DR. NAILA ALI Assistant Professor OPHTHALMOLOGY.
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Transcript of DR. NAILA ALI Assistant Professor OPHTHALMOLOGY.
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DR. NAILA ALIAssistant Professor OPHTHALMOLOGY
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Categories.
Congenital Anomalies Inflammations Disorders of position. Trauma Tumours
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Inflammations/ Infections Stye Chalazion Lid cellulitis Preseptal orbital cellulitis Blephritis
AnteriorPosterior
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Treatment Options for Trichiasis
1. Epilation - but recurrences within few weeks
2. Electrolysis - but frequently repeated treatments required
3. Cryotherapy - for many lashes
4. Laser ablation - for few scattered lashes
5. Surgery - for localized crop resistant to other methods
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Stye (Common Boil)
Small abscess, staph infection of the eyelash, gland of Zeis or Moll
Tender, inflammed swelling in lid margin, single or multiple, may involve entire lid margin– preseptal cellulitis
Treat with hot compresses, removal of eyelash or systemic antibiotics in severe cases
Drain if puss points
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Chalazion (Tarsal cyst or mebomian cyst)
Chronic inflammatory granuloma of mebomian gland—blockage and accumulation of secretions
One or more glands involved, mainly children and young adults involved
Swelling, heaviness, irritation blurring if large- induced
astigmatism
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Chalazion (Tarsal cyst or mebomian cyst)
Small, cystic, hard swelling a little away from the lid margin, fixed to tarsus, non-tender
No signs of inflammation,no lymphadanopathy
Small may resolve, may remain the same, may burst on skin- fistula may infect- internal hordeolum.
treatment Surgery steroid injections Leave alone the small ones.
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Signs of chalazion (meibomian cyst)
Painless, roundish, firm lesion within tarsal plate
May rupture through conjunctiva and cause granuloma
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Histology of chalazion
Multiple, round spaces previously containing fat with surrounding granulomatous inflammation
Epithelioid Multinucleated cells giant cells
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Treatment of chalazion
Injection of local anaesthetic Insertion of clamp Incision & curettage
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Acute hordeola
• Staph. abscess of •Meibomian glands• Tender swelling • May discharge through skin or conjunctiva
• Staph. abscess of lash follicle and gland of Zeis or Moll• Tender swelling at lid margin
• May discharge through skin
Internal hordeolum ( acute chalazion )
External hordeolum (stye)
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Lid cellulitis Etiology
Multiple styes Insect bites Trauma Clinical features
whole of the lid is involvedtender indurationmay lead to abscess formation/ skin necrosis
TreatmentSystemic antibioticsDrainage
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•
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CHRONIC MARGINAL BLEPHARITIS
1. Anterior• Staphylococcal• Seborrhoeic
• Meibomianitis• Meibomian seborrhoea
2. Posterior
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Blephritis
Usually chronic infection of the lid margin
Common external eye disease Causes—not clear but staph infection
and sebhorrea play a part Associated with tear film instability Anterior and posterior variety
Anterior blephritis—staph or ulcerative and Sebhorroeic or squamous
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Staph Anterior Blephritis Chronic infection of the bases of the
lashes resulting in tiny intrafollicular abscesses
Secondary dermal and epidermal ulceration and tissue distruction
More common in children but may affect any age group
Females more affected than males Unhygienic conditions and dietary
factors involved
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Staph Anterior Blephritis—Cont.
Symptoms:Sourness of lid marginLacrimation, itching and photophobia
Signs:Yellow crusts at the roots of the lidsOn removing the crusts, small ulcers may appearFall of the lashes—either not replaced or abnormal replacement
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ComplicationsIf not treat may lead to
Poliosis, madarosis, trichiasis, tylosis
Treatment:General:
Improvement in general healthBalanced dietCorrection of refractive errors
Local:Broad spectrum antibiotic ointment, steroid ointment
Artificial tears. Treat the sequlae.
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Staphylococcal blepharitis
• Hyperaemia and telangiectasia of anterior lid margin• Scarring and hypertrophy if longstanding
Scales around base of lashes (collarettes)
• Chronic irritation worse in mornings
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Sebhorroeic Ant Blephritis Disorder of the glands of Zeis and
Moll Sebhorreoa may involve scalp,
eyebrows, nasolabial folds, retroauricular area and sternum.
Oily type and dry type (true seborrheoa)
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Sebhorroeic Ant Blephritis Symptoms:
less severe, discomfort in the eyes, lacrimation, tear film instability (stinging)
Signs:Shiny, waxy appearance of the anterior lid margin, dandruff like desquamation lid epidermis (yellow, greasy scales)
Treatment:Lid hygiene— artificial tearsScalp treatment with antidandruff lotion
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Seborrhoeic blepharitis
• Shiny anterior lid margin • Greasy scales • Lashes stuck together• Hyperaemia of lid margin
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Posterior Blephritis
May present as:*Dysfunction of the mebomian glands.*Isolated mebomian seborrhoea and primary mebomenitis.*Combination of ant. Seb. Blephritis and meibominitis
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Primary Mebominitis
Diffuse inflammation around glands Associated with acne rosacea (2/3rd) or Seb. Dermatitis (1/3rd)Signs:
*Pouting of gland orifices with dome of secretions—may become solid. (tooth-past like)*Obliteration of ducts—dilatation (thick, round, vascularised, notched Posterior border)*Secondary changes include papillary conjunctivitis, punctate epitheliopathy, and tear film instability (stinging)
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Meibomianitis
Meibomian cyst formation Thickened posterior lid margin
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Mebomian Seborrheoa
Dilated mebomian glands—easily expressed
Tear film is oily and foamy In severe cases—mebomian foam at
medial canthus.
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Meibomian seborrhoea
Oil globules over meibomian gland orifices
Oily and foamy tear film
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Treatment:A: Systemic antibiotics
Tetracycline, Doxocycline, Erythromycin
B: Others:Lid hygiene, topical steroids,
artificial tears.C: Local measures:
Warm compresses, mechanical expressions of secretions
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Complications
Recurrent styes
Marginal keratitis Tear film instability
trichiasis, madarosis , poliosis
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Trauma
Lid margin Lid tissue Loss of lid tissue
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Eyelid haematoma
Orbital roof fracture if associated withsubconjunctival haemorrhage without visible posterior limit
Usually innocuous but exclude associated trauma to globe or orbit
Basal skull fracture - bilateral ring haematomas (‘panda eyes’)