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There are short curved hair, the eyelashes situated on their free edges. The
layers of tissue which form the eyelids are:
• A thin covering of skin.
• A thin sheet of areolar tissue.
•Three muscles—the orbicularis oculi, levator palpebrae superioris and Muller’s
muscle.
•A thin sheet of dense connective tissue, the tarsal plate, larger in the upper
than in the
lower eyelid. It supports the other structures.
• A lining of palpebral conjunctiva.
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•It is about 2 mm broad and is divided into two parts by the
punctum (divided into rounded anterior and sharp posterior
borders by the grey line.
•The eyelashes originate anterior to the grey line and ducts of
the meibomian glands are located posterior to the grey line.
•Grey line is important in operations where the lid is split as it
indicates the position of loose fibrous tissue between the
orbicularis muscle and the tarsus.

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Meibomian Glands (Tarsal Glands)

These are modified sebaceous glands about

•20 -30 in number embedded in the tarsal plate.
•They are directed vertically and open on the lid margin.
Therefore vertical incision is given while incising the
chalazion.

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1. Clinical features SQUAMOUS BLEPHARITIS ULCERATIVE BLEPHARITIS

i. Scales White, fine and dry Yellowing, coarse, and sticky

ii. Ulceration Absent Present

iii. Bleeding Absent Present

iv. Loss of eyelashes Few and temporary Permanent and almost all
lashes are involved
2. Course Mild Progressive
3. Complications Occasional Usual and serious

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Symptoms
redness, soreness, lacrimation,photophobia
Irritation
Burning
Itching of the lid margins

Signs
•Scales on lid margin(hard or soft/both

•Eye lid margin ulceration and redness

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Depending on the severity of the disease, one or multiple therapeutic
treatments are utilized; pharmacologic agents and mechanical
treatments are often required.
such as lid hygiene
warm compress
Antibiotics
1. Lid hygiene is essential at least twice daily and Crust removal and lid
margin cleaning with the help of cotton buds dipped in the dilute baby
shampoo or solution of 3% sodium bicarbonate.
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Applied to the lids for 5–10 minutes to soften
the crusts,can increase oil production and
melt the oil in the meibomian glands.

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Several types of topical antibiotics: drops and ointments,
some of the commonly prescribed are:
 Azithromycin , usually prescribe as one drop at bed time f
or
one week or more.
 Erythromycin ophthalmic ointment:apply to base of
eyelids one or more times a day for several days.
 Ciprofloxacine 0.3% eye drop four times per a day

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•A stye is an infection (abcess) of one of the small oil producing glands
lining the eyelid, usually caused by the bacteria that are normally found
along the eyelids.
•A stye can occur on either the upper or lower eyelid.
•There are two types of styes, internal and external hordeola.
•An internal hordeolum (stye) is a bacterial infection of the meibomian
glands inside the eyelids.
Internal styes tend to be more severe and occur a little less often than an
external hordeolum.
•An external hordeolum (stye) is a bacterial infection of the Glands of
Zeis and/or Glands of Moll inside the eyelids.

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• A well defined lump or bump on either upper or lower eyelid
• Localized swelling of the eyelid
• Mild pain in the eyelid
• Sensitive to touch
• Redness of the affected eyelid
• Crusting of the eyelid margins
• Burning in the eye
• Eyelid may appear full or droopy
• Mucous or watery discharge in the eye
• Irritation of the eye
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 A red, tender, swollen bump on the
edge of the eyelid. You may be able to
see the infected gland on the eyelid or
it may be under the skin.
The infection may quickly become
quite large and painful.
The eyes are teary.

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• It is an acute suppurative
inflammation of lash follicle
and its associated glands
of Zeis or Moll.

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1. Predisposing factors are as below:
•Age. It is more common in children and young adults (though no age is
bar) and in patients with eye strain due to muscle imbalance or
refractive errors.
•Habitual rubbing of the eyes or fingering of the lids and nose, chronic
blepharitis and diabetes mellitus are usually associated with recurrent
styes.
•Metabolic factors, chronic debility, excessive intake of carbohydrates
and alcohol also act as predisposing factors.
2. Causative organism commonly involved is staphylococcus aureus.

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Symptoms include acute pain associated with swelling of lid, mild
watering and photophobia.
Signs are as follows:
•Stage of cellulitis is characterised by localised, firm, red, tender
swelling at the lid margin associated with marked oedema .
Usually, there is one stye, but occasionally, these may be multiple.
•Stage of abscess formation is characterised by a visible pus point on
the lid margin in relation to the affected cilia.

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•Hot compresses 2–3 times a day are very useful especially in
cellulitis stage.
•Evacuation of the pus should be done by epilating the
involved cilia, when the pus point is formed.
• Surgical incision is required rarely for a large
abscess.
•Antibiotic eye drops (3–4 times a day) and eye ointment (at
bed time) should be applied to control the infection.

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It is a suppurative inflammation of the meibomian
gland associated with blockage of the duct.
Etiology
Predisposing factors are similar to hordeolum externum
Causative mechanism. Hordeolum internum may occur as:
•Primary Staphylococcal infection of the meibomian gland or
due to
• Secondary infection in a chalazion (infected chalazion)

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Symptoms include acute pain associated with swelling of the lid, mild watering and
photophobia.
Thus, the symptoms are similar to hordeolum externum, except that pain is more
intense, due to the swelling being embedded deeply in the dense fibrous tissue.
Signs
A localized, firm, red, tender swelling of the lid associated with marked oedema.
On examination, hordeolum internum can be differentiated from hordeolum
externum by the fact that in it, the point of maximum tenderness and swelling is
away from the lid margin and that pus usually points on the tarsal conjunctiva
(seen as yellowish area on everting the lid) and not on the root of cilia.

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• It is similar to hordeolum externum, except that, when pus
is formed, it should be drained by a vertical incision from
the tarsal conjunctiva.

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 Meibomian Cyst (Chalazion)
•It is a chronic lipogranulomatous inflammatory
lesion caused by blockage of meibomian gland
orifices and stagnation of sebaceous secretion.
•Patient with acne rosacea or seborhoeic
dermatitis are at increased risk of chalazion
formation which may be multiple or recurrent.
•If it is recurrent, one should think of
sebaceous gland carcinoma

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1.It is probably due to chronic irritation caused by an
organism of low virulence.
The glandular tissue is replaced by granulation tissue
containing giant cells predominantly.
2. It is often multiple in number occurring in crops.
3. It is more common in adults than in children.

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Includes
non pharmachological
Pharmachological
Surgical

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