Chalazion symptoms
- Painless lump
- Recurrent disease
- Gradual onset
- Blurred vision
- History of internal hordeolum
- Conjunctival granuloma
- Chronic
Chalazion
- Inflammatory and sterile not infectious
- Caused by the blockage of secretary gland the meiobian gland and zeis and moll
- Following acute infection such as internal haredolum
- Risk factors are chronic blepharitis, pregnancy and diabetes
Chalazion signs
- Well defined solid nodule on tarsal plate
- Eyelid eversion reveals conjunctival granuloma
Chalazion management
- Warm compression and hot spoon on closed eye
- Lid massage, breaks down the granulation
- Management of underlying disease chronic blepharitis
Reassurance and advice - Advice them it will take weeks/ months to resolve
- not an infection so can not take antibiotics
- If lump is large and interfering with vision might have to steroid infection
Hordeolum
Infection of glands - acute staphyloocal
red and tender
- Predisposing factors chronic blepharitis
- Infection of the meiobian gland
- Zeis and moll and eyelash follice infection
Hordeolum symptoms
- Tender lump
- Redness and swelled eyelid
- Epiphoria
- On the lid
- Hot to touch
- Painful
- Acute onset
Hordeloum Signs
Tender inflamed area of the lid/ tarsal plate caused by infection and inflammation anterior pointing posteriorly through the conjunctiva and skin
Hordeloum advice
- Warm compresses and hot spoon
- Epilation of eyelashes
- Management of undelying disease chronic blepharitis
Advice - It will take 1-2 weeks to resolve
- Internal hordeolum may turn into chalazion
- If discharge continues and no improvement give antibiotics to take 1 time day for 7 days
Ectropian
- Outward rotation of the eyelid margin
- Predosping by age increase in laxity
- Mostly bilateral about 70%
Causes - Cicatricial caused by trauma, burn or surgery
- invulation cause by older age as there is increase lid laxity and the eye muscles and tendons begin to weaken
- Parcytical nerve innervation problem to the eyelid muscle
- congenital, genetics, rare
- Mechanical, due to a trauma causing obstruction in or around the eye
Ectropian Symtoms
- Painful, discomfort and sign
- Redness
- Excessive lacrimation
Ectropian signs
- Lower lid no longer against the globe
- Abnormal attachment of the pauncta, visible all the time with no force pulling the eye
- Conjunctival hyperaemia, redness of the conjunctiva
- Exposure keratopathy exposure of the cornea causes epithelium damage due to excessive tears reaching and moistening it
Ectropian management
- Reassurance and advice caused by rubbing of the eyelids increase in laxity
- Ocular lubricants
For Manage keratitis
- Tap the lip close to reduce exposure
- Theraputic contact lenses
- Ocular lubricants
Where significant corneal involvement and risk of infectious keratitis
- urgent referral to the ophthalmologist
- Consider for surgery
Ectropian magnitude test
Snap back and distraction test can be done to measure the magnitude of ectropian
- snap back test, poor recovery means poor ocularis tone
- Distraction test, pull the eyelid down
lax>6mm
Floppy eyelid syndrome
- Not too common
- Symptoms presenting worse in the morning, gretty eyes, dry eyes
- Common on middle aged and obese men
- Easy eyelid eversion
- Abnormal snap back and distraction test
Entropian
- Tarsal and eyelid margin rotate inwards
- Predesposing factors, older age and cicatrising disease of conjunctival tarsal
Causes - Congenital, abnormal attachtment between the rector muscle and inferior tarsal plate
- Cicatrsial, scarring and contraction of the palpebral conjunctival tissue pulls the eyelid margin inwards
- Invulation, agre related degeneration atrophy of tarsal which supports the structure of the eye
Entropian symptoms
- Irritation
- Grittiness
- Blurrned vison
- Redness
- Lacrimation
Entropian signs
- Conjunctival scarring
- Conjunctival hyperaemia
- Absence of lower lid crease
Entropian mag test
- snap back and distraction test
Entropian management
- Tapping lid to cheek provides temporary relief
- Ocular lubricatnts
- Epilation of eyelashes associated
- Theraputic contact lenses
- Referral for surgery if rucurrent infection
Trichiasis
- Misdirection of lashes, growth in direction of the ocular surface
Cause - Congenital, failure of epithelial cell to differentiate completely to meiobiam gland
- Acquired, abnormal growth of the eyelid tissue following after an injury
Predisposing factors
- Staphyloccal blepharitis
- HZO
Trichiasis symptoms
- Discomfort/ foreign body sensation
- Lacrimation
- Hyperaemia
Trichiasis signs
- Rubbing of the lashers on the ocular surface
- Conjunctival redness
- Corneal epithelial abrasion
- Stain with flourasciene and check ocular surface
Severe sign - Corneal ulcer and infective keratitis due to constant rubbing of the eyelashes on the ocular surface and transferring infection
Trichiasis management
- Epilation, removal of troublesome lashes using forcep and sterile tweezer
- Therapeutic contact lenses
- Manage underlying cause such as blepharitis and or entropian
- Ocular lubricants at day time and ointment at night
Referral in severe cases with significant corneal involvement
- Electrolysis
- Laser photocoagulation
