TRICHIASIS PDF - Eyelid Eyelash Conditions

TRICHIASIS: misdirection of eyelashes towards the globe -different to pseudotrichiasis in which the eyelashes are turned inwards secondary to entropian -PRIMARY CAUSES: v Ageing v Congenital v Scarring of the posterior lid lamella (superior or inferior)...

TRICHIASIS: misdirection of eyelashes towards the globe -different to pseudotrichiasis in which the eyelashes are turned inwards secondary to entropian -PRIMARY CAUSES: v Ageing v Congenital v Scarring of the posterior lid lamella (superior or inferior) SIGNS: v Several condition predispose a px to trichiasis: v Conjunctival injections Blepharitis v Pain Epiblepharon v Foreign body sensation Past herpes zoster ophthalmicus infection v Tear film abnormalities Trachoma v Posterior lamellar scarring v Involutional entropian Ocular ciatrical pemphigoid v Punctate epitheliopathy Stevens Johnson Syndrome v Microbial keratitis Vernal Keratoconjunctivitis v Scarring Chemical burns MANAGEMENT: v Removal of the offending eyelash – epilation may need to be repeated 4-6 weeks v Tackling any underlying condition v If due to entropian, the eyelid should be taped for temporary relief of symptoms v Therapeutic contact lenses v Ocular lubricants TRACHOMA: 6 million people are blind with trachoma; endemic in Africa, ME, Asia v Caused by infection with bacterium Chlamidya Trachomatis v Incubation period of 5-12 days v Begins slowly as conjunctivitis which leads to tarsal conjunctival scarring v Scarring distorts the upper tarsal plate + leads to entropian and trichiasis v Eyelashes may turn in and rub against the cornea: Cause eye ulcers, further scarring, visual loss + blindness ENTROPIAN: inversion of the eyelid with the lid margin turned inwards toward the globe Involutional, Cicatrical, Spastic, Congenital INVOLUTIONAL - Related to ageing - Most common - Typically on the lower lid - F>M, people with involutional entropian have smaller than normal tarsal plates CICTRICAL - Scarring + contration of conjunctival tissue which pulls the lids margin inwards towards the globe - Trauma, chemical burns, OCP, infections or local response to topical medication - Involutional entropian – lids are lax so easy to evert BUT not in ciatrical SPASTIC - results from ocular irritation - infection, inflammation or traumatic processes - usually resolves spontaneously once cause has been eliminatedc CONGENITAL - very rare - results from improper development of lower lid retractor aponeurosis insertion in lower border of tarsal plate - causes instability in eyelid with consequent entropian SYMPTOMS: - redness - irritation - eye discomfort + pain: due to eyelashes rubbing against the cornea + conjunctiva SIGN: - corneal and or conjunctival epithelial disturbance by the lashes - conjunctival hyperaemia MANAGEMENT: - Surgery: remove part of the lower lid, strengthen the canthal tendons or inferior lid retractors - Ocular lubricants - Bandage contact lens to prevent eyelashes rubbing against conjunctiva - Taping the lower lid to the cheek ECTROPIAN: outward rotation of eyelid margin - Occurs in 4% of population over 50 years old - 50% have bilateral SIGN: - Conjunctival hyperaemia - Corneal exposure - Tearing - Globe apposition - Keratinisation of the palpebral conjunctiva - Visual loss - Mucous discharge INVOLUTIONAL -due to ageing -most common -disinsertion of lower lid retractors -decreased tone of lower pre-septal/pre-tarsal orbicularis muscle in combination with medial/lateral canthal tendon laxity CICATRICAL -occurs from scarring of anterior lamella of the lid by conditions such as burns, trauma, chronic dermatitis -less common cause: tumors PARALYTIC -may occur due to 7th Nerve Palsy -Bell’s palsy, cerebellopontine angle tumors, herpes zoster oticus (viral ear infection), infiltrations/tumors of parotid gland MECHANICAL -lid tumors such as neurofibromas which evert the eyelid SYMPTOMS: - Irritated eyes - Red eyes - Tearing - Constant wiping of eyes which will increase the laxity of the eyelid – remind px to not rub MANAGEMENT: - Adv px to not rub to prevent further more lid laxity - Taping the lids closed at night - Therapeutic lids - when there is risk of corneal exposure - Tape the lateral canthus to the skin above and temporally to provide temporary relief – esp with 7th nerve - SURGERY: shorten lower lid/canthal plication under local anaesthetic PRE-SEPTAL CELLULITIS: common infection of eyelid + periorbital soft tissues - Acute eyelid erythema - Eyelid oedema - Mainly affecting children: 80% medial > superior > temporal - Stem from the basal layer – deepest layer of the skin - Most common among light skinned individuals with high uv exposure - Incidence of BCC increase with age – peaking in the seventh decade of life - M>F: 3:2 - More in immunocompromised who have been on immunosuppresants for many years THREE MAIN BCC TYPES: a) NODULAR – small, translucent, poorly defined borders, firm to touch b) ULCERATIVE – classic ulcerative presentation is a nodular lesion, reddish hue due to permanent blood vessels along the surface, pearly appearance, excavated centre c) MORPHEIC: firm, pale, waxy yellow plaque with indistinct borders which may spread underneath skin surface SIGNS: - May present as a change in lid contour/direction - Redirection/loss of eyelashes - Texture of surrounding skin may be lost - Secondary infection/inflammation may be evident - Referral necessary - If left untreated: can metastasise and can threaten sight MANAGEMENT: - Surgical removal - Skin grafting may be required if large - Cryotherapy - Radiation therapy - Early detection: good prognosis SQUAMOUS CELL CARCINOMA: - Rare - More aggressive malignancy than BCC - 2nd most common eyelid malignancy: 5% of all eyelid lesions - Mostly in the elderly - Fair skinned individuals - History of chronic sun exposure - Associaton with other pre-cancerous lesions: actinic keratosis, bowen dermatosis - Immunocompromised pxs - Px exposed to oil/tar - Xeroderma pigmentosa association BENIGN EYELID LESIONS: - Cysts from any of the glands around the eyelid margin - CYSTS OF MOLL: benign clear fluid-filled cysts occurring upper/lower lid margins - CYSTS OF ZEISS: small sebaceous glands assoc with lash follicles, blockage of lash follicles leads to accumulation of yellow/white sebaceous material - Removal of these two will only be for cosmetic purposes - MOLLUSCUM CONTAGIOSUM: benign skin lesion Contagious Spreads through direct contact Lesion can be single/multiple Dome shaped waxy nodule 2-3mm in diameter Release toxic viral products can lead to follicular conjunctivitis THYROID EYE DISEASES: - Most common present in women in their 4th to 6th decade - Graves Disease (autoimmune thyrotoxicosis) - SYSTEMIC SYMPTOMS: tremor, mood change/irritability, weight loss, tachycardia) - OCULAR SYMPTOMS: proptosis, lid retraction, lid lag, irritation due to corneal dryness, lid oedema, conjunctival chemosis, serious complication of optic nerve compression (