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Ectropion: eversion of the eyelid/lashes Risk Factors: MC in the elderly Pathophysiology: relaxation of the orbicularis oculi muscle causes the eyelid to drop and evert over time S/S: Irritation and dryness Treatment: Artificial tears (day) and ocular lubricants (night); surgical correction (definitive) Entropion: inversion of the eyelid/lashes Pathophysiology: scarring of the palpebral conjunctiva and loosening of the fascial attachment; spasms of the orbicularis oculi; Trachoma (chronic infection by chlamydia trachomatis) S/S: eye redness, corneal irritation/ulceration/scarring Treatment: Lubricating eye drops/ointments; botulinum toxin inj. (temporary); surgical correction (definitive) Hordeolum (stye) Pathophysiology: blockage/inflammation/infection of meibomian gland or zeiss or moll gland Etiology: Staphylococcus sp (S. aureus) Risk Factors: Poor eye or hand hygiene & eye rubbing (increased risk if underlying skin condition); sharing contaminated makeup Symptoms: External: localized, red, swollen, acutely tender area on the upper or lower lid Internal: meibomian gland abscess that usually points onto the conjunctival surface of the lid
Treatment: Most resolve spontaneously; Warm compresses (15 min, 4x/day) – Mainstay; antibiotic ointment (bacitracin or erythromycin); needle drainage or I&D *DO NOT RUB OR SQUEEZE Chalazion Pathophysiology: Chronic blockage/granulomatous inflammation of a meibomian gland; may follow an internal hordeolum Symptoms: Hard, nontender swelling on the upper or lower lid with redness and swelling of adjacent conjunctiva Treatment: Often resolves spontaneously; warm compresses; incision and curettage or corticosteroid injection
Etiology: S.aureus, streptococci (if acute) Symptoms: Unilateral; tearing and discharge; redness, swelling, pain in the area of the lacrimal sac Treatment: Warm moist compresses; PO Abx (amoxicillin-clavulanate, cephalexin, ciprofloxacin, clindamycin, TMP-SMZ) Keratoconjunctivitis sicca (Dry eye) Etiology: Systemic drugs (antihistamine, anticholinergics, some psychotropic meds), Systemic illness (Sarcoidosis, Sjogren’s Syndrome), hormonal changes, radiation therapy, CN V or VII lesion, excessive evaporation of tears. Pathophysiology: Decreased tear production: lacrimal gland dysfunction > reduced volume of aqueous fluid and hyperosmolarity of tear film/ocular surface > inflammation of the ocular surface Increased evaporative loss: meibomian gland dysfunction > altered lipid component of tear film > increased evaporation of tear fluid > inflammation of the ocular surfac Lacrimal gland dysfunction > reduced volume of aqueous fluid and hyperosmolarity of tear film/ocular surface
Ectropion: eversion of the eyelid Risk Factors: MC in the elderly Pathophysiology: relaxation of the orbicularis oculi muscle that causes the eyelid to droop and evert over time S/S: irritation and dryness Treatment: artificial tears (day) and ocular lubricants (night); surgical correction (definitive) Entropion: inversion of the eyelid Pathophysiology: scarring of the palpebral conjunctiva and loosening of the fascial attachment; spasms of the orbicularis oculi; trachoma (chronic infection by chlamydia tricasis)
Anterior Blepharitis Pathophysiology/Etiology: chronic inflammation of the lid margin; bacterial (S. aureus, Staph), seborrheic type, demodex (cylindrical dandruff, “sleeves”) Symptoms: itching redness swollen eyelids, gritty or burning sensation, flaking or scaling of the eyelid skin, trichiasis, dry eye disease, blurry vision gets better with blinking Diagnosis: Clinical, Slit lamp Treatment: Warm compresses; bacterial (Antibiotic ointment – bacitracin, erythromycin, azithromycin; severe affected conjunctiva or cornea oral antibiotic – doxycycline, tetracycline, erythromycin); demodex (oral ivermectin or tea tree oil scrub) Dacryocystitis: infection of the lacrimal sac due to the obstruction of the nasolacrimal duct Epidemiology: infants and >40 y/o Etiology: S.aureus Symptoms: unilateral, tearing and discharge, redness, swelling, pain in the area of the lacrimal duct Treatment: warm compresses; PO Abx (amoxicillin-clavulanate, cephalexin, ciprofloxacin, clindamycin, TMP-SMZ); Some cases (correction of obstruction
