JBC
Conjunctivitis - Allergic
• This is usually appears in grown-up children and
is seasonal. Most of the time it disappears after
running season
• Clinical features: Itching redness and ropy
discharge are common feature
• Treatment: Cold compress and anti-allergy/anti-
histamine eye drop will be helpful to resolve the
symptoms
• Refer to eye hospital in the condition of
photophobia and not improving with treatment

26. June 28, 2014 Disorder of Lids and Red Eye 26
JBCHimalaya Eye Hospital, Pokhara JBC
Phlyctenular conjunctivitis
Vernal conjunctivitis
Palpebral
Bulbar
Allergic Conjunctivitis

27. June 28, 2014 Disorder of Lids and Red Eye 27
JBCHimalaya Eye Hospital, Pokhara JBC
Follicles-papillae
Papillary hypertrophyPapillary hypertrophy
Follicles-lower fornixFollicles-lower fornix
Follicles-upper tarsalFollicles-upper tarsal
conjunctivaconjunctiva

28. June 28, 2014 Disorder of Lids and Red Eye 28
JBCHimalaya Eye Hospital, Pokhara JBC
Types of Discharge/Secretions
Serous
Mucopurulent
Hemorrhagic
Ropy
Membranous

29. June 28, 2014 Disorder of Lids and Red Eye 29
JBCHimalaya Eye Hospital, Pokhara JBC
Fornicial Congestion

30. June 28, 2014 Disorder of Lids and Red Eye 30
JBCHimalaya Eye Hospital, Pokhara JBC
Phlyctenular - Conjunctivitis
• Triangular whitish nodule in limbal area.
Common in children. This is usually due to
endogenous reaction to tubercular protein or
exogenous organism bacterial infection mainly
staphylococcus
• Clinical features : Pain, tenderness, localised
red and whitish nodules in the limbal area
• Treatment : Treat with antibiotic (Tetracycline)
eye ointment
• Refer to nearest eye hospital if not resolves
within five days and pain associated with
photophobia and loss of vision.

31. June 28, 2014 Disorder of Lids and Red Eye 31
JBCHimalaya Eye Hospital, Pokhara JBC
Phlycten

32. June 28, 2014 Disorder of Lids and Red Eye 32
JBCHimalaya Eye Hospital, Pokhara JBC
Pterygium
• This is fibrovascular growth of sub conjunctival
tissue towards the cornea.
• More common with the people living in dry, dusty
and hot climate
• Chronic dryness of eye id another cause
• Treatment: Surgical excision should be
performed if 2/3 of cornea is involved
• Chances of recurrence
• Surgery should be performed once it becomes
vision threatening

33. June 28, 2014 Disorder of Lids and Red Eye 33
JBCHimalaya Eye Hospital, Pokhara JBC
Pterygium

34. June 28, 2014 Disorder of Lids and Red Eye 34
JBCHimalaya Eye Hospital, Pokhara JBC
Corneal ulcer
• Discontinuation of corneal epithelium, cellular
infiltration and tissue necrosis
• The common causative organism can be
bacteria, virus and fungus
• Investigation: Fluorscein stain and refer to
eye hospital
• Grams/geimsa stain, culture and sensitivity test

35. June 28, 2014 Disorder of Lids and Red Eye 35
JBCHimalaya Eye Hospital, Pokhara JBC
Corneal ulcer
• Clinical features: Grayish infiltration appears in
cornea Circum corneal congestion associated
with pain tenderness, photophobia and loss of
vision
– Bacterial ulcer are more virulent type with
mucopurulent discharge
– Viral are more chronic with geographical and branch
lesions with serous discharge
– Fungal are more chronic and less virulent
• Treatment: Topical broad-spectrum antibiotic
eye drop/ointment hourly. Immediate Refer to
eye hopital/center

36. June 28, 2014 Disorder of Lids and Red Eye 36
JBCHimalaya Eye Hospital, Pokhara JBC
Corneal Ulcer

37. June 28, 2014 Disorder of Lids and Red Eye 37
JBCHimalaya Eye Hospital, Pokhara JBC
Episcleritis/Scleritis
• Inflammation of Epiclera/Sclera.
• Clinical features: Localized swelling , pain and
tenderness in episcleritis and more diffuse
swelling and inflammation in scleritis
• Treatment: NSAID locally and systemically will
resolve the immediate problem.
• Recurrences are frequent
• Refer if it does not improve

38. June 28, 2014 Disorder of Lids and Red Eye 38
JBCHimalaya Eye Hospital, Pokhara JBC
Episcleritis/Scleritis

39. June 28, 2014 Disorder of Lids and Red Eye 39
JBCHimalaya Eye Hospital, Pokhara JBC
Anterior Uveitis
• This is inflammation of anterior vascular layer
(Iris and ciliary body) of the eye
• Classification:
– Anatomical
• Anterior,
• Intermediate,
• Posterior
– Clinical:
• Acute,
• Chronic
– Aetiological
• Exogenous,
• Endogenous (Sarcoidosis, Tuberculosis, Herpes Zoster)

40. June 28, 2014 Disorder of Lids and Red Eye 40
JBCHimalaya Eye Hospital, Pokhara JBC
Anterior Uveitis
Posterior Synechia
KPsPosterior Synechia
Occulsio Pupilae

41. June 28, 2014 Disorder of Lids and Red Eye 41
JBCHimalaya Eye Hospital, Pokhara JBC
Uveitis
• Symptoms :
– Pain, Tenderness, Loss of vision, Photophobia
• Signs:
– Circum ciliary congestion, Irregular and constriction
pupil, Flares and cells in AC, Posterior synechia and
Nodules in iris
– Usually unilateral
• Treatment : Requires thorough investigation
• Refer to eye hospital/centrs

42. June 28, 2014 Disorder of Lids and Red Eye 42
JBCHimalaya Eye Hospital, Pokhara JBC
Acute Angle Glaucoma
• Glaucoma is a condition in which optic
nerve fibres are damaged due to raised
intra-ocular pressure
• Clinical features: Pain, watering,
photophobia, halos, loss of vision, nausea,
vomiting, circum ciliary congestion, hazy
cornea, fix and dilated pupil, raised IOP
and shallow anterior chamber
• Refer immediately to eye hospital

43. June 28, 2014 Disorder of Lids and Red Eye 43
JBCHimalaya Eye Hospital, Pokhara JBC
Acute Angle Glaucoma

44. June 28, 2014 Disorder of Lids and Red Eye 44
JBCHimalaya Eye Hospital, Pokhara JBC
Thank You
With Raute Girls in DailekhWith Raute Girls in Dailekh