Entropion
Lid inturning is typically due to degeneration of lower (rarely upper) lid fascial attachments and their muscles. It is rare if <40yrs old. The inturned eyelashes irritate the cornea. Taping the (lower) eyelids to the cheek gives temporary relief; more lasting relief needs surgery.
Ectropion
Lower lid eversion causes eye irritation, watering (drainage punctum malaligned) exposure keratitis.
Associations
Old age; facial palsy. Plastic surgery may correct the deformity. If facial palsy is the cause, consider eg a modified temporalis muscle transfer.
Upper lid malposition
may result from the globe's hypotropic position or excess tissue in the lid pseudoptosis, or intrinsic levator weakness, true ptosis from:
- Congenital (absent nerve to levator muscle; poorly developed levator);
- Mechanical (oedema, xanthelasma or upper lid tumour);
- Myogenic (muscular dystrophy, myasthenia);
- CNS (III nerve palsy; Horner's). Congenital ptosis is corrected surgically early if the pupils are covered or if it is unilateral (risk of amblyopia ex anopsia,).
Lagophthalmos
This is difficulty in lid closure over the eyeball.
Causes
Exophthalmos; mechanical impairment of lid movements (eg injury or lid burns); leprosy; paralysed orbicularis oculi giving sagging lower lid; infective keratitis. Corneal ulceration and keratitis may follow. Lubricate eyes with liquid paraffin ointment. If corneal ulceration develops, temporary tarsorrhaphy (stitching lids together) may be needed.
Styes
The word stye is used more by patients than by ophthalmologists for referring to inflammatory lid swellings. Hordeolum externum is an abscess or infection, usually staphylococcal, in a lash follicle; these may also involve the glands of Moll (sweat glands) and of Zeis (sebum-producing glands attached directly to lash follicles). They point outwards and may cause much inflammation. Treatment is with local antibiotics eg fusidic acid. (The word stye implies infection: if this is not present, the term marginal cyst of Zeis or Moll may be used.) Less common is the hordeolum internum, an abscess of the Meibomiam glands (hordeolum is Latin for barleycorn). These point inwards, opening on to conjunctiva, cause less local reaction but leave a residual swelling called a chalazion or a Meibomian cyst (tarsal cyst) when they subside. Vision may be if corneal flattening occurs (rare). Treatment for residual swellings is incision & curettage (+ eg fusidic acid applied for some days pre-op). Lidocaine-prilocaine cream can obviate need for GA.
Blepharitis
(Lid inflammation eg from staphs, seborrhoeic dermatitis, or rosacea). Eyes have burning itching red margins, with scales on the lashes.
Treatment
Cleaning crusts off the lashes is essential (use cotton-wool buds) Tears Naturale, fusidic acid, or steroid drops (or creams). In children with blepharokeratitis, consider oral erythromycin too.
Pinguecula
Degenerative vascular yellow nodules on the conjunctiva either side of the cornea (usually the nasal side).
Typical patient
Adult male.
Associations
Hair & skin pigment; sun-related skin damage.10 [n = 3564] If inflamed (pingueculitis) topical steroids are tried. If encroaching on to the cornea, as it may in dusty,11 wind-blown life-styles, the word pterygium is used; surgery may be needed.12 images
 |
| Pingecula |
Dendritic ulcer
(Herpes simplex corneal ulcer)
Signs
Photophobia & watering. If steroid drops are used, corneal invasion and scarring may occur, risking blindness. 1% fluorescein drops stain the lesion.
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