Ocular plastic causes of the irritated eye Geoff Wilcsek

An irritated eye should not be dismissed as blepharitis or dry eye. An irritated eye should not be dismissed as blepharitis or dry eye. Ocular plastic conditions can exacerbate mild dry eye or blepharitis Ocular plastic conditions can exacerbate mild dry eye or blepharitis

Lid Malposition Lid Malposition Lash malposition Lash malposition Globe malposition Globe malposition Tear Malposition Tear Malposition Dangerous conditions Dangerous conditions

Lid Malposition Lower lid retraction Lower lid retraction

Lid Malposition Upper lid retraction Upper lid retraction

Lid Malposition Ectropion Tearing Tearing Gritty red eye Gritty red eye Early morning discharge Early morning discharge

Lid Malposition

Entropion Tearing Tearing Foreign body sensation Foreign body sensation Can result in corneal abscess -/+ scarring Can result in corneal abscess -/+ scarring

Lid Malposition Floppy Eyelid Syndrome Irritation on waking in the morning Irritation on waking in the morning Papillary Conjunctivitis Papillary Conjunctivitis

Lid Malposition Facial nerve palsy Lagphthalmos Lagphthalmos

Lid Malposition Congenital Ptosis Dystrophic levator Dystrophic levator

Lid Malposition

Lid Malposition: Children Epiblepharon Rub eyes Rub eyes “sore eyes” “sore eyes” Red eyes Red eyes Epiphora Epiphora

Lash Malposition Chronic meibomitis/blepharitis Chronic meibomitis/blepharitis Skin cancer involving the lid margin Skin cancer involving the lid margin

Lesion Malposition

Tear Malposition Ocular irritative problems Ocular irritative problems

Additive Effect Sub-clinical dry eye or blepharitis can become symptomatic when combined with any lid malposition. Sub-clinical dry eye or blepharitis can become symptomatic when combined with any lid malposition. Conditions that require excess use of brows to clear the visual axis may affect the frequency of blinking and thus exacerbate underlying dry eye or blepharitis Conditions that require excess use of brows to clear the visual axis may affect the frequency of blinking and thus exacerbate underlying dry eye or blepharitis

Ptosis I feel tired, I want to close my eyes I feel tired, I want to close my eyes Difficulty reading Difficulty reading Frontal headache Frontal headache

Globe Malposition Thyroid Orbitopathy Thyroid Orbitopathy Mix of epiphora and dry eye symptoms Mix of epiphora and dry eye symptoms Tried multiple drops Tried multiple drops C/L intolerance C/L intolerance

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Signs Ocular Surface Ocular Surface Exposure Exposure Superior Limbic Keratitis Superior Limbic Keratitis Chemosis Chemosis Lid Signs Lid Signs Lid retraction/flare Lid retraction/flare Lid lag Lid lag Lagophthalmos Lagophthalmos Orbital Signs Orbital Signs Proptosis Proptosis Restricted ocular rotations Restricted ocular rotations

Dangerous