Ocular Disorders: Trichiasis and Trachoma

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary difference between trichiasis and pseudotrichiasis?

Trichiasis is caused by bacteria, while pseudotrichiasis is caused by viruses.

Trichiasis occurs in older adults, while pseudotrichiasis is congenital.

Trichiasis involves inflammation, while pseudotrichiasis is purely mechanical.

Trichiasis involves misdirection of eyelashes, while pseudotrichiasis is secondary to entropion. (correct)

Which of the following is NOT a common cause of trichiasis?

Excessive tear production (correct)

Ageing

Congenital factors

Scarring of the posterior lid lamella

A patient presents with conjunctival injections, pain, and foreign body sensation. Which condition is MOST likely to be associated with these signs?

Epiblepharon alone

Trichiasis (correct)

Blepharitis alone

Involutional entropian alone

Which of these conditions is a known cause of trachoma?

Chlamydia trachomatis Signup and view all the answers

What is the typical incubation period for trachoma?

5 to 12 days Signup and view all the answers

Which of the following describes the MOST common type of entropian?

Involutional Signup and view all the answers

A patient with involutional entropian is MOST likely to present with which of these physical findings?

Lower lid turning inwards Signup and view all the answers

Which treatment is LEAST likely to provide long-term relief for trichiasis?

Taping the eyelid Signup and view all the answers

Which of the following is NOT a typical cause of spastic entropion?

Improper development of the lower lid retractor aponeurosis Signup and view all the answers

What is a common symptom associated with both entropion and ectropion?

Conjunctival hyperaemia Signup and view all the answers

Which surgical intervention would be MOST appropriate for managing entropion?

Strengthening the canthal tendons Signup and view all the answers

An outward rotation of eyelid margin is best described by which term?

Ectropion Signup and view all the answers

What is the MOST common cause of ectropion in the general population?

Involutional changes due to ageing Signup and view all the answers

Which of the following is LEAST likely a cause of cicatrical ectropion?

Disinsertion of the lower lid retractors Signup and view all the answers

Which of these options is the most likely cause of paralytic ectropion?

Seventh Nerve Palsy Signup and view all the answers

Which of the following treatments is used to manage entropion symptoms but does not address the underlying cause?

Bandage contact lens Signup and view all the answers

Which of the following actions is NOT typically recommended for managing eyelid laxity?

Applying a warm compress to the affected area Signup and view all the answers

Pre-septal cellulitis is most likely to affect which area in children?

Medial aspect of the eye Signup and view all the answers

Which characteristic is NOT typically associated with a nodular basal cell carcinoma (BCC)?

Well-defined borders Signup and view all the answers

An ulcerative basal cell carcinoma (BCC) is typically characterized by which of the following?

A pearly appearance with an excavated center Signup and view all the answers

Which feature is most indicative of a morpheic basal cell carcinoma (BCC)?

A firm, pale, waxy plaque with indistinct borders Signup and view all the answers

Squamous cell carcinoma (SCC) of the eyelid is LEAST likely to be associated with which of the following?

Long-term eye rubbing Signup and view all the answers

Cysts of Moll are BEST described as:

Benign clear fluid-filled cysts on the upper/lower lid margins Signup and view all the answers

Cysts of Zeiss are the result of:

A blockage of lash follicles Signup and view all the answers

Study Notes

Trichiasis

Misdirection of eyelashes towards the globe, different from entropion
Causes include: aging, congenital, scarring of posterior lid lamella, blepharitis, epiblepharon, herpes zoster, trachoma, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, vernal keratoconjunctivitis, chemical burns
Signs include conjunctival injection, pain, foreign body sensation, tear film abnormalities, posterior lamellar scarring, involutional entropian, punctate epitheliopathy, microbial keratitis, scarring
Management involves epilation (lash removal), addressing underlying conditions (e.g., taping the eyelid, therapeutic contact lenses, or ocular lubricants)

Trachoma

Caused by Chlamydia trachomatis infection, endemic in Africa, Middle East, and Asia
Incubation period is 5-12 days
Initially conjunctivitis, progressing to scarring of tarsal conjunctiva, entropion and trichiasis
Leading cause of preventable blindness
Causes eye ulcers, further scarring, and vision loss

Entropian

Inversion of the eyelid margin inward towards the globe
Types include involutional, cicatrical, and spastic
Involutional: age-related, typically lower lid, affecting more women, smaller tarsal plates, lax lids, often resolves spontaneously
Cicatrical: scarring, often from trauma, burns, infections, or medication, leads to lid margin being pulled inward
Spastic: involuntary muscle contractions, less common, causes irritation, inflammation or trauma
Congenital: rare, results from improper development of lower eyelid retractor insertion, eyelid instability

Symptoms of Eyelid Disorders

Redness
Irritation
Eye discomfort and pain (from eyelashes rubbing against the cornea/conjunctiva)
Corneal and/or conjunctival epithelial disturbance by lashes
Conjunctival hyperemia (redness of the conjunctiva)
Corneal exposure
Tearing
Mucous discharge

Pre-septal Cellulitis

Common infection of eyelid and periorbital soft tissue, primarily in children
Common causes are Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus, Anaerobes, bacterial infection of upper respiratory tract.
Signs and symptoms include acute pain, swollen eyelids, redness, blurred vision, conjunctivitis, and tearing.
May be preceded by upper respiratory tract infections, such as sinusitis.
Differential diagnosis should include insect bites, allergic conjunctivitis, trauma, contact dermatitis, hordeolum.

Bacterial Orbital Cellulitis

Infection of tissues behind the septum
Commonly spreads from adjacent sinuses, such as the ethmoid sinus
Possible causes include Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Beta-hemolytic streptococci
More severe than pre-septal cellulitis
Progresses rapidly, may compress optic nerve
Symptoms include pain with eye movement, chemosis (swelling of conjunctiva), proptosis (eye bulging), ophthalmoplegia (eye muscle paralysis), restricted EOM's (extraocular movements), reduced vision

Management of Eyelid Disorders

Confirmation of diagnosis
Treatment of underlying conditions (e.g., addressing pre-disposing conditions like upper respiratory tract infections, diabetes, or other medical conditions)
Appropriate use of antibiotics (IV in more severe cases)
Considering CT scans for no improvement following antibiotics.

Tumors (Basal Cell Carcinoma, Squamous Cell Carcinoma)

Basal cell carcinoma: most frequent eyelid malignancy (80-90% of all eyelid cancers); slow growing, destructive, locally invasive, pearly borders, ulcerative center
Squamous cell carcinoma: aggressive, 2nd most common (5%), elderly, fair-skinned individuals, more aggressive than BCC
Management includes surgical removal, skin grafting where needed, cryotherapy, radiation therapy. Early diagnosis is crucial for successful outcomes.

Benign Eyelid Lesions

Cysts of Zeis, cysts of moll
Molluscum contagiosum: contagious skin lesion, usually presents as small, dome shaped, waxy nodules
Thyroid eye disease: most common in middle-aged women; symptoms include proptosis, lid retraction, lid lag, irritation due to corneal dryness, lid edema, conjunctival chemosis, and possible optic nerve compression (rare)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores two significant ocular disorders: trichiasis and trachoma. Learn about their causes, signs, and management options. Test your understanding of how these conditions affect eye health and contribute to vision impairment.