EYELID INFLAMMATION & TUMORS

July 7, 2012

LID INFLAMMATION
• Blepharitis

DEFINITION
• It is the inflammation of the lid margin

blepharitis
• Inflammation of the lid margin (crusting/redness of lids) • Causes ‘gritty’/foreign body sensation, often concomitant with other ocular surface disease

• Associated with recurrent hordeolum (styes) or chalazia
• Improvement with warm compresses/lid hygeine, artificial tears, tetracycline

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Ulcerative 2.Types 1. Squamous b. Posterior a. Anterior a. Meibomian seborrhoea b. Meibomianitis .

ANTERIOR BLEPHARITIS • It involves the outer parts of the eyelid • It is commonly caused by bacteria .

SEBORRHEIC/SQUAMOUS • • • • It is characterized by the deposition of scales Eyelashes fall Hyperemic lid margin Absence of ulcers .

Squamous Blepharitis .

redness of lid margins. deposits / crusting along lid margins. grittiness .Symptoms • Burning. photophobia • Symptoms are worse in the morning .

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ULCERATIVE • It is characterized by the presence of infective materials such as yellow crusts or scales • There is matting of the lashes • Presence of ulcers .

Symptoms • Redness of lid margins. this features differentiate it from conjunctivitis . burning. watering and photophobia • Signs: – Small ulcers at lid margins on removal of discharge. itching.

Ulcerative Blepharitis .

Ulcerative blepharitis .14.

15.Ulcerative blepharitis .

POSTERIOR BLEPHARITIS • It involves the inner parts of the eyelids • It is due to problems in the oil glands .

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LID LUMPS .

STYE • It is a tender. painful red bump located at the base of an eyelash or inside the eyelid • It is due to infection of the oil glands of the eyelid or from an infected hair follicle at the base of an eyelash .

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..  painful  -Most cases are self limiting .It is an abscess in eyelash follicle.   -Treatment requires the removal of the associated eyelash and application of hot compresses.

  .Internal hordeolum  an abscess in meibomian gland. -May respond to topical antibiotics but incision by be necessary. -Painful.

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Hordeolum Internum .

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Chalazion  -It is a granuloma within the tarsal plate caused by obstructed meibomian gland. -Painless. -Symptoms are unsightly lid swelling which resolve within six months if the lesion persist we remove it surgically   .

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Chalazion .

redness. caused by pox virus. -Can be presented with umbilicated lesion found on the lid margin. follicular conjuctivitis(small elevation of lymphoid tissue found on tarsal conjunctiva) -Treatment requires excision of the lid lesion. -Cause irritation. -Is a viral infection of the skin or the mucous membranes.    .

waxy. umbilicated nodule • Chronic follicular conjunctivitis • May be multiple in AIDS patients • Occasionally superficial keratitis .Molluscum contagiosum Signs Complications • Painless.

Histology of molluscum contagiosum • Lobules of hyperplastic epithelium • Circumscribed lesion • Surface covered by normal epithelium except in centre • Intracytoplasmic (Henderson-Patterson) inclusion bodies • Deep within lesion bodies are small and eosinophilic • Near surface bodies are larger and basophilic .

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  . . . .Usually associated with hyperlipidemia .Removed for cosmetic reasons.Lipid containing bilateral lesions.

subcutaneous plaques containing cholesterol and lipid • Usually bilateral and located medially .Xanthelasma • Common in elderly or those with hypercholesterolaemia • Yellowish.

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Adenoma of Meibomian Gland .

Eyelids inflammation • Blepharitis – – – – – – – – – Anterior Posterior Staphylococcal Seborrhoeic Meibomianitis Lid hygiene Tears Antibiotics Warm compresses • Treatment .

Eyelids inflammation • Allergy – Acute allergic blepharoconjuctivitis – Allergic dermatoblepharitis .

Eyelids inflammation • Chalazion – Focal inflammation of the eye lids which result from obstruction of the meibomian glands – Chronic lipogranulomatous inflammatory changes – Treatment • Warm compresses • Local antibiotic • Excision .

EYELID CYST .

CYST OF MOLL .

CYST OF ZEIS .

SEBACEOUS CYST .

HIDROCYSTOMA .

BENIGN TUMORS .

VIRAL WART .

ACTINIC KERATOSIS .

NAEVI .

KERATOACANTHOMA .

PYOGENIC GRANULOMA .

HEMANGIOMA .

Malignant eyelid tumors • • • • • • Basal cell carcinoma Squamous cell carcinoma Meibomian gland carcinoma Melanoma Kaposi sarcoma Merkel cell carcinoma .

Basal cell carcinoma • Most common malignancy(90%) of the eyelid • Usually located on the lower lid and medial canthus • Pearly nodules which ulcerate and have telangiectasias • Treatment – Surgical excision – Cryotherapy – Radiation therapy .

Squamous cell carcinoma • Less common than BCC • May arise de-novo or from pre-existing actinic keratosis • May metastasize .

BENIGN EYELID LESIONS 1. Nodules • Chalazion • Acute hordeola • Molluscum contagiosum • Xanthelasm a • Cyst of Moll • Cyst of Zeiss • Sebaceous cyst • Hidrocystoma 2. Tumours • Viral • wart • Keratoacanthoma • Capillary haemangioma Naevi • Port-wine stain • Pyogenic granuloma • Cutaneous horn . Cysts 3.

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

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

Treatment of chalazion Injection of local anaesthetic Insertion of clamp Incision and curettage .

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

Viral wart (squamous cell papilloma) • Most common benign lid tumour • Raspberry-like surface Pedunculate d Sessil e .

Histology of viral wart Finger-like projections of fibrovascular connective tissue Epidermis shows acanthosis (increased thickness) and hyperkeratosis Rete ridges are elongated and bent inwards .

greasy. hyperkeratotic lesion .Keratoses Seborrhoeic Actinic • Common in elderly • Discrete. brown lesion • Friable verrucous surface • Flat ‘stuck-on’ appearance • Affects elderly. fair-skinned individuals • Most common pre-malignant skin lesion • Rare on eyelids • Flat. scaly.

fast growing nodule • Acquires rolled edges and keratin-filled crater • Central keratin-filled crater • Involutes spontaneously within 1 year • Chronic inflammatory cellular infiltration of dermis .Keratoacanthoma • Lesion above surface epithelium • Uncommon.

Naevi • Appearance and classification determined by location within skin • Tend to become more pigmented at puberty Intradermal Junctional Compound • Elevated • Flat. well-circumscribed • May be non-pigmented • Pigmented • No malignant potential • Low malignant potential • Has both intradermal and junctional components .

Capillary haemangioma • Rare tumour which presents soon after birth • May be associated with intraorbital extension • Starts as small. red lesion. most frequently • Grows quickly during first year on upper lid • Begins to involute spontaneously • Blanches with pressure and swells on crying during second year .

endrochondromas and bowing of long bones .Periocular haemangioma Treatment options • Steroid injection in most cases • Surgical resection in selected cases Occasional systemic associations • High-out heart failure • Kasabach-Merritt syndrome thrombocytopenia. anaemia and reduced coagulant factors • Maffuci syndrome .skin haemangiomas.

Histology of capillary haemangioma Lobules of capillaries Fine fibrous septae Lobules under high magnification .

Port-wine stain (naevus flammeus) • Rare. congenital subcutaneous lesion • Segmental and usually unilateral • Does not blanch with pressure Associations • Ipsilateral glaucoma in 30% • Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5% .

pedunculated or sessile mass • • Bleeds easily Uncommon.Pyogenic granuloma Cutaneous horn • Usually antedated by surgery or trauma• • Fast-growing pinkish. horn-like lesion protruding through skin May be associated with underlying actin keratosis or squamous cell carcinoma .

PATHOLOGY OF THE LACRIMAL APPARATUS

CANALICULITIS

DACRYOCYSTITIS

DACRYOCYSTITIS

DACRYOADENITIS .

NASOLACRIMAL DUCT OBSTRUCTION .

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Eyelid cysts Cyst of Moll Eccrine sweat gland hidrocystoma • Translucent • On anterior lid margin • Similar to cyst of Moll • Not confined to lid margin Cyst of Zeis Sebaceous cyst • Opaque • On anterior lid margin • Cheesy contents • Frequently at inner canthus .

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