EXTERNAL EYE DISEASES

By Dr. Abduselam

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 DISEASES OF THE EYELIDS
Hordeolum

Definition:
Ahordeolum is the result of an acute bacterial
infection of one or more eyelid glands.
 If several glands are affected at the same time, it is
called hordeolosis.
Epidemiology and etiology.
Staphylococcus aureus is a common cause of
hordeolum.
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 EXTERNAL EYE DISEASES

INTERNAL HORDEOLUM
A small abscess collection in the Meibomian glands
Caused by staphylococcus
Symptoms: pain, redness, swelling within eye lid
Signs: Tender, inflamed mass within the eye lid
Treatment
Hot compress
Topical antibiotics
If the above treatment fails, referral for Incision and
curettage under local anesthesia

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 EXTERNAL EYE DISEASES

EXTERNAL HORDEOLUM /Stye/

An acute staphylococcal infection of a lash follicle
and its associated gland of Zeis or Moll
Symptoms: Pain, redness, lid margin swelling of short
duration
Signs: Tender inflamed mass in the lid margin which
points anteriorly through the skin
More than one lesion may be present and occasionally
minute abscesses may involve the entire lid margin
In severe cases a mild preseptal cellulitis may be present

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EXTERNAL EYE DISEASES
2. DISEASES OF THE EYELID – Benign Lesions

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 EXTERNAL EYE DISEASES

Treatment of External Hordeolum

Warm compress
Topical antibiotics - Chloramphenicol eye ointment.
Systemic antibiotic – cloxacillin50mg/kg, divided in four
doses for 7 days if secondary eye lid cellulitis develops.
Epilation (pulling out) of the eyelash associated with
the infected follicle may enhance drainage of focus.
If the above management fails and if there is an abscess,
referral for surgical drainage.

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 EXTERNAL EYE DISEASES

CHALAZION
 A chronic lipogranulomatous inflammatory lesion caused by
blockage of meibomian gland orifices and stagnation of
sebaceous secretion
 Patient with Acne Roscea or seborrheic dermatitis are at
increased risk of Chalazion formation which may be multiple or
recurrent.
 Symptoms: Painless nodule within the eye lid
 Signs: Non tender, firm, roundish mass within the eye lid.
 Treatment
 Hot compression
 Referral for surgical incision and curettage

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EXTERNAL EYE DISEASES

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EXTERNAL EYE DISEASES
2. DISEASES OF THE EYELID – Benign Lesions

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 EXTERNAL EYE DISEASES

MOLLUSCUM CONTAGIOSUM
Uncommon skin infection caused by a poxvirus
It is common in children and immunocompromized patient.
In immunocompromized patient, it is multiple, large size, bilateral,
recurrent and resistant to treatment.
Symptoms: painless, raised, skin lesion.
Signs: Single or multiple Pale, waxy Umblicated nodules
◦ If the nodule is located on the lid margin it may give rise to ipsilateral
chronic follicular conjunctivitis and occasionally a superficial keratitis
Treatment
◦ Expression
◦ Shaving and excision
◦ Destruction of the lesion by cauterization, Cryotherapy
DDx: Malignant lesions

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EXTERNAL EYE DISEASES
2. DISEASES OF THE EYELID – Benign Lesions

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This noninflammatory
contagious infectionis
caused by DNA viruses.
The disease usually
affects children and
teenagers and is
transmitted by direct
contact.

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 EXTERNAL EYE DISEASES
BLEPHARITIS
Is a general term for inflammation involving the eyelid margin
Can be associated with conjunctivitis
There are two main types of blepharitis
1. Staphylococcal blepharitis
◦ Caused by Staph. aureus
◦ Is ulcerative in type with redness of lid margins with scales and
easily pluck able lashes
2. Seborrheic blepharitis
◦ Is associated with seborrhea of the scalp, brows and ears
◦ Is non –ulcerative
◦ The scales are greasy with less marked redness of the lid margin
A patient may present with a mixed type of Blepharitis

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 EXTERNAL EYE DISEASES

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EXTERNAL EYE DISEASES

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 EXTERNAL EYE DISEASES
Symptoms of Blepharitis
 Irritation, Burning, Itching of the lid margins
Signs of Blepharitis
 Scales on lid margin
 Eye lid margin ulceration and redness
Treatment of Blepharitis
 Lid hygiene, Warm Compresses
 Topical antibiotics (erythromycin or Chloramphenicol eye drops
QID) for infectious cases
 Systemic antibiotics: Doxcycline 50 to 100 mg/day for four weeks
 Tear substitutes
 Topical steroid (Terracortril eye suspension once –twice a day) for
seborrheic

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 EXTERNAL EYE DISEASES

ECTROPION
Means eversion of eyelid
Treatment: Referral for surgical correction.
ENTROPION
Means the eyelids turn in wards allowing the eyelashes to
rub against and damage the globe (Trichiasis)
Treatment: Referral for surgical correction
PTOSIS
Means drooping of the upper eye lid due to Levator muscle
weakness.
It can cause ambylyopia if it is unilateral and/ or severe
Treatment: Referral for surgical correction
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EXTERNAL EYE DISEASES

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EXTERNAL EYE DISEASES
– Neoplasms-BENIGN

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 EXTERNAL EYE DISEASES
– Neoplasms-MALIGNANT

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 EXTERNAL EYE DISEASES

DACRYOCYSTITIS
Definition: an inflammation of the lacrimal sac that
occurs primarily because of Nasolacrimal duct obstruction.
Chronic tear stasis and retention leads to secondary
bacterial infection
 is unilateral in most cases.
Etiologic pathogens
Staphylococcus, Pneumococcus, Streptococcus .etc
Classification: Clinically classified as Acute and Chronic
Dacryocystitis

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 EXTERNAL EYE DISEASES

ACUTE Dacryocystitis
Symptoms
◦ Painful, swollen mass below the medial side of the eye
◦ Conjunctival injection, tearing
Signs
◦ Tender mass on the medial side of the eye.
◦ Pressure on the sac will often fail to result in regurgitation of
mucopurulent material.
Treatment
◦ Hot compression
◦ Systemic antibiotic
◦ Incision and abscess drainage may be required
Complications
◦ Preseptal cellulitis
◦ Orbital cellulitis
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Acute inflammation that has
spread to the surrounding
tissue of the eyelids
and cheek entails a risk of
sepsis and cavernous sinus
thrombosis, which is a
life-threatening complication.

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 EXTERNAL EYE DISEASES
2. CHRONIC Dacryocystitis
Symptoms
◦ Tearing, Swelling over the medial aspect of the eye
◦ Mucoid or purulent discharge with pressure on the
lacrimal sac area
Signs
◦ Non tender mass on medial aspect of the eye
◦ Decompressing digitally over the mass drain mucoid
or purulent discharge through the punctum
Treatment
◦ Referral for surgery - Dacryocystorhinostomy (DCR)

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 EXTERNAL EYE DISEASES

DACRYOCYSTITIS

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 DISEASES OF THE ORBIT
Occurring Predominantly in Children
 Orbital cellulitis - most common cause of proptosis in children
 Rhabdomyosarcoma - most common primary orbital
malignancy in children
 Dermoid and Epidermoid cysts
 Capillary Hemangionia and Lymplangioma
 Orbital nerve glioma
 Leukemia (granulocytic chloroma)
 Orbital inflammatory syndrome (Orbital Pseudotumor )
 Neurofibroma
 Retinoblastoma
 Metastatic Neuroblastoma (most common metastatic ca. to
the orbit in children)
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EXTERNAL EYE DISEASES
4. DISEASES OF THE ORBIT

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 DISEASES OF THE ORBIT

Occurring predominantly in Adults

 Thyroid Ophthalmopathy - most common cause of unilateral
and bilateral proptosis in Adults
 Cavemous hemangioma - most common benign primary
orbital tumor in Adults
 Orbital inflammatory syndrome (orbital Pseudotumor)
 Lymphocytic lesions
 Meningioma
 Lacrimal gland tumors
 Dermoid and Epidermoid cysts
 Treatment of Orbital disorders : Mainly Surgical

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EXTERNAL EYE DISEASES

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 DISEASES OF THE ORBIT

ORBITAL INFECTIONS
Microbial Etiology
H. influenza, S. aureus, S. pneumonae etc.
Predisposing factors:
Trauma, Stye, Dacryocystitis etc.

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 DISEASES OF THE ORBIT (INFECTIOUS)
PRESEPTAL CELLULITIS

Definition: it is infection of the tissues anterior to the orbital septum

Symptoms
◦ No visual reduction
◦ Mild periorbital pain
◦ Localized eyelid redness and swelling
Signs
◦ V/A is normal
◦ Tender and hot eyelid
◦ Ocular motility is normal
Treatment
◦ Ciprofloxacillin 500mg PO bid for seven days.
◦ If no improvement within 48hrs, It needs early referral.

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EXTERNAL EYE DISEASES

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ORBITAL CELLULITIS
Definition: An infection of orbital tissue posterior to the orbital septum.
Symptoms:
Pain, Proptosis, Fever, Limited ocular movement, Visual reduction
Signs:
 V/A is reduced, Tender eye, Reduced to absent ocular motility
Treatment:
◦ It is an ophthalmic emergency that needs admission; intravenous
antibiotics and close follow up.
◦ So early referral to ophthalmic center is highly recommended
Complications - If it is left untreated, it is vision and life threatening.
◦ Loss of vision
◦ Meningitis
◦ Brain abscess
◦ Cavernous sinus thrombosis
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EXTERNAL EYE DISEASES
4. DISEASES OF THE ORBIT (INFECTIOUS)

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