Download 1 ) Eyelid disorders: Affecting the outer surface of the eyelid

Common Ocular disorders
1 ) Eyelid disorders: Affecting the outer surface of the eyelid
A – Blunt traumas; that affect the surface of the eye
The skin around the eye is very thin in terms of the amount of subcutaneous fat as
well as stratum corneum thickness due to the lack of friction in that area.
A blunt trauma to the Highly vascularised eyelid results in bleeding , leading to
swelling and ocular discomfort.
After the trauma , the patient should be assessed, as blurred vision requires referral
of the patient to an ophthalmologist. But, mostly, blunt traumas do not result in
internal damage and treatment is usually supportive: A. cold compresses; B. Oral
OTC analgesics
In case of excessive trauma , referral is needed to rule out any complications such as
internal eye bleeding, secondary glaucoma, retinal detachment.
*Note: in cases of acute inflammation we use cold compresses to reduce odema ,
while in chronic situations , hot compresses are preferred
B - Blepharitis (Very common)
Is an inflammatory condition accompanied with an accumulation of debris along the
eyelid margin. usually happens in one eye, rarely in two (not painful), mostly
recurrent
Almost always it’s staphylococcal blepharitis, ie, caused by Staphylococcus
epidermidis or Staphylococcus aureus and in some case it could be seborrheic
blepharitis (characterized by greasy scaling)
Blepharitis is generally characterized by red, scaly, thickened eyelids, itching and
burning sensations and in chronic cases, loss of eyelashes.
Treatment: hot compresses are used to relief the burning sensation along with a
topical antibiotic.
In case of chronic blepharitis , there's usually a high bacterial load on the eyelid and
it's recommended to use an eyelid scrub every two to three days by wiping the
surface of the eye with using an OTC eyelid hygienic preparation (diluted babyshampoo)
C – Lice infestations of the eyelids
Mostly due to Phthirius Pubis (pubic lice) or Pediculus humanus capitis (head lice)
Usually presents with symptoms similar to blepharitis ; causing itching and redness
but to a lesser extent.
Treatment:
A bland ophthalmic ointment (e.g petrolatum) used for 10 days and it's effective
because it suffocates the louse and deprives its eggs of oxygen
Hygienic measures: wash clothing & bedding that may contain unhatched eggs
*Peduculicides may be given to treat accompanying head or pubic lice but shouldn't
be used on the eyelids because of their irritant effect
D – Dermatitis
Is a reaction to an allergen or irritant, usually caused by changing make-up , soap, or
exposure to some foreign substance. (ask patient about newly used products)
Symptoms: swelling, scaling of eyelid with profuse itching, usually involving both
eyes.
Treatment: (1) best treatment is removal of offending substances through washing
(2) OTC oral antihistamines; (3) cold compresses to relief the odema and itching
2 ) Eyelid disorders: Affecting the inner part of the eyelid (glands)
A - Hordeolum
There are multiple types of glands present in the eye, amongst them are:
1 ) meibomian gland: they're present in the eyelids and secrete the meibum
2 ) Zeis & Moll glands: present on the eyelid margins, along with the eyelashes ,
they keep the eyelashes healthy
In case of gland obstruction and infection it would lead to a hordeolum (stye) and it's
classified depending on its origin as follows: An inflammation of the meiboian glands
is an internal hordeolum (imbedded in the eyelid) and the inflammation of Zeis and
moll glands is considered an external hordeolum
They are usually red, palpable, tender and may present with purulence as they're
cause by a bacterial infection of Staphylococcus epidermidis or Staphylococcus
aureus.
Treatment: (1) Hot compresses 3-4 times/day (5-10 minutes; clearing within 1week),
gentle rolling would help; (2) In case of an external hordeolum a topical antibiotic can
be used; but an Internal hordeolum need referral and the use of an oral antibiotic; (3)
if resistant to antibiotic treatment, resort to surgical drainage
B – Chalazion
Is a painless, slowly enlarging nodule on the eyelids formed due to the inflammation
of the meibomian glands (deep chalazion) or Zeis sebaceous glands ( superficial
chalazion).
Chalazions are non infectious, don't present with any purulence and aren't tender.
They may be recurrent and cosmeticly inconvenient.
Treatment: (1)may be resorbed with hot compresses (2) oral antibiotics may be used
(3) if resistant surgery or intralesional steroid injection
**Recurrence of both chalazions and hordeloum may be reduced by periodic use of
lid scrubs , especially the hordeolum because it's caused by microbial infection
which is decreased by decreasing the microbial load.
3 ) Ocular surface disorders:
A - Foreign substance contact
Usually reflex tearing and blinking would protect from the entry of the foreign
substance, but in case they fail to, the eye may need to be flushed with sterile saline
or specific eye wash preparations.
washing should be directed towards the outer corner of the eye, not towards the
nasolacrimal drainage as not to block it.
If the object is trapped up within the eye lid and its removal wasn't successful after
several washing attempts, refer the patient to an ophthalmologist.
If the foreign body is metallic, don’t attempt to remove it by any means ; self irrigation
or removing the object using tweezers may lead to corneal scratching.
B - Abrasions :
Are superficial injuries to a skin or mucous membrane, in this case, the cornea or
conjunctiva.
Causes: Scratches by fingernails or by foreign bodies
Such injuries cause partial or total loss of the epithelium and are painful especially if
cornea is involved
Self treatment is not recommended because of the risk of bacteria or fungi
contaminating and infecting the eye and referral is preferred.
C - Chemical exposure:
Resulting from splashes of fumes or solid chemicals, it is a medical emergency and
needs immediate referral
Initial treatment: flushing eye with sterile saline or water for at least 10 minutes.
D - Thermal damage:
Damage due to heat, could be minor or major
1 – Minor thermal damage: results from extensive exposure to UV radiation and
causes mild to severe dryness to the surface of the eye .
Happens during skiing : because reflection of the UV light by the snow is very intense
and may lead to snow blindness, similar cases would happen in long sun exposures.
Minor cases are treated with artificial tears
2 – severe thermal damage, also known as the welders' arc.
Exposure to very intense UV light leading to Keratoconjunctivitis, a very painful
inflammation of the conjunctiva. needs referral or given a diclofenac sodium eyedrop
and artificial tears
Infrared radiation and intense visible light may contribute to welders' arc and damage
due to sun exposure, compromising the tear film , resulting in dry eyes, as in the
case of extensive electronics use.
E - Conjunctivitis :
Inflammation of the conjunctiva , resulting in redness all over the eye
Keratoconjunctivitis is more severe presenting with blurry vision , eye pain and
redness, hazy or cloudy cornea, increased sensitivity to the light and conjunctival
swelling and requires the application of topical diclofenac
Types of conjunctivitis:
1 – Viral conjunctivitis
Usually presents after recent cold, sore throat, exposure to someone with pink eye
(acute contagious conjunctivitis)
Symptoms: “pink-eye” not red with copious amounts of watery discharge; ocular
discomfort; mild to moderate foreign body sensation (gritteiness); occasionally
blurred vision; low grade fever, swollen lymph nodes -resulting from the viral infection
.Treatment: relief major symptoms using artificial tears & ocular decongestants
Certain forms are extremely contagious: wash hand ,do not share towels, properly
dispose of tissues used to dry the eye
Usually self limiting with symptoms resolving after 1-3 weeks but sometimes it is
persistent and needs antiviral treatment, but mostly self limiting