DISEASE OF THE EYELID
STY,BLEPHRITIS,ENTROPION,
ECTROPION,CHALAZION,TRICHI
ASIS,PTUSIS
DEPARTMENT OF HEALTHCARE PROFESSIONAL
Learning objectives
At the end of the session, student will be able
to:
■ Identify the types of eyelids infection
■ State the causes of eyelids infection
■ State the signs and symptoms of eyelids infection
■ State the pathophysiology of eyelids infection
■ State investigations used to detect eyelids infection
■ Explain the specific management of eyelids infection
EYELID INFECTIONS AND
INFLAMMATION
■ Related to gland and lashes
■ Inflammation cause by a staphylococcal infection from
seborrheic origin , dandruff of eyebrows or lashes
■ Causes irritation , burning, itchy, mucus discharge , lid ulcerate
, loss eye lashes
COLLABORATIVE CARE
■ Management of infection and inflammation
■ Physical assessment
■ Visual acuity test
■ Hospitalize
■ Medical emergency
LABORATORY TEST
■ Fluorescein stain with slit lamp : allow visualize corneal ,
abrasions , which appear green staining
■ Conjunctival or ulcer scraping : exam microscopically or
cultured to identify organism
■ Additional test : blood count or antibody titres
PHARMACOLOGICAL
■ ANTIBIOTIC OR ANTIVIRAL THERAPY
Topical anti-infectives eye drops or ointment erythromycin ,gentamicin,penicillin, bacitracin,
sulfacetamide sodium,amphotericin B or idoxuridine
■ ANALGESIC :Acetaminophen or codeine for pain management
■ ANTIHISTAMINE: Used to minimize symptom such as allergic Corticosteroids
■ IMMUNOSUPPRESIVE THERAPY
With azathioprine (Imuran) or cyclosporine (Sndimmune) to suppress inflammatory response
HORDEOLUM
DEFINITION OF HORDEOLUM
■ Also known as sty
CAUSES
■ Staphylococcal organism – most common cause of eyelid
infection
TYPES OF HORDEOLUM
________________________________ _____________________________________
TYPES OF HORDEOLUM
■ Involved follicle of the eyelashes
■ ____________________________ : small and more
superficial .Always point to the skin
■ _____________________________ : large swelling known as
Meibomian cyst. May point to the skin or the conjunctiva
surface.
SIGN AND SYMPTOMS
1.
2.
3.
4.
5.
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
ASSESSMENT
HISTORY
■A hordeolum usually has an acute onset
■Usually client has past history of similar eyelid lesion and past
ocular history of blepharitis or Meibomian gland disease
■Client will complaint : eyelid pain , swelling , eye discomfort
and burning sensation
ASSESSMENT
Physical examination
■Reveals an acute inflammatory reaction
with eyelids erythema and edema
■Cellulitis of the surrounding soft tissue
may develop in external and internal eyelid
lesion
■Eyelid margin inflammation are noted in
clients with blepharitis and history of
recurrent or multiple chalazion.
INVESTIGATION
■ Eye swabbing –swab culture and sensitivity
MANAGEMENT
■ Warm compress 3-4 times a ■ Antibiotic therapy
day for 10-1 minutes ■ Systemic secondary
■ Incision on drainage ( I&D ) bacterial infection e.g
if the process does not begin CEPHALEXIN ,
to resolve within 48 hours . Thiamcinolone for cellulitis
COMPLICATIONS
■ Large lesion of the upper eyelid cause decrease vision
secondary to hyperopia (farsightedness) resulting from central
corneal flattening
CHALAZION
DEFINITION
■ Meaning small lump
■ Swelling within the eyelid caused by inflammation of an oil
gland
■ Happens sometimes after effects of a stye
■ Less tender but last longer
SIGN AND SYMPTOMS
■ Localize pain
■ Swelling last for a week
■ Mild inflammation > tenderness
■ Slightly redness or elevated , Irritation
■ Large chalazion may press on the eyeball and cause astigmatism (blur vision)
■ Some disappear within few months, in certain cases cyst may become larger
within 2 years time
■ Condition include seborrhea,chronic lid inflammation,dry eye and acne
INVESTIGATION
■ BIOPSY
ENTROPION &
ECTROPION
ENTROPION
DEFINITION
■ Lower eyelids turns inwards , rubbing against the cornea
AGING EYELIDS
■ Muscle weaken & lose their smooth and rounded from > drooping
and wrinkled
■ This sometimes allows the eyelids to rotate inwards or outwards
and problems appears
CAUSES
■ Occurs results of aging
■ Infection and scarring inside the eyelids
PATHOPHYSIOLOGY
■ When the eyelids turns inwards , the eyelashes and skin rub against
the eye causing redness, irritated and sensitive to light and wind
■ Over the time , many people develop excess eyelid skin
■ Eyelid skin is the thinnest skin of the body > so it is more likely to
stretch
■ In the upper eyelid , this stretch may limit the vision and may produce
feeling of heaviness and tired apprearance
■ In the lower eyelid “bag “ will be form
SIGN AND SYMPTOMS
MANAGEMENT
1. Removal of the excess skin in either the upper or
lower eyelids helps to improve the field of the vision,
appearance and other symptoms.
2. If any fatty tissue is present , it may be removed at the
same time.
MANAGEMENT
3. Surgery – the eyelid can
be turned outward to its
normal position
> Entropion Lower Eyelid
Reconstruction
ECTROPION
DEFINITION
■ Sagging and eversion of the
lower lid
CAUSES
SIGN AND SYMPTOMS
■ Epiphora (excessive tear productions)
■ Eye irritation causing discomfort
■ Ocular redness
MANAGEMENT
■ Repair of ectropion is relatively quick and easy
■ Surgery is performed on an outpatient basis.
■ Length of surgery takes approximately 10-15 minutes
and absorbable sutures are used
■ The recovery time approximately 1 week
BLEPHARITIS
Definition :
Is a chronic inflammation of the
eyelids
TYPES
■ Seborrheic blepharitis
■ Ulcerative blepharitis
SIGN AND SYMPTOMS
■ Red eye with scales and flakes apparent of the base of the eyelashes
■ Burning sensation
■ Irritation of the sensation of foreign body
■ Itching at eyelid margin
■ In the morning- eyelids may sticks crusted scales and debris caused by
an oily discharge from the eyelid glands
■ Untreated – these glands may become plugged and infected – leading to
recurrent sty, dry eye syndrome and loss of lashes
MANAGEMENT
■ The scalp , eyebrow and lid margins must kept clean –particularly
in seborrheic type of blepharitis – clean with soap or shampoo
■ Scales must be removed from the lid margin daily with cotton
applicator and baby shampoo
- fill small container with warm water
- add 3 drops of baby shampoo
- soak a clean cotton ball in the solution
MANAGEMENT
■ Gently scrub both eyelids for 2 minutes with eye closed
■ Rinse with cool tap water
■ Gently dry with clean towel
■ Use medication as directed e.g antibiotic or topical steroid
■ Treatment for oily scalp with antidandruff shampoo maybe
useful
