5th Year Ophthalmology Clinical Round PDF

# 5TH YEAR OPHTHALMOLOGY CLINICAL ROUND Department of Ophthalmology Alexandria University ## Eyelid ### Inflammations of the lid - Stye - Chalazion - Blepharitis ### Ptosis ### Anomalies in eyelid margin - Trichiasis - Entropion - Ectropion ### Lagophthalmos ### Xanthelasma ### Lid Tumors #...

# 5TH YEAR OPHTHALMOLOGY CLINICAL ROUND Department of Ophthalmology Alexandria University ## Eyelid ### Inflammations of the lid - Stye - Chalazion - Blepharitis ### Ptosis ### Anomalies in eyelid margin - Trichiasis - Entropion - Ectropion ### Lagophthalmos ### Xanthelasma ### Lid Tumors ## Eyelid ### Inflammations of the lid - Stye - Chalazion - Blepharitis ## Eyelid ### Stye "A localized acute suppurative inflammation of the eyelash follicle or the associated zeiss gland." ### Treatment: - Topical antibiotic ointment on the lesion + Oral antibiotics - Pus may be evacuated by epilation of the affected lash or incision of the overlying skin. IT MUST BE NEVER SQUEEZED. ## Eyelid ### Chalazion "A chronic inflammatory granuloma of one of the meibomian glands caused by retention of its secretion." ### Treatment: - Warm compresses with gentle massage - Incision and curettage through the conjunctival side ## Eyelid ### Anterior blepharitis - Seborrheic blepharitis - Greasy soft scales on the lashes. (no ulceration) - Treatment - Lid hygiene (warm compresses and lid scrubs with diluted baby shampoo) - Staphylococcal / ulcerative blepharitis - Caused by S. aureus and S. epidermidis. - Hard dry scales around the bases of lashes (collarettes) - Ulceration of the lid margin. - Complication - Madarosis (Loss of eyelashes) - Trichiasis - Stye(recurrent ) - Conjunctivitis & marginal keratitis - Treatment - Lid hygiene (warm compresses and lid scrubs with diluted baby shampoo) - Topical (fusidic acid) - Systemic antibiotics (tetracyclines doxycycline, azithromycin) - Managing complications. ## Eyelid ### Posterior blepharitis - MGD: oil globules + frothy foamy secretion - Diffuse inflammation around gland with telangiectasia - inspissated secretions with plugged meibomian gland orifices - Treatment - Eyelid hygiene (warm compresses and lid scrubs with diluted baby shampoo) - Oral Tetracyclines or Doxycycline - Tear substitutes (drops and/or gel) - Topical steroids may be needed to control ocular surface inflammation ## Eyelid ### Ptosis - Drooping of the upper eyelid below its normal position, so that it covers more than 2 mm of the superior limbus in the primary position - Clinical types - Congenital: defective development of levator muscle - Aponeurotic: Due to disinsertion or dehiscence of the levator aponeurosis - Paralytic: III nerve palsy - Sympathetic: Horner's syndrome - Myogenic: Due to a disease of the levator muscle e.g., myasthenia - Mechanical - Traumatic - Aponeurotic ptosis (Good levator function) - Congenital ptosis (Poor levator function) ### Treatment: Surgical - (levator resection, frontalis sling, etc) - Levator resection (Good levator function) - Frontalis sling (Poor levator function) ## Eyelid ### Anomalies in the position of the lashes and margin - Trichiasis - Entropion - Ectropion ## Eyelid ### Trichiasis - The eyelid margin is in its normal position, but the eyelashes that are misdirected toward the eye, causing irritation - Complication - Corneal abrasions, ulceration, scarring resulting in vision loss - Chronic conjunctivitis - Treatment - Epilation (temporary) - Cryotherapy - Electrolysis - Surgery (mm graft in gray line) ## Eyelid ### Entropion - Most commonly affects the lower lid. - Cicatricial entropion: only type that may affect both upper and lower lid - Complication: same as trichiasis - Treatment: Surgical ## Eyelid ### Ectropion - It mainly affects the lower lid - Complication: - Epiphora - Incomplete closure: dryness of cornea - Treatment: Surgical ## Eyelid - Lagophthalmos - Xanthelasma - Lid Tumors ## Eyelid ### Lagophthalmos "Incomplete closure of eyelid." - Paralytic (facial palsy) - Cicatricial lagophthalmos - Physiologic (sleep) - Mechanical (e.g., exophthalmos) - Functional (GA, unconsciousness) ### Treatment: aim is to protect the cornea: - Temporary measures: - Artificial tears - At bedtime : ointment and tapping of the lids by strips of adhesive plaster - Permanent measures: - Lateral tarsorrhaphy & medial canthoplasty - Treatment of the cause ## Eyelid ### Xanthelasma - Yellowish plaque - Due to high Cholesterol level - Investigation : lipid profile - Treatment - Surgical excision - Co2 laser therapy ## Eyelid ### Malignant Lid Tumors - BCC - SCC ## Thank you