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I (Allah) Swear by the (passing)time.(1)

I (Allah) Swear by the (passing)time.(1). Indeed mankind is in loss (because of this loss of time)(2). Except those, who are believers, and have done righteous deeds, and advise each other to truth and patience.(3). Dr. Faizur Rahman Professor of Ophthalmology Peshawar Medical College.

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I (Allah) Swear by the (passing)time.(1)

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  1. I (Allah) Swear by the (passing)time.(1) Indeed mankind is in loss (because of this loss of time)(2) Except those, who are believers, and have done righteous deeds, and advise each other to truth andpatience.(3)

  2. Dr. Faizur Rahman Professor of Ophthalmology Peshawar Medical College Inflammations and Infections of the Eyelids

  3. Coloboma • Epicanthus • Distichiasis • Blephrophimosis syndrome • Anchyloblephron • Congenital ectropion • Telecanthus Congenital anomalies

  4. Coloboma of the Eyelid

  5. EPICANTHIC FOLDS • BILATERAL VERTICAL FOLDS OF SKIN THAT EXTEND FROM UPPER OR LOWER LID TOWARDS MEDIAL CANTHUS. • MAY GIVE RISE TO PSEUDO-ESOTROPIA

  6. Congenital Dystichiasis

  7. Blephrophimosis Syndrome

  8. Ankyloblephron

  9. Congenital Ectropion • Aetiology • Clinical features • Treatment

  10. TELECANTHUS • UNCOMMON • INCREASED DISTANCE BETWEEN THE MEDIAL CANTHI AS A RESULT OF ABNORMALLY LONG MEDIAL CANTHAL TENDONS • TREATMENT • SHORTENING AND REFIXATION OF MEDIAL CANTHAL TENDONS

  11. EPIBLEPHARON • COMMON IN ORIENTALS • EXTRA HORIZONTAL FOLD OF SKIN STRETCHES ACROSS ANT. LID MARGIN & LASHES ARE DIRECTED VERTICALLY • TREATMENT • RECOVER SPONTANEOUSLY • PERSISTENT CASES REQUIRE HOTZ PROCEDURE

  12. Congenital Anomalies • Inflammations • Disorders of position. • Trauma • Tumours Categories.

  13. ALLERGIC DISORDERS • Acute allergic oedema • Contact dermatitis • Atopic dermatitis • INFECTIONS • Herepes zoster ophthalmicus • Impetigo • Erysipelas • Stye • Internal hordeolum • CHRONIC MARGINAL BLEPHARITIS • Anterior blepharitis • Posterior blepharitis • MISCELLANEOUS INFLAMMATIONS OF EYE LID

  14. ACUTE ALLERGIC OEDEMA • INSECT BITES, ANGIOEDEMA, URTICARIA, DRUGS • SUDDEN ONSET OF PAINLESS, PITTING PERIORBITAL AND LID OEDEMA • TREATMENT • SYS. ANTI-HISTAMINES

  15. CONTACT DERMATITIS • ANY SENSITIVITY TO TOPICAL MEDICATION • LID OEDEMA • ERYTHEMA • TEARING • ITCHING • TREATMENT • REMOVAL OF CAUSE • TOPICAL STEROIDS

  16. Patient with a nail polish allergy, otherwise known as eczematoid allergy.

  17. Atopic dermatitis • Common idiopathic skin condition • Associated with asthma and hay fever • Presentation: • Chronic irritation and itching • Associated with more generalized skin lesions

  18. Close-up of a patient with atopic dermatitis of the face demonstrating darkening of the lids

  19. Signs: • Bilateral thickening , crusting and fissuring • Treatment: • Emollients such as oily cream • Mild topical steroid such as hydrocortisone 1% • Secondary infection require antibiotic therapy.

  20. Acute subcutaneous spreading cellulitis caused by strep pyogens causes eyelid necrotization and secondary eyelid contracture • Signs: Red well defined indurated expanding subcutaneous plaque • Treatment: • Oral phenoxymethylpencillin Erysipelas

  21. Unilateral condition effects children • Sign: crops of small vesicles associated with mild lid oedema associated with ipsilateral follicular conj and keratitis • Treatment: • Acyclovir or penciclovir cream Herpes simplex

  22. HERPES ZOSTER OPHTHALMICUS • VARICELLA-ZOSTER VIRUS • ELDERLY AND IMMUNOCOMPRISED • PRESENTS WITH PAIN IN THE DISTRIBUTION OF 5 NERVE • MACULOPAPULAR RASH OVER FOREHEAD • PROGRESSION THROUGH VESICLES, PUSTULES TO CRUSTING & ULCERATION

  23. TREATMENT • SYSTEMIC • VALACYCLOVIR OR FAMCYCLOVIR FOR 7 DAYS • TOPICAL, • ACYCLOVIR • STEROID-ANTIBIOTIC COMBINATION • TALC & CALAMINE TO BE AVOIDED HERPES ZOSTER OPHTHALMICUS

  24. IMPETIGO • UNCOMMON • SUPERFICIAL SKIN INF. CAUSED BY Staph. aureus OR Strep. Pyogenes • MACULES THAT RAPIDLY DEVELOP INTO VESICLES & BULLAE TO PRODUCE YELLOWISH CRUSTS • TREATMENT • TOPICAL ANTIBIOTICS • ORAL CLOXACILLIN / ERYTHROMYCIN

  25. STYE • EXTERNAL HORDEOLUM • AN ACUTE STAPH. INFECTION OF LASH FOLLICLE AND ITS GLAND OF ZEIS OR MOLL • TREATMENT • HOT COMPRESSES • EPILATION OF LASH

  26. INTERNAL HORDEOLUM • AN ABSCESS CAUSED BY AC. STAPH INFECTION OF MEIBOMIAN GLAND • TREATMENT IS INCISION AND CURETTAGE

  27. CHALAZION • MEIBOMIAN CYST • CH. STERILE LIPO-GRANULOMATOUS INFLAMMATORY LESION • BLOCKADE OF GLAND ORIFICES AND STAGNATION OF SECRETIONS • NON TENDER, ROUND, FIRM LESION • EVERSION OF LID MAY SHOW AN ASSOCIATED CONJ. GRANULOMA

  28. CHALAZION • TREATMENT • SURGERY • STEROID INJECTION • SYSTEMIC TETRACYCLINE

  29. BLEPHARITIS

  30. Inflammation or infection of the eyelid margins • One the most common ophthalmological complications as well as one of the most difficult conditions to treat. BLEPHARITIS

  31. TRADITIONAL • STAPHYLOCOCCAL • SEBORRHEIC • MIXED CLASSIFICATION

  32. McCulley’s • STAPHYLOCOCCAL • SEBORRHEIC • SEBORRHEIC WITH STAPH. SUPER-INFECTION • SEBORRHEIC WITH MEIBOMIAN SEBORRHEA • SEBORRHEIC WITH SECONDARY SPOTTY MEIBOMIANITIS • PRIMARY MEIBOMIANITIS CLASSIFICATION

  33. STAPHYLOCOCCAL • SEBORRHEIC • MEIBOMITIS • LOCALIZED • GENERALIZED • ACNE ROSACEA CLASSIFICATION

  34. Duration of ocular symptoms • Unilateral or bilateral presentation • Association with potential exacerbating conditions • Smoke • Allergens • Wind • contact lenses • low humidity • Recent exposure to an infected individual (e.g., pediculosis) HISTORY

  35. Ocular history • previous ophthalmic surgery • Trauma (including radiation and chemical trauma) • Systemic history • dermatological diseases, such as acne, rosacea, eczema, allergies) • Use of ocular medications or retinoids. HISTORY

  36. Visual acuity • Careful external examination of facial skin, eyelids, and eyelashes. • Slit lamp biomicroscopy • Tear film • Anterior eyelid margin, eyelashes, posterior eyelid margin, tarsal conjunctiva, bulbar conjunctiva, and cornea. • Tests • Lissamine green • Rose bengal • Tear break-up time • Schirmer testing • Cochet-Bonnet esthesiometry to check corneal sensation for a unilateral case EXAMINATION

  37. ALSO CALLED INFECTIVE BLEPHARITIS • Staphylococcus Aureus And Epidermidis • 80% ARE YOUNG WOMEN • USE OF COSMETICS • USUALLY UNILATERAL IN CHRONIC CASES MAY BE BILATERAL • SYMPTOMS • BURNING, ITCHING, STINGING • EYESTRAIN • PHOTOPHOBIA • FOREIGN BODY SENSATION • WORSE IN THE MORNING STAPHYLOCCAL BLEPHARITIS

  38. SIGNS • BRITTLE, HARD SCALES WITH COLLARETTES AROUND CILIA • STERILE CORNEAL INFILTERATES 1mm FROM THE LIMBUS • SMALL ULCERATIONS • PANNUS • MADAROSIS • POLIOSIS • TRICHIASIS Patient with chronic staphylococcus blepharitis.

  39. STAPHYLOCCAL EXOTOXINS • STAPHYLOCCAL EXOTOXINS HAVE BEEN IMPLICATED AS A CAUSATIVE AGENT FOR BOTH MARGINAL INFILTRATES AND PHLYCTENULAR DISEASE ASSOCIATED WITH BLEPHARITIS

  40. AGGRESSIVE EYELID HYGIENE • WARM COMPRESSES • EYELID SCRUBS • TOPICAL ANTIBIOTIC • ERYTHROMYCIN • BACITRACIN • TOPICAL CORTICOSTEROIDS • IN MARGINAL INFILTRATES AND PHLYCTENULAR DISEASE TREATMENT

  41. GENERALIZED SEBACEOUS GLAND ABNORMALITY EXTENDING ONTO EYELID MARGIN • USUALLY BILATERAL • SYMPTOMS • ARE USUALLY OUT OF PROPORTION TO PHYSICAL FINDINGS SEBORRHEIC BLEPHARITIS

  42. CLINICAL FINDINGS • MAY REVEAL MILD INFLAMMATION OF ANTERIOR LID MARGIN • ERYTHEMA • EDEMA • TELANGIECTASIA AT LID MARGIN • SCALING & CRUSTING AT LID MARGIN OFTEN EXTENDING ONTO LASHES “SCURF”

  43. EYELID HYGIENE • WARM COMPRESSES • EYELID SCRUBS • LOCAL ANTIBIOTICS • IF SUPERINFECTION IS SUSPECTED • SELENIUM SHAMPOO • FOR CONCURRENT SCALP SEBORRHEA TREATMENT

  44. MEIBOMIAN GLAND INFLAMMATION • LOCALIZED MEIBOMITIS • CHALAZION • INTERNAL HORDEOLUM • GENERALIZED MEIBOMITIS • MEIBOMIAN SEBORRHEA • MEIBOMIAN KERATOCONJUNCTIVITIS MEIBOMIANITIS

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