Eye: Infections,Tumors and Deformities of Eyelids

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EYELIDS- INFECTIONS, TUMORS AND DEFORMITIES
  1. Hordeolum
  • Is an infection of the sebaceous glands in the lid margin.
  • Common bacterial infective agent - staphylococcus aureus.
  • C/F- Red swollen circumscribed & acutely tender area develops rapidly.
  • Treatment- Application of warm, moist compresses at least 4 times per day is beneficial. Antibiotic ointments or drops.
  1. Chalazion
  • Chronic inflammatory granuloma of the sebaceous (meibomian) glands in the lid.
  • It may evolve from a hordeolum.
  • Usually appears on the upper lid as a swollen, tender reddened area that may be painful.
  • Treatment is similar to hordeolum
  • Surgical removal of lesion as well as Injection with corticosteroids
  1. Blepharitis
  • Chronic bilateral inflammation of the lid margins, caused by staphylococcal infection
  • The lids are red rimmed with many scales or crusts on the lid margins & lashes.  
  • C/F- itching, burning, irritation & photophobia

 Eyelid deformities
There are many deformities that can affect the eyelids. These can be congenital, acquired or posttraumatic.
Common deformities include the following:
  • Ectropion- turning out of the eyelid Entropion- turning in of the eyelid
  • Lid retraction - pulling of the lower eyelid downward or upper eyelid upward
  • Telecanthus -abnormally long distance from the inside corner of the eye to the nose
  1. Lid retraction
Abnormally high position of upper lid with rim of sclera visible above the cornea. Most commonly a sign of thyroid disease (50% of patients will be euthyroid).
  1. Telecanthus
Abnormally long distance from the inside comer of the eye to the nose
  1. Ectropion -
  • When the lower eyelid turns outwards, it hangs away from the eyeball forming a kind of a bucket or a pocket around the eye.  
  • Though it does not cause any problem in general, but when the tears start collecting, this bucket overflows making the lower eyes water continuously.  
  • On the other hand, this makes the middle part of the eye exposed, thereby making it dry and irritated and more prone to eye infections.
Causes
l . Cicatricial ectropion- contracture or loss of eyelid skin by burns, trauma, infection etc.
2.Paralytic ectropion- Paralysis of the Orbicularis Oculi muscle which closes the eye.
3.Senile ectropion- results from stretching of the lower eyelid tissues in old age.
4.Mechanical ectropion- by tumour or thickening of the lower eyelid, which by its weight pulls the eyelid away from the eyeball
Management
  • The Z plasty- If there is only a localised linear scar it may be possible to release the contracture caused by the sear with a Z- plasty   
  • Skin graft - If there is an extensive loss of skin
  • Tarsorrhaphy- closes the eyelids with sutures
4. Entropion --
  • Both, upper and lower, lids turn inwards
  • This leads to the eye lashes rubbing the eye ball, resulting in irritation in the eye, which may feel painful and watery.
  • Also cause damage to the sclera or the cornea, which might further turn into an ulcer resulting in the loss of vision.
Causes
l . Contracture of the tarsal conjunctiva and distortion of the tarsal plate
2.  Laxity of the connective tissue and the tarsal plate of the lower lid in old age
Management
l . To remove the lashes.
  • Epilation
  • Cutting the lashes
  • Electrolysis
  • Cryotherapy
  • Excision of lash follicles or small clumps of lashes  
2. To operate to alter the direction of the lashes, and correct the deformity in the tarsal  plate. 
5. Ptosis
Means a drooping of the upper eyelid
Causes
A congenital abnormality of the levator muscle which elevates the upper lid.
A paralysis of the third cranial nerve supplying the levator muscle
A paralysis of the cervical sympathetic nerve supplying Muller's muscle/ tarsal muscle
Senile stretching of the insertion of the levator muscle into the upper lid.
Myopathy or myasthenia affecting the levator muscle.  
Trauma to the upper lid.




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notes.nursium.com: Eye: Infections,Tumors and Deformities of Eyelids
Eye: Infections,Tumors and Deformities of Eyelids
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