1. Ocular plastic causes of the irritated eye Geoff Wilcsek

2. 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

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

4. Lid Malposition Lower lid retraction Lower lid retraction

5. Lid Malposition Upper lid retraction Upper lid retraction

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

7. Lid Malposition

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

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

10. Lid Malposition Facial nerve palsy Lagphthalmos Lagphthalmos

11. Lid Malposition Congenital Ptosis Dystrophic levator Dystrophic levator

12. Lid Malposition

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

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

15. Lesion Malposition

16. Tear Malposition Ocular irritative problems Ocular irritative problems

17. 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

18. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Dangerous