Lid Disorders

Question 1

Blepharitis-

Etiology

Answer 1

Etiology

• allergic conjunctivitis
• smoking
• contact lens use
• retinoid use
• may involve bacterial or parasitic infection/infestation

Question 2

Blepharitis-

Pathophysiology

Answer 2

Pathophys

Posterior Blepharitis

• inflammation of inner portion of the eyelid
• hyperkeritinization of meibomian gland ductal epithelium
• alteration of secretion
• favorable environment for bacterial growth

Anterior Blepharitis

• Inflammation at base of eyelashes
• Bacterial: fibrinous scales crust around eyelashes (S aureus or coag negative staph)
• Parasitic: demodex folliculorum
• Seborrheic:: dandruff-like skin changes, greasy scales at base of eyelids

Question 3

Blepharitis-

Clinical Presentation

Answer 3

Clin Presentation

• Rosachea (posterior blepharitis)
• Seborrheic dermatitis (posterior blepharitis)
• chronic infection (posterior bepharitis - coag neg staph, corynebacterium sp, cutibacterium acnes)

Hx

• red, swollen itchy eyes
• gritty burning
• tearing
• crusting lashes
• light sensitivity

PE
-Anterior bacterial and demodex
Adherent material around lashes
Colarettes (bacterial) or sleeves (demodex)
-Anterior Seborrheic
Greasy flakes
-Posterior
Enlarged meibomian gland opening/plugging
-Conjunctival infection
-Increased tear break up time and evaporative loss (more likely in posterior)

Question 4

Blepharitis-

Management

Answer 4

Tx

Mild/Moderate
-Lid Hygiene routine (2-4 times daily for tx, 1-2 for prevention)
      Warm compress
      Lid massage
      Lid wash
      Apply artificial tears

Severe

• refer to ophthalmologist
• continue lid hygiene
• topical antibiotic (bacitracin or erythromycin to lid margins at bedtime)
• oral antibiotics (after topical has failed - doxycycline, tetracycline, azithromycin)
• topical tree oil, invermectin antibiotic (demodex)

Question 5

Blepharitis-

Prevention

Answer 5

Prevention

• limit triggers (smoking)
• lid hygiene
• dispose old cosmetics, applicators

Question 6

Chalazion

Answer 6

Overview

• Inflammation/obstruction of sebaceous glands of eyelids
• first, eyelid swelling and erythema
• SLOW GROWING, RUBBERY, PAINLESS LESION
• often heal on their own
• may need lid hygiene or glucocorticoids injected into lesion

Question 7

Hordeolum

Answer 7

Overview

• acute PURULENT inflammation of eyelid (usually bacterial)
• Internal: meibomian gland
• External: “STYE” - eyelash follicle or Zeis gland
• Lid hygiene routine
• may develop into chalazion or spread to cellulitis (oral antibiotics needed then)
• usually treated with topical abx

Question 8

Entropion

Answer 8

Overview

• Inward turning of lower lid (degeneration of lid fascia)
• more common in elderly
• acute irritation and scarring from lashes rubbing cornea
• surgical repair usually tx
• lubrication and Botox also therapy (spastic variants)

Question 9

Ectropion

Answer 9

Overview

• OUTWARD turning of lower lid
• commonly age related (weakness of cantonal ligaments and pretarsal obicularis muscle)
• Irritated red eye with tearing
• constantly wipe eyes
• most repaired surgically

Question 10

Xanthelasma

Answer 10

Overview

• Cholesterol-filled, soft, yellow plaques on medial aspects of the eyelids
• 50% xanthelasma pts will also have hypercholesterolemia
• 75% older pts with hypercholesterolemia will have xanthelasma
• Middle aged and older adults
• Tx is cosmetic (lesions are harmless)
• CHECK LIPID PANEL FOR ALL PTS WITH THESE LESIONS

Question 11

Basal Cell Carcinoma

Answer 11

Overview

• MOST COMMON MALIGNANT TUMOR OF EYELID
• more likely in fair skinned and Hx of prolonged sun exposure
• small, slow growing, firm, painless and indurated
• more common in lower lid
• rarely metastasizes
• may have telangiectasia
• surgical excision treatment

Question 12

Squamous Cell Carcinoma

Answer 12

Overview

• Less common but faster growing than basal cell
• fair skinned, Hx long sun exposure
• can be new lesion or transformation of actinic keratosis
• lower lid nodule or plaque with exerted edges and crusting
• confirm with biopsy
• surgical excision treatment (radiation is alternative)

Question 13

Melanoma

Answer 13

Overview
-2/3 of all tumor related deaths
-nodular most common form
-risk factors
     Excessive sun
     Genetics
     Caucasian
     Changing skin nevi
-irregular borders, discoloration
-wide surgical excision with regional lymph node dissection if extension suspected