6.1.4. Identifies external pathology and offers appropriate advice to patients not requiring referral.

Limbal dermoid

• Description

• Symptoms

• Signs

• Management

Congenital mass of collagen tissue covered by epithelium.

Typically appearing at inferotemporal limbus and may extend onto the cornea.

Symptoms: asymptomatic, cosmetic concern, FBS, dry eye

Signs: well circumcised oval, colour may be white/grey/pinkish

Management

• Manage any astigmatism and amblyopia risk in children

• Routine referral if lesion is affecting vision or significant cosmetics

Conjunctival inclusion cyst

• Description

• Symptoms

• Signs

• Management

Benign, fluid-filled lesion of conjunctiva

Formed when conj. epithelial cells become trapped beneath the surface

Symptoms: asymptomatic, FBS, dryness, cosmetic concern

Signs: smooth, thin-walled translucent cyst, mobile over the sclera

Management

• Lubricants for mild irritation and dryness

• Avoid manipulation

• Routine referral is symptomatic, rapidly enlarging, recurrent after rupture

Pyogenic granuloma

• Description

• Symptoms

• Signs

• Management

Common benign fibrovascular lesion

Pyogenic = pus forming. Occurs over chalazion after strabismus or pterygium removal

Symptoms: FBS, occasional bleeding, cosmetic concern

Signs: red, fleshy smooth mass, highly vascular, rapidly

growing, easily bleeds on touch, non-tender

Management

• Routine referral if persistent or enlarging, frequent bleeding.

• Topical or injected steroids, or excision

Pterygium

• Description

• Symptoms

• Signs

• Management

Wing-shaped fibrovascular growth of conjunctival tissue extending onto the cornea

Associated with chronic UV exposure and ocular surface irritation

Symptoms: asymptomatic, cosmetic concern, FBS, dryness

Signs: often nasal, bilateral, apex points to cornea centre, may cause flattening of corneal curvature (WTR astigmatism)

Management

• UV protection, lubrication

• Routine referral if progressive growth to visual axis or recurrent inflammation or serious cosmetic concern

Pinguecula

• Description

• Symptoms

• Signs

• Management

Benign, raised degeneration of bulbar conjunctiva

Often from UV exposure and chronic irritation

Symptoms: asymptomatic, FBS, cosmetic concern

Signs: yellow-white lesion, often nasal, non- vascular, smooth + un-keratinised

If inflamed = pingueculitis

Management

Reassure patient, UV protection & lubrication

If pingueculitis - lubricants and cold compress

Hordeolum

• Description

• Symptoms

• Signs

• Management

Acute, localised bacterial infection of lid glands

Usually caused by Staphylococcus aureus

Symptoms: painful, tender, swelling, warmth, FBS

Signs: (external) base of lid margin, visible pustule (internal) painful swelling deeper in lid, diffuse lid swelling

Management

• Warm compress & lid massage, lubrication

• Topical antibiotic ointment (chloramphenicol)

• Avoid squeezing or manipulation, avoid makeup

Chalazion

• Description

• Symptoms

• Signs

• Management

Chronic, sterile inflammation of meibomian gland

Common in people with meibomian gland

Symptoms: painless lump, cosmetic concern, discomfort

Signs: painless nodule with tarsal plate, may be more visible on conjunctival side

Management

• Warm compress & lid massage, lubrication

• Avoid squeezing or manipulation, avoid makeup

Sebaceous gland carcinoma

• Description

• Symptoms

• Signs

• Management

Malignant keratinised tumour from sebaceous glands

High malignant, often misdiagnosed as recurrent chalazion

Symptoms: painless, loss of lashes, unresolving lump

Signs: painless, firm, yellowish or pink nodule, madarosis

Management

• Refer urgently to ophthalmology

• Requires full-thickness lid biopsy

Basal cell carcinoma

• Description

• Symptoms

• Signs

• Management

Slow-growing, most common malignant eyelid tumour

Slow growth, locally invasive, non-metastasing

Symptoms: asymptomatic, bleeding, local itching

Signs: firm, raised, pearly nodule, vessels visible over lesion, may develop central ulcer with rolled edges Non-healing lesion that slowly enlarges over months

Management

Urgent referral to ophthalmology for surgical excision if:

Non-healing, lash loss, rapid growth, medial canthus involvement

Squamous cell carcinoma

• Description

• Symptoms

• Signs

• Management

Malignant tumour, high risk of metastasis Less common than basal, but more aggressive

Symptoms: pain, tenderness, crusting, bleeding

Signs: firm, irregular, nodular lesion, keratinised surface, bleeds easily or forms a crust, fast growth

Non-healing lesion that rapidly enlarges over months

Management

Urgent referral to ophthalmology for surgical excision if:

Non-healing, lash loss, rapid growth, medial canthus involvement

Trichiasis

• Description

• Symptoms

• Signs

• Management

Misdirection of lashes towards the globe Pain from rubbing on cornea or conjunctiva

Symptoms: FBS, watering, irritation, redness

Signs: interned lashes, punctate staining/corneal abrasion

Management

Epilation of offending lashes; lubricants or bandage CL

Refer if recurrent for electrolysis

Distichiasis

• Description

• Symptoms

• Signs

• Management

Extra row of lashes emerging from meibomian gland openings

Symptoms: irritation, tearing, redness

Signs: second row of fine lathes from posterior lid margin

Management

• Lubrication; epilation if few lashes

• Refer if extensive for electrolysis

Madarosis

• Description

• Symptoms

• Signs

• Management

Loss of eyelashes, may be due to inflammation, trauma or disease

Symptoms: cosmetic concern

Signs: missing or sparse lashes, associated with lid margins inflammation

Management

• Treat underlying cause

• Refer if suspicious malignancy (e.g. lash loss over lesion)