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DISEASES OF THE EYELID AND ADNEXAE

DISEASES OF THE EYELID AND ADNEXAE. Disorders of the lashes. Trichiasis : Abnormal position of the eyelashes common, acquired, unilateral, bilateral. Causes: Idiopathic, blepharitis , HZO , trachoma, trauma, burns . Compl : punctate epithelial erosions, ulcer, pannus formation.

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DISEASES OF THE EYELID AND ADNEXAE

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  1. DISEASES OF THE EYELID AND ADNEXAE

  2. Disorders of the lashes • Trichiasis : Abnormal position of the eyelashes • common, acquired, unilateral, bilateral. • Causes: • Idiopathic, blepharitis, HZO, trachoma, trauma, burns. • Compl: punctate epithelial erosions, ulcer, pannus formation. • Rx: epilation, cryoRx, electrolysis, laser ablation,surgery(wedge resection or anterior lamellar excision.)

  3. Madarosis • Decrease in number or complete loss of lashes. • Causes: blepharitis, burns, radio Rx syphilis, leprosy, gen. alopecia, iatrogenic, trichotilomania. • POLIOSIS • Premature Whitening of hair which may involve lashes and eyebrows. Seen in chronic blepharitis and sympathetic ophthalmitis.

  4. Lid disorders • Allergic disorders: • Acute allergic edema: unila/bilat, painless pitting periorbital lid edema. • Rx: systemic antihistamines. • Contact dermatitis: sensitivity to topical agents;: erythema, crusting. • Rx: topical steroids.

  5. Atopic dermatitis (eczema) • Very common, assoc with asthma and hay fever. • Chronic irritation, itching, thickening, crusting and fissuring of the eyelids. • Rx: oily cream to hydrate the skin, topical hydrocortisone cream, topical antibiotics for secondary infection. • INFECTIONS: • Blepharitis: anterior, posterior, mixed. • Associated with staphylococcal infection, seborrhea and meibomianitis.

  6. Symptoms include: • Burning sensation, grittiness, photophobia, xterized by remissions and exacerbations. • Signs: • Hyperaemia, scales(staph blepharitis), greasy lashes, oil globules capping the meibomian gland orifices. • Rx: systemic tetracyclines for 6-12wks. Avoid in pregnant women and children less than 12 years.

  7. Contd.. • Erythromycin but not as effective. • Lid hygiene • Artificial tears • Topical steroids • Warm compress to melt solidified sebum. • Herpes simplex: uncommon, unilateral, affects children. Severe in atopic or immunocompromised pts.

  8. Contd: • Small vesicles, mild lid edema +/- folloicular conjunctivitis and keratitis. • Rx: acyclovir or penciclovir cream. • HZO: • common, unilateral, initially more common in the elderly, seen now in the young due to immunodeficiency. • Pain in the 1st division of trigerminal nerve, maculopapular rashes followed by vesicles then pustules and crusting ulceration.

  9. Periorbitaledema due to secondary bacteria infection. May affect the 2nd eye giving a false impression of bilateral disease.. • Rx: topical acyclovir, steroid antibiotic cream egterracortril. • Systemic valaciclovir 3 X daily for 1 week.

  10. Nodules and cysts • Chalazion: meibomian cyst. • Lipogranulomatous inflammatory lesion • Painless roundish nodule • Asso with acne rosacea or seborrhoeic dermatitis. • Rx: • Incision and curettage • Intralesional injection of 0.1-0.2mlsof triamcinolone mixed with xylocaine. • Systemic tetracycline for prophylaxis.

  11. External hordeolum (sty) • Acute staphylococcal abscess of a lash follicle and the assoc gland of Zeis or moll. • Tender inflamed swelling pointing anteriorly. • Multiple swellings: preseptalcellulitis. • Rx: • No Rx • Warm compress • Epilation • Systemic antibiotics.

  12. Internal hordeolum • Acute staphylococcal infection of the meibomian gland. • Tender, inflamed swelling within the tarsal plate. • May discharge anteriorly through the skin or posteriorly through the conjunctiva. • Rx: acute infection with antibiotics. • I&C for residual nodule.

  13. Xanthelasma • Common ,frequently bilateral. • Seen in the elderly and in hypercholesterolaemia. • Rx: • For cosmesis • Excision • Vaporisation with carbon dioxide laser.

  14. Molluscumcontagiosum • Uncommon skin infection caused by pox virus. • Multiple and confluent in immunodeficiency and difficult to treat. • Pale umbilicated nodules. • On the lid margin, may cause ipsilat chronic follicular conjunctivitis. • Occasional superficial keratitis. • Rx: shave excision, cautery, laser, cryoRx.

  15. Ectropion • Involuional • Cicatricial • Paralytic • Mechanical • MGT: • Prevent exposure keratopathy • Surgery • Remove the cause.

  16. Entropion • Involutional • Cicatricial • Congenital • Rx: • Protect the cornea. • Surgery.

  17. Ptosis • Drooping of the upper lid. • Causes: • Neurogenic: 3rd nerve palsy, horners syndrome. • Myogenic: myaesthenia gravis, myotonic dystrophy • Aponeurotic: involutional, post operative. • Mechanical: chalazion, NF • Rx: • Depends on the cause.

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