Lids and Lashes (pt 11)

Potential Dx for “how does my systemic disease affect my eyelids”

• Thyroid Eye Disease

• Rosacea

• Sturge-Weber Syndrome

Thyroid Eye Disease (TED)

Autoimmune condition that affects EOMs and fatty tissues behind the eye associated with hyperthyroidism, hypothyroidism, or normal thyroid function

TED risk factors

• Female

• Race (Black)

• 40+

• Smoking

• FHx

TED clinical findings

• Lids: Retraction and lagophthalmos

• Ocular surface: Unstable tear film, PEE, conj hyperemia (dry eye)

• EOM: Swelling, strabismus, restricted movement, proptosis

• Orbit: ON compression from orbital fat and EOM swelling (decreased VAs, APD, decreased color saturation)

TED complications

• PEE from exposure keratitis

• Secondary bacterial infections

• Diplopia

• Decreased vision and VF defects

TED Tx

• Systemic Tx for thyroid disease

• Lubrication and surgery

• Topical steroids and immunomodulators

• Prism

• Orbital decompression

TED NO SPECS

N: No signs or symptoms (if early in disease)

O: Ocular symptoms

S: Soft tissue involvement

P: Proptosis

E: EOM involvement

C: Corneal involvement

S: Sight

Rosacea

Chronic inflammatory skin condition

Common in fair skin individuals and middle aged females

Rosacea triggers

• Sun

• Spicy food

• Stress

• Alcohol

• Exercise

Rosacea clinical findings

• Red patches and dilated blood vessels on nose and cheek

• Swollen red bumps on face

• Enlarged nose

Rosacea ocular clinical findings

• Meibomian gland capping

• Telangiectasia of lids

• Conj hyperemia

• PEE

Rosacea vs. posterior blepharitis

Can’t tell difference, Tx are the same

Ocular rosacea complications

Corneal neovascularization and ulceration

Ocular rosacea Tx

• Lubrication

• Lid hygiene

• Oral doxycycline and tetracycline

Sturge-Weber Syndrome

Rare non0inherited congenital disorder by abnormal capillary development of brain, skin, and eyes

Sturge-Weber Syndrome clinical findings

• Port Wine Stain

• Headaches/migraines

• Seizures and convulsions

• Stroke like symptoms of body weakness and memory loss

Sturge-Weber Syndrome complications

Glaucoma

Sturge-Weber Syndrome Tx

• Systemic medications for seizures and headaches

• Laser for Port Wine Stain

• Glaucoma Tx with topical medications or surgery