Blepharitis Inflammation of eyelids due to various
etiologies Main cause is low grade bacterial infection or generalized skin condition
Seborrheic blepharitis Systemic: due to overactive sebaceous glands of scalp, eyebrow, face, torso Ocular: excess oil production
by meibomian glands
Bacterial Blepharitis Usually caused by excess S. aureus Usually chronic Lid mattering, heavier crust
Symptoms Ocular irritation, crustiness, FB sensation, dry eye, itching, burning, tearing, worse upon awakening Bacterial- eyes
often stuck shut upon awakening
Signs Crusty, red, thickened eyelid margins with prominent blood vessels May have abundant yellowish scurfs Conjunctival
injection, swollen lids, mild mucous discharge Shallow ulcerations at lid margins
Management Most important is chronic lid hygiene Hot compresses and lid scrubs BID X 2 weeks then taper Possible topical
antibiotics Possible oral antibiotics Can lead to madarosis, poliosis, trichiasis, hordeolum
Hordeolum Staph. Infection of glands in eyelid Often associated with chronic blepharitis Two forms
External Hordeolum-Infection of zeis or moll glands Minor symptoms- slight tenderness, mild erythema Treatment- selfresolving
Internal hordeolum Infection of meibomian glands More pain, lid edema, deeper tissue, erythema Focal lump
Management Hot compresses QID Topical antibiotics indicated only if secondary conjunctivitis exists
Chalazion Stationary, non-progressive Often follows internal hordeolum or chronic meibomian gland inspissation Usually
cosmetic concern Firm round mass
Management Hot compresses QID X 1 month If no resolution can inject steroid Surgical excision also possible
Preseptal cellulitis
Bacterial infection of eyelid, anterior to orbital septum
Etiology Internal hordeolum Direct innoculation from FB or laceration Spread from ethmoid sinuses
Signs Deeper lid edema Increased erythema Pain Mild fever possible
Orbital cellulitis Infection of post-septal aspect of lid
Etiology: preseptal cellulitis, extension from sinus infection, orbital fracture, dental surgery, FB, bite wound.etc.
Symptoms Increased pain to touch Swollen lid Mucous discharge Diplopia Decreased vision Fever Vomiting headache
Signs Proptosis EOM restriction Decreased visual acuity Increased lid edema Deep reddish-purple erythema
management Check EOMs, visual acuity, proptosis, vital signs Order CT Scan of orbits and sinuses Hospitalization with
broad-spectrum antibiotics
Nasolacrimal duct obstructions (NLO)
Tears produced = tears drained Lid anatomy functions to push tears to puncta Majority of tears are eliminated by evaporation
Signs & symptoms Tearing Discharge Lid mattering Recurrent conjunctivitis
Management Warm compresses and lid massage BID to QID Topical antibiotics if conjunctivitis present At 9-12 months will
need dilation and irrigation Can insert silicone tubes
Aquired NLO
Symptoms Epiphora Mild discharge Irritation
management Jones test- insert fluorescein dye Hot compresses QID Antibiotic/steroid ung QID Dilation & irrigation Silicone
tube inserted
Dacryocystitis Infection of lacrimal sac
Etiology: NLO, trauma, nasal or sinus surgery
Symptoms Pain Swollen lid Discharge Fever tearing
Signs Palpable painful mass at inner canthus of lower lid Erythema Mucous discharge upon palpation
management Palpate lacrimal sac Rule-out orbital cellulitis Hot compresses QID Oral antibiotics IV antibiotics if orbital
cellulitis co-exists
Entropian Inward turning of eyelid margins
Etiology: Involutional Cicatricial Congenital
Symptoms Irritation FB sensation Tearing redness
Signs Corneal abrasion Conjunctival injection Everted lid
Management Antibiotic ung for abrasion Evert lid and tape lid margin Will need surgical repair Epilate lashes while waiting for
surgery
Ectropian Congenital
Paralytic- CN 7 palsy Involutional Cicatricial
Symptoms Tearing Eyelid irritation
Signs Corneal scarring from desiccation Injection Corneal abrasion
management Look for orbicularis oculi weakness from 7th nerve palsy Artificial tears and ung Antibiotics ung Tape lids
Surgical repair
Dermatochalasis A.K.A. blepharochalasis Superior eyelid droops and hangs over eye May limit superior visual field Usually agerelated Surgical repair- blepharoplasty
