Disorder of eyelids

HORDEOLUM

: is the result of an acute bacterial infection of one or more eyelid glands. If several glands are affected at the same time, it is called hordeolosis. Epidemiology and etiology. Staphylococcus aureus is a common cause of hordeolum. External hordeolum involves infection of the glands of Zeis or Moll. Internal hordeolum arises from infection of the meibomian glands. Hordeolum is often associated with diabetes, gastrointestinal disorders, or acne. Symptoms and diagnostic considerations. Hordeolum presents as painful nodules with a central core of pus. External hordeolum appears on the marginof the eyelid where the sweat glands are located (Fig. 2.17). Internal hordeolum of a sebaceous gland is usually only revealed by everting the eyelid and usually accompanied by a more severe reaction such as conjunctivitis or chemosis of the bulbar conjunctiva. Pseudoptosis and swelling of the preauricular lymph nodes may also occur. Differential diagnosis. Chalazion (tender to palpation) and inflammation of the lacrimal glands (rarer and more painful). Treatment. Antibiotic ointments and application of dry heat (red heat lamp) will rapidly heal the lesion. Clinical course and prognosis. After eruption and drainage of the pus, the symptoms will rapidly disappear. The prognosis is good. An underlying internal disorder should be excluded in cases in which the disorder frequently recurs.

CHALAZION
within the tarsus.

: Firm nodular bulb

Epidemiology and etiology. Chalazia occur relatively frequently and are caused by a chronic granulomatous inflammation due to buildup of secretion from the meibomian gland. Symptoms. The firm painless nodule develops very slowly. Aside from the cosmetic flaw, it is usually asymptomatic (Fig. 2.18). Differential diagnosis. Hordeolum (tender to palpation) and adenocarcinoma. Treatment. Surgical incision is usually unavoidable (Fig. 2.19). After the chalazion clamp has been introduced, the lesion is incised either medially, perpendicular to the margin of the

eyelid, or laterally, perpendicular to the margin of the eyelid (this is important to avoid cicatricial ectropion). The fatty contents are then removed with a curet. Prognosis. Good, except for the chance of local recurrence
Hyphema Bleeding in the anterior chamber.

Hypopyon Collection of pus in the anterior chamber.

IRIDITIS Inflammation Inflammations of the uveal tract are classified according to the various portions of the globe: 1. Anterior uveitis (iritis). 2. Intermediate uveitis (cyclitis). 3. Posterior uveitis (choroiditis). However, some inflammations involve the middle portions of the uveal tract such as iridocyclitis (inflammation of the iris and ciliary body) or panuveitis (inflammation involving all segments). Epidemiology. Iritis is the most frequent form of uveitis. It usually occurs in combination with cyclitis. About three quarters of all iridocyclitis cases have an acute clinical course. Etiology. Iridocyclitis is frequently attributable to immunologic causes such as allergic or hyperergic reaction to bacterial toxins. In some rheumatic disorders it is known to be frequently associated with the expression of specific human leukocyte antigens (HLA) such as HLA-B27. Iridocyclitis can also be a symptom of systemic disease such as ankylosing spondylitis, Reiter syndrome, sarcoidosis, etc. (Table 8.1). Infections are less frequent and occur secondary to penetrating trauma or sepsis (bacteria, viruses, mycosis, or parasites). Phacogenic inflammation, possibly with glaucoma, can result when the lens becomes involved. Symptoms. Patients report dull pain in the eye or forehead accompanied by impaired vision, photophobia, and excessive tearing (epiphora). In contrast to choroiditis, acute iritis or iridocyclitis is painful because of the involvement of the ciliary nerves. In contrast to choroiditis, acute iritis or iridocyclitis is painful because of the involvement of the ciliary nerves. Diagnostic considerations. Typical signs include: Ciliary injection. The episcleral and perilimbal vessels may appear blue and red. Combined injection. The conjunctiva is also affected. The iris is hyperemic (the iris vessels will be visible in a light-colored iris). The structure appears diffuse and reactive miosis is present. Vision is impaired because of cellular infiltration of the anterior chamber and protein or fibrin accumulation (visible as a Tyndall effect). The precipitates accumulate on the posterior surface of the cornea in a triangular configuration known as Arlts triangle. Exudate accumulation on the floor of the anterior

chamber is referred to as hypopyon (Fig. 8.8). Viral infections may be accompanied by bleeding into the anterior chamber (hyphema; Fig. 8.9). Corneal edema can also develop in rare cases.

Blepharitis Infectious Blepharitis Blepharitis is a common condition of the eyelids causing chronic ocular irritation and foreign body sensation. It is associated with thickening of the eyelids, telangiectatic vessels along the lid margins, and plugging of the meibomian glands (Fig. 1.3A,B). There is usually crusting along the eyelashes and sometimes misdirection and loss of eyelashes. Staphylococcus bacteria are the most common offending organisms. In many patients, blepharitis is associated with rosacea, manifested by telangiectatic vessels on the facial skin, and with rhinophyma in more advanced cases (Fig. 1.4).

Figure 1.3. A: Blepharitis is associated with crusting of the eyelashes, thickening of the eyelids, telangiectatic vessels along the lid margins, and plugging of the meibomian glands. B: The meibomian glands become plugged in posterior blepharitis with or without rosacea.

Good lid hygiene with mechanical scrubbing of the lid margins, warm compresses, and antibiotic ointment at bedtime using bacitracin or erythromycin is the standard treatment for blepharitis. Patients whose condition is unresponsive, those who have rosacea, or those who have corneal complications such as margin infiltrates benefit from the use of systemic tetracycline (250 mg, orally four times each day for 1 week, then twice daily) or doxycycline (100 mg, orally twice daily for 1 week, then once daily). Systemic erythromycin is an alternative to systemic doxycycline for patients who are unable to tolerate doxycycline and for children who cannot take doxycycline because it stains developing teeth.