2.01 Disorders of the eyelids

Label

1. Preaponeurotic fat pad

2. Superior transverse ligament (whitnalls)

3. Levator palpebrae superioris muscle

4. Müller muscle

5. Tarsus

6. Brow fat pad

7. orbicularis oculi muscle

8. Orbital septum

9. Upper lid crease at levator insertiom

10. Meibomian gland

11. Gland of zeis

12. Conjunctiva

13. Gland of moll

What is anterior blepharitis

Chronic inflammation of eyelash and follicle and its associated gland

Anterior blepharitis - causes

Infection

Infestation

Inflammation

Such as staphylococcal bacteria (infestive), demodex mites, or seborrheic (greasy oily skin)

What is this

Anterior Blepharitis

How to distinguish between anterior blepharitis and dry eye

In AB symptoms are worse in the morning

In dry eye symptoms get worse as the day goes on

What does chronic mean

No full cure, condition can come back

Anterior/posterior blepharitis - risk factors

Anterior/posterior blepharitis - symptoms

Same except worse on awakening is only for anterior blepharitis

Anterior Blepharitis - signs for

• bacterial

• Seborrheic

• Demodex

What is seborrheic

Bacterial toxins irritate/inflame your eye but youre not infected

Lifecycle of demodex mites

3 weeks

Anterior Blepharitis- treatments

What is posterior blepharitis/meibomian gland dysfunction (MGD)

Chronic posterior lid inflammation typically due to meibomian glands

Posterior blepharitis/MGD - causes

Glands dont produce good quality meibum/oil (too thick)

Meibomian glands stop producing oil (extreme)

Posterior blepharitis/MGD - Signs

also dry eye symptoms -

increased tear film evaporation

Irritation

Redness

Reflex tearing

Corneal conjunctival exposure (extreme)

What is this

Posterior blepharitis/MGD

Capped meibomian glands

Posterior blepharitis/MGD - Treatments

What is this

Posterior blepharitis/MGD

Notching due to meibomian gland death

What is this

Posterior blepharitis/MGD

Foamy tear film

What is an ectropion

When the eyelid turns outwards

Ectropian - causes

Usually no cause it happens on its own

Associates with aging due to horizontal eyelid laxity - lose muscle tension so lid droops out

cicratrial ectropion (due to scarring or prior surgery causing lid contraction )

paralytic ectropion (due to a facial palsy - lose laxity due to nerve fibre loss - eyelid cant blink and starts to droop )

Ectropian - symptoms

Eyelash loss

What is epiphoria

Excess tearing

What is this

Ectropion

Ectropion - management and treatment

Management:

Topical lubricants (helps dry eye symptoms)

Lid hygiene (stop blepharitis)

Treatment:

surgery where lid can be excised and pulled together to tighten routine refferel is indicated

What is an entropion

When the eyelid turns inwards

Entropion - causes

Irregularities of lid skin and muscle tension

Skin/conjunctiva contracts and tightens causing lid to fold inwards

Scarring of conjunctical tissue

Prolapse of orbital fat into lower lid

Entropion - symptoms

Similar to ectropion but more severe

Stinging

Itchy

Severe pain

Photophobia

Entropioin - signs

Trichiasis

Deep and perfuse corneal staining

Red eye

Epiphoria

Inflamed lids

Chemosis

What is trichiasis

Misdirected eyelashes

Can grow inwards and scratch cornea

Entropion - management and treatment

Management:

Bandage contact lenses - protect the cornea from scratching

Chemodenervation. - drugs to reduce nerve impulses

Topical lubricants - smooth the surface and keep eye moist

Treatment:

Refer within 2 weeks

Surgery

What is ditichiasis

Additional row of eyelashes

What is this

Entropion

What is a chalazion

A small granuloma (area of inflammation)

Chalazion - risk factors

Prior blepharitis

Meibonian gland dysfunction

Seborrheic dermatitis

Rosacea

Chalazion - causes

Thickening and blockage of meibum which leaks into surrounding tissue outside of acinor cell/ducts and causes inflammation (more common on top lid bc more meibomian glands)

Sterile (no infeciton)

Chalazion - symptoms

Symptomless (sterile - no infection)

Typically unilateral unless underlying systemic condition

Chalazion - signs

Defined Promenant red bump

When inverting the lid the tarsal surface will not be smooth - will have an irregular nodule or cobblestone like appearance

Chalazion - management/treatment

Can resolve spontaneously but can take a few months

Eyebag/hot compress (melts meibum and enourages its content release to reduce swelling)

Lid massage

Can be referred - HES will either use steriod injection to reduce inflammation or perform surgical excision (but referrel not always accepted)

What is this

Chalazion

What is this

Chalazion

What is this

Chalazion

What is a hordeolum

Stye

Infected lesion, typically from an eyelash follicle which then spreads to one of the lid glands

Can be internal or external

Hordeolum - causes (internal and external)

Interal - meibomian glands

External - blockage of glands of zeis

How to tell the difference between hordeolum and chalazion

Hordeolum is more painful becuase theyre infected

Hordeolum - symptoms

Pain (internal hordeolum is more painful than external)

Tenderness

Swelling

Burning sensation

Hordeolum - risk factors

Prior infection eg respiritory infection/cold

Similar to blepharitis and chalazions

Onset is sudden and without warning

Hordeolum - signs

Trichiasis (bump causes eyeslashes to be misdirected)

Filled with mucopurulent pus

Anterior and posterior form a nodular mass and a larger redder amount of inflammation than a chalazion

Hordeolum - management/treatment

Similar to chalazion

Warm compress to soften the coagulated material and allow it to drain but it can be painful

Usually spontaneosly resolve in a fortnight

Best to monitor and refer if it doesnt resolve in 3 weeks

If it doesnt resolve, antibiotics may be prescribed as it may increase the risk of cellulitis or other secondary infections

What is this

Hordeolum

What is this

Hordeolum

What is this

Hordeolum

What is this

Hordeolum

What is Xanthalasma

Raised plaques that may look nodular and have a yellow like tinge

Accumulation of lipid/fat deposits under the skin (usually medial and bilateral but asymmetric)

Xanthalasma - symptoms

Asymptomatic

Although patients can find it cosmetically unappealing

Xanthalasma - causes

Idiopathic (unknown)

Correlations with arcus, high blood lipids/cholesterol

What is arcus

White tinge around cornea

Xanthalasma - risk factors

Arcus

High blood lipids/cholestrol

More frequent in older peoplle

Rare in younger people but then can be due to other systemic conditions

Xanthalasma - management/treatment

Reassure patient and refer to GP non urgently for lipid evaluation blood test if not done recently

Treatment is surgical and only cosmetic (private) as it has a high rate of recurrence

What is this

Xanthalasma

What is mollescum contagiosm

A type of virus that can infect skin, giving pink/flesh coloured bumps that can have a central crater

Usually in clusters but can be in isolation. Can be found around the body

Mollescum Contagiosm - symptoms

Usually asymptomatic But if any infection enters the eye it can case viral conjunctivitis like symptoms with follicles on the tarsal conjunctiva

Flesh coloured bumps

Discharge is watery if popped

Tends to get worse before it gets better

Mollescum Contagiosm - treatment

Can resolve spontaneously over a few months

Refer if it doesnt resolve in over 2 months

No treatment usually necessary just advise on hygiene/reduction of transmission (as its a virus)

Treatment can include removal and cauterization/cryotherapy

What is this

Mollescum Contagiosm

What is Sqamous papilloma

Skin tag that can occur around the body

Sqamous papilloma - risk factors

Obesity

More common in older poeple

Sqamous papilloma - signs

Brownish or flesh coloured

Had a larger viewable size

Can appear nodular and/or finger like projections

Sqamous papilloma - treatment

Minimal risk so treatment is only cosmetic - surgical excision

Sqamous papilloma - symptoms

No symptoms

What is this

Sqamous papilloma

What is this

Sqamous papilloma

What is Cysts of Moll (apocrine hidrocystomas)

Benign, fluid filled cysts that develop from the blocked glands of moll

Cysts of Moll - symptoms

Painless unless infected

Cysts of Moll - signs

Small, round, fluid filled cysts on the eyelid margin

Translucent or bluish appearance

Slowly growing

Soft and fluctuant on palpation

Cysts of Moll - risk factors

Older people

Hot climates

Blockage of appocrine sweat gland (glands of moll)

Cysts of Moll - causes

Blockage of glands of moll

Accumuation of sweat and glandular secretions

Cysts of Moll - management/treatment

Warm compress to help it drain

Surgical excision

Antibiotics if infected

Needle aspiration (drains the fluid) - providees temporary relief but recurrance is common

What is Cysts of Zeiss

Benign, oil filled cysts that develop from the blocked glands of zeiss

Cysts of Zeiss - symptoms/signs

Small, round, yellowish cysts on the yelid margin

Painless

Slow. Growing

Firm to touch

Contains oily or sebaceous material

Cysts of Zeiss - risk factors

Older people

Poor lid hygeine

Cysts of Zeiss - causes

Blockage of glands of zeiss

Accumulation of sebaceous secretions

Cysts of Zeiss - management/treatment

Needle aspiration

Surgical excision

Warm compress

Antibiotics (if secondary infection occurs)

What is this

Cysts of Zeiss

What is this

Cysts of moll

What is a benign tumor

Abormal but noncancerous collection of cells that may or may not be progessive in its size

What is a malignant tumor

Abormal cancerous growth of cells that progresses and is expected to get worse, and is capable of invading adjacent tissues

What is metastasise

Spread to other parts of the body

Do benign or malignant lesions ulcerate?

Malignant

What is ulceration of a lesion

When theres a breakage or cratering of the skin

Are benign or malignant lesions painful

Benign are usually more painful but not always

If something is growing quickly and is painful it could be a cyst or infection rather than a tumor

Are benign or malignant lesions firm?

Malignant

What shape is a malignant lesion?

They have a very diffuse, irregular, asymmetric shape and are raised

The more weird the shape the more suspicious it is

Malignant lesions coloud

Usually darker if they have lots of material/pigment in them

But so can benign lesions

Do benign or malignant lesions cause telangiectasia?

Malignant

What is telangiectasia

When blood vessels appear more obviously

What is pearly border and they they appear in benign or malignant lesions

Malignant lesions

It is a rolled transculcent margins that are shiny and whitish

Do benign or malignant lesions have feeder vessels

Malignant

What are feeder vessels and what do they do

Cause the blood supply to look aggravated

Cancer cells need more blood becuase they grow at a faster rate so they encourage blood vessels to grow into them

What is basal cell carcinoma

A malignant skin cancer

Most common cancer in europe

Basal/squamous cell carcinoma - risk factors

Sun exposure (more common in people who live in sunny climates)

Old age