CATEGORIES, COMMON INFECTIVE AND INFLAMMATORY DISORDERS DR. NAILA ALI Assistant Professor OPHTHALMOLOGY

Categories. Congenital Anomalies Inflammations Disorders of position. Trauma Tumours

Inflammations/ Infections Stye Chalazion Lid cellulitis Preseptal orbital cellulitis Blephritis Anterior Posterior

Treatment Options for Trichiasis 1. Epilation - but recurrences within few weeks 2. Electrolysis - but frequently repeated treatments required 3. Cryotherapy - for many lashes 4. Laser ablation - for few scattered lashes 5. Surgery - for localized crop resistant to other methods

Stye (Common Boil) Small abscess, staph infection of the eyelash, gland of Zeis or Moll Tender, inflammed swelling in lid margin, single or multiple, may involve entire lid margin– preseptal cellulitis Treat with hot compresses, removal of eyelash or systemic antibiotics in severe cases Drain if puss points

Chalazion (Tarsal cyst or mebomian cyst) Chronic inflammatory granuloma of mebomian gland—blockage and accumulation of secretions One or more glands involved, mainly children and young adults involved Swelling, heaviness, irritation blurring if large- induced astigmatism

Chalazion (Tarsal cyst or mebomian cyst) Small, cystic, hard swelling a little away from the lid margin, fixed to tarsus, non-tender No signs of inflammation,no lymphadanopathy Small may resolve, may remain the same, may burst on skin- fistula may infect- internal hordeolum. treatment Surgery steroid injections Leave alone the small ones.

Signs of chalazion (meibomian cyst) Painless, roundish, firm lesion within tarsal plate May rupture through conjunctiva and cause granuloma

Histology of chalazion Epithelioid Multinucleated cells giant cells Multiple, round spaces previously containing fat with surrounding granulomatous inflammation

Treatment of chalazion Injection of local anaesthetic Insertion of clamp Incision & curettage

Acute hordeola Staph. abscess of Meibomian glands Internal hordeolum ( acute chalazion ) External hordeolum (stye) Staph. abscess of Meibomian glands Staph. abscess of lash follicle and gland of Zeis or Moll Tender swelling Tender swelling at lid margin May discharge through skin or conjunctiva May discharge through skin

Lid cellulitis Etiology whole of the lid is involved tender induration Multiple styes Insect bites Trauma Clinical features whole of the lid is involved tender induration may lead to abscess formation/ skin necrosis Treatment Systemic antibiotics Drainage

CHRONIC MARGINAL BLEPHARITIS 1. Anterior Staphylococcal Seborrhoeic 2. Posterior Meibomianitis Meibomian seborrhoea

Blephritis Usually chronic infection of the lid margin Common external eye disease Causes—not clear but staph infection and sebhorrea play a part Associated with tear film instability Anterior and posterior variety Anterior blephritis—staph or ulcerative and Sebhorroeic or squamous

Staph Anterior Blephritis Chronic infection of the bases of the lashes resulting in tiny intrafollicular abscesses Secondary dermal and epidermal ulceration and tissue distruction More common in children but may affect any age group Females more affected than males Unhygienic conditions and dietary factors involved

Staph Anterior Blephritis—Cont. Symptoms: Sourness of lid margin Lacrimation, itching and photophobia Signs: Yellow crusts at the roots of the lids On removing the crusts, small ulcers may appear Fall of the lashes—either not replaced or abnormal replacement

Poliosis, madarosis, trichiasis, tylosis Treatment: General: Complications If not treat may lead to Poliosis, madarosis, trichiasis, tylosis Treatment: General: Improvement in general health Balanced diet Correction of refractive errors Local: Broad spectrum antibiotic ointment, steroid ointment Artificial tears. Treat the sequlae.

Staphylococcal blepharitis Chronic irritation worse in mornings Hyperaemia and telangiectasia of anterior lid margin Scales around base of lashes (collarettes) Scarring and hypertrophy if longstanding

Sebhorroeic Ant Blephritis Disorder of the glands of Zeis and Moll Sebhorreoa may involve scalp, eyebrows, nasolabial folds, retroauricular area and sternum. Oily type and dry type (true seborrheoa)

Sebhorroeic Ant Blephritis Symptoms: less severe, discomfort in the eyes, lacrimation, tear film instability (stinging) Signs: Shiny, waxy appearance of the anterior lid margin, dandruff like desquamation lid epidermis (yellow, greasy scales) Treatment: Lid hygiene— artificial tears Scalp treatment with antidandruff lotion

Seborrhoeic blepharitis Shiny anterior lid margin Greasy scales Hyperaemia of lid margin Lashes stuck together

Posterior Blephritis May present as: *Dysfunction of the mebomian glands. *Isolated mebomian seborrhoea and primary mebomenitis. *Combination of ant. Seb. Blephritis and meibominitis

Primary Mebominitis Diffuse inflammation around glands Associated with acne rosacea (2/3rd) or Seb. Dermatitis (1/3rd) Signs: *Pouting of gland orifices with dome of secretions—may become solid. (tooth-past like) *Obliteration of ducts—dilatation (thick, round, vascularised, notched Posterior border) *Secondary changes include papillary conjunctivitis, punctate epitheliopathy, and tear film instability (stinging)

Meibomianitis Meibomian cyst formation Thickened posterior lid margin

Mebomian Seborrheoa Dilated mebomian glands—easily expressed Tear film is oily and foamy In severe cases—mebomian foam at medial canthus.

Meibomian seborrhoea Oily and foamy tear film Oil globules over meibomian gland orifices

Treatment: A: Systemic antibiotics Tetracycline, Doxocycline, Erythromycin B: Others: Lid hygiene, topical steroids, artificial tears. C: Local measures: Warm compresses, mechanical expressions of secretions

Complications trichiasis, madarosis , poliosis Recurrent styes Marginal keratitis Tear film instability

Trauma Lid margin Lid tissue Loss of lid tissue

Eyelid haematoma Orbital roof fracture if associated with Usually innocuous but exclude associated trauma to globe or orbit Orbital roof fracture if associated with subconjunctival haemorrhage without visible posterior limit Basal skull fracture - bilateral ring haematomas (‘panda eyes’)