Definition of Hordeolum

Acute inflammation or infection of a gland or the eyelid; also called stye

Etiology of Hordeolum

Staphylococcus aureus (most common)

Staphylococcus epidermitis

Pathophysiology of Hordeolum

Infection of meibomian glands - usually internal and less circumscribed

Infection of ciliary glands (Zeis and Moll) - usually external and focal

Presentation of Hordeolum

Pain with palpation

Acutely swollen and edematous eyelid

Normal vision

Treatment of Hordeolum

Warm compresses for 10-15 minutes four times a day

Usually self-limited infections

Incision may be indicated if resolution does not begin within 48 hours

Definition of Chalazion

A non-infectious, granulomatous inflammation of a meibomian or Zeis gland

Pathophysiology of Chalazion

Nodule consists of many types of steroid-responsive immune cells, including connective tissue macrophages known as histiocytes, multinucleate giant cells, plasma cells, polymorphonuclear leukocytes and eosinophils

May follow a hordeolum

Presentation of Chalazion

Hard nodule

Painless

May be in upper or lower eyelid

May follow a hordeolum

Treatment of Chalazion

25% resolve without intervention

Warm compresses for 10-15 minutes at least 4 times a day

Large or persisting >1 month can refer to ophthamologist for incision and curettage

Definition of Blepharitis

Common chronic inflammation of the eyelids

Anterior - involves the eyelid skin, eyelashes and associated glands

Posterior - involves the meibomian glands

Etiology of Blepharitis

Non-infectious

Occupation that causes dirty hands
Poor hygiene
Seborrhea
Unknown

Infectious
Staphylococcal

Etiology of Blepharitis

(Anterior/Posterior)

Anterior

Bacteria (Staphylococcus)

Seborrheic dermatitis

Allergy

Psoriasis

Posterior

Dysfunction of the oil (meiborean) gland

Acne roseacea

Seborrheic dermatitis

Allergy

Pathophysiology of Blepharitis

Excess lipid production causes:

Reduced lipid layer of tear

Increased formation of debris

Ideal environment for bacteria

Risk Factors of Blepharitis

Candida

Seborrheic dermatitis

Acne rosacea

Diabetes Mellitus

Immunocompromised state (AIDS, chemotherapy, etc)

Presentation of Blepharitis

Itching

Irritation

Burning

Usually worse in morning

Presentation of Blepharitis

(Anterior/Posterior)

Anterior

Red rimmed eyes

Scales or granulations at lash base

Posterior

Lid margins hyperemic with telangiectasias

Meibomian glands inflammed/dilated

Lid margin may be rolled inward

Abnormal secretions

Differential Diagnosis of Blepharitis

Masquerade syndrome

-persistent inflammation and thickening of eyelid margin may indicate squamous cell, basal cell, or sebacous cell carcinoma

-any swelling or inflammation of eyelid which does not resolve promptly (within one month) with treatment, is suspect as a possible underlying carcinoma

Possible Complications of Blepharitis

Hordeolum

Scarring of eyelid margin

Misdirection of eyelashes

Corneal irritation/ulcer

Treatment of Blepharitis

Eyelid scrubs

For moderate, severe, or chronic cases ophthalmic antibiotic ointment

- Bacitracin or Erythromycin to eyelid margins up to 4 times a day

Definition of Dacryocystitis

Inflammation of the lacrimal sac

Etiology of Dacryocystitis

Most in older population or neonates

Result from

- Chronic mucosal degeneration

- Ductile stenosis

- Stagnation of tears

- Bacterial overgrowth

Pathophysiology of Dacryocystitis

Nasolacrimal obstruction secondary to mucocele of lacrimal sac, which is precipitated by chronic blockage

Presentation of Dacryocystitis

Pain

Redness

Tearing

Swelling

Possible fever

Possible purulent discharge from inferior punctum

Secondary conjunctivitis

Usually unilateral

Sudden onset, can be chronic

Treatment of Dacryocystitis

Warm compresses; massage downward and open up

Systemic antibiotics of febrile

IV antibiotics if infection is severe

In adults, definitive treatment reqauires dacryocystorhinostomy

Congenital obstruction often resolves spontaneously

Epidemiology of Dacryostenosis

Most common cause of tearing in children <1 year

Occurs in up to 20% of all normal newborns

Pathophysiology of Dacryostenosis

Blockage can occur anywhere in lacrimal drainage system but most commonly at the membraneous blockage of the valve of Hasner (lower valve - why you massage downward)

Presentation of Dacryostenosis

History of chronic or intermittent tearing

Debris on the eyelashes

Occassionally redness of the conjunctiva

Palpation of lacrimal sac may cause reflux of tears

Complications of Dacryostenosis

Dacryocystitis

Treatment of Dacryostenosis

Lacrimal duct massage 2-3 times per day by applying downward moderate pressure over lacrimal sac in a downward direction

90% resolve spontaneously by 6 months of age

If no resolution, refer to ophthamologist for possible lacrimal duct probing

Quick Overview of Dacryocystocele

Noted at or shortly after birth

Both proximal and distal portions of nasolacrimal system are obstructed

Urgent referral to ophthamologist

Definition of Entropion

Inversion of the anatomical eyelid margin towards the globe

Etiology of Entropion

Pseudo - trichiasis = aberrant lashes because of constant pressure on lashes

Involutional (aging) is most common cause

Cicatricial = scarred (burns, Steven-Johnson Syndrome, surgery)

Presentation of Entropion

Dry eye

Tearing (inverted puncta)

Cornea irritation

Cosmetic

Treatment of Entropion

Lubricants

Evert lid with tape

Botox injections for lower lid

Surgery (usually required to avoid damage to the cornea)

Definition of Ectropion

Eversion of the anatomical eyelid margin away from the globe

Etiology of Ectropion

Paralytic

Usually aging

Cicatricial (burns, surgery)

Mechanical (tumor, herniated fat)

Presentation of Ectropion

Dry eye

Tearing (everted puncta)

Cosmetic

Treatment of Ectropion

Lubricants

Surgery