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Lid 2

The document discusses various eyelid conditions, including chronic blepharitis, styes, chalazia, xanthelasma, and basal cell carcinoma (BCC). It outlines symptoms, signs, and treatment options for each condition, emphasizing the importance of lid hygiene, antibiotics, and surgical interventions where necessary. Additionally, it highlights the differences between benign and malignant tumors, particularly focusing on BCC and squamous cell carcinoma (SCC).

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12 views4 pages

Lid 2

The document discusses various eyelid conditions, including chronic blepharitis, styes, chalazia, xanthelasma, and basal cell carcinoma (BCC). It outlines symptoms, signs, and treatment options for each condition, emphasizing the importance of lid hygiene, antibiotics, and surgical interventions where necessary. Additionally, it highlights the differences between benign and malignant tumors, particularly focusing on BCC and squamous cell carcinoma (SCC).

Uploaded by

murtadaadnan99.5
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Ophthalmology Eye lid 2

Dr.RanaDakhil
M

Chronic blepharitis
(chronic marginal blepharitis) is inflammation of the lid margin a very common
cause of ocular discomfort and irritation. Blepharitis may be subdivided into
anterior and posterior, although there is considerable overlap and both types are
often present (mixed blepharitis).

• Anterior blepharitis affects the area surrounding the bases of the eyelashes and
may be staphylococcal or seborrhoeic.
• Posterior blepharitis is caused by meibomian gland dysfunction and alterations in
meibomian gland secretions.
sebaceous gland-dwelling mite Demodex and other microorganisms may play a
causative role in some patients.

Symptoms
Burning, grittiness, mild photophobia, and crusting and redness of the lid margin.
The symptoms are characterized by remissions and exacerbations. usually worse
in the mornings.

Signs
staphylococcal blepharitis Hard scales and crusting mainly located around the
bases of the lashes.Mild papillary conjunctivitis and chronic conjunctival
hyperaemia are common.Long-standing cases may develop scarring and notching .
seborrhoeic blepharitis
Hyperaemic and greasy anterior lid margins with soft scales and adherence of
lashes to each other .
posterior blepharitis
capping of meibomian gland orifices with oil globules .Hyperaemia and
telangiectasis of the posterior lid margin.Pressure on the lid margin results in
expression of meibomian fluid that may be turbid or toothpaste-like.The tear film
is oily and foamy .

Treatment
• Lid hygiene can be carried out once or twice daily initially;
A warm compress . scrubbing the lid margins with a cotton bud or clean facecloth
dipped in a warm dilute solution of baby shampoo or sodium bicarbonate.
Commercially produced soap/alcohol impregnated pads

1
Antibiotics
* Topical sodium fusidic acid, erythromycin, bacitracin, azithromycin or
chloramphenicol .
* Oral antibiotic regimens include doxycycline other tetracyclines, or
azithromycin . antibiotics are thought to reduce bacterial colonization and may also
exert other effects such as a reduction in staphylococcal lipase production with
tetracyclines.
Topical steroid. A low potency preparation .
Tear substitutes.

Inflammations of the lid

1.Stye (External hordeolum) :


• Acute Staphylococcus infection of a eyelash hair follicle or one of the
associated glands.
• Clinical features; small tender swelling in the lid margin
• Treatment;
a- Hot compresses
b- Topical antibiotics eye ointment
c- Epilation (removal of eyelashes by a forceps) to enhance drainage of pus.
d- Systemic antibiotics if there is severe preseptal cellulitis.

2. Internal hordeolum;
 Acute Staphylococcus infection of a meibomian gland
 Clinical features; tender hyperemic, swelling within the lid .
 Treatment;
 Topical antibiotics
Surgical drainage for the residual nodule after the acute infection has resolved.

Chalazion

2
(meibomian cyst) is a sterile chronic granulomatous inflammatory lesion
(lipogranuloma) of the meibomian, or sometimes Zeis, glands caused by retained
sebaceous secretions.
Blepharitis is commonly present. A recurrent chalazion should
be biopsied to exclude malignancy.
Symptoms gradually enlarging painless rounded nodule , sterile inflammation or
bacterial infection with localized cellulitis .
• Signs
○ A nodule within the tarsal plate, sometimes with associated inflammation.

Treatment

• Oral antibiotics are required for significant bacterial infection, but not for sterile
inflammation.
• Conservative. At least a third of chalazia resolve Spontaneously.

• Hot compress .
• Expression.
• Steroid injection .
.Surgery

Xanthelasma
is a common, bilateral condition typically affecting middle-aged and elderly
individuals. It is a subtype of xanthoma. A yellowish subcutaneous plaques,
usually in the medial aspects of the eyelids.
Hyperlipidaemia is found in about one-third of patients, in whom corneal arcus
may also be present.

Treatment
Recurrence occurs in up to 50%,

• Simple excision .
• Microdissection.

Basal cell carcinoma (BCC)


3
BCC is a common human malignancy and most frequently affects elderly patients.
People with fair skin and chronic exposure to sunlight are at particular risk. BCC is
the mostcommon malignant lid tumor, accounting for 90% of all cases. This tumor
most frequently affects the lower lid. It is a slow growing tumor and locally
invasive but non-metastasizing. It arises from the basal layer of the epidermis.

Clinical types:
1- Nodular: slow growing, firm, pearly nodule with dilated surface vessels.
2- Noduloulcerative (rodent ulcer): has central ulceration, raised rolled edges
and dilated blood vessels over its lateral margins.
3- Sclerosing: indurated plaque with loss of lashes.

Squamous cell carcinoma (SCC)


SCC is much less common, but more aggressive tumor than BCC with
metastasis to regional lymph nodes in 20% of cases and also can spread to
the intracranial cavity. The tumor may be indistinguishable clinically from a
BCC but surface vascularization is usually absent and growth is more rapid

Treatment of the tumours


* Surgical excision aims to remove the entire tumour with preservation
of as much normal tissue as possible and reconstruction of theresulted defect
according to its size.
*Radiotherapy.
*Cryotherapy.

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