Blepharitis Inflammation of eyelids due to various

etiologies Main cause is low grade bacterial infection or generalized skin condition

Seborrheic blepharitis Systemic: due to overactive sebaceous glands of scalp, eyebrow, face, torso Ocular: excess oil production
by meibomian glands

Bacterial Blepharitis Usually caused by excess S. aureus Usually chronic Lid mattering, heavier crust

Symptoms Ocular irritation, crustiness, FB sensation, dry eye, itching, burning, tearing, worse upon awakening Bacterial- eyes
often stuck shut upon awakening

Signs Crusty, red, thickened eyelid margins with prominent blood vessels May have abundant yellowish scurfs Conjunctival
injection, swollen lids, mild mucous discharge Shallow ulcerations at lid margins

Management Most important is chronic lid hygiene Hot compresses and lid scrubs BID X 2 weeks then taper Possible topical
antibiotics Possible oral antibiotics Can lead to madarosis, poliosis, trichiasis, hordeolum

Hordeolum Staph. Infection of glands in eyelid Often associated with chronic blepharitis Two forms

External Hordeolum-Infection of zeis or moll glands Minor symptoms- slight tenderness, mild erythema Treatment- selfresolving

Internal hordeolum Infection of meibomian glands More pain, lid edema, deeper tissue, erythema Focal lump

Management Hot compresses QID Topical antibiotics indicated only if secondary conjunctivitis exists

Chalazion Stationary, non-progressive Often follows internal hordeolum or chronic meibomian gland inspissation Usually
cosmetic concern Firm round mass
Management Hot compresses QID X 1 month If no resolution can inject steroid Surgical excision also possible

Preseptal cellulitis

Bacterial infection of eyelid, anterior to orbital septum

Etiology Internal hordeolum Direct innoculation from FB or laceration Spread from ethmoid sinuses

Signs Deeper lid edema Increased erythema Pain Mild fever possible

Orbital cellulitis Infection of post-septal aspect of lid

Etiology: preseptal cellulitis, extension from sinus infection, orbital fracture, dental surgery, FB, bite wound.etc.

Symptoms Increased pain to touch Swollen lid Mucous discharge Diplopia Decreased vision Fever Vomiting headache

Signs Proptosis EOM restriction Decreased visual acuity Increased lid edema Deep reddish-purple erythema

management Check EOMs, visual acuity, proptosis, vital signs Order CT Scan of orbits and sinuses Hospitalization with
broad-spectrum antibiotics

Nasolacrimal duct obstructions (NLO)

Tears produced = tears drained Lid anatomy functions to push tears to puncta Majority of tears are eliminated by evaporation

Signs & symptoms Tearing Discharge Lid mattering Recurrent conjunctivitis

Management Warm compresses and lid massage BID to QID Topical antibiotics if conjunctivitis present At 9-12 months will
need dilation and irrigation Can insert silicone tubes

Aquired NLO

Symptoms Epiphora Mild discharge Irritation

management Jones test- insert fluorescein dye Hot compresses QID Antibiotic/steroid ung QID Dilation & irrigation Silicone
tube inserted

Dacryocystitis Infection of lacrimal sac

Etiology: NLO, trauma, nasal or sinus surgery

Symptoms Pain Swollen lid Discharge Fever tearing

Signs Palpable painful mass at inner canthus of lower lid Erythema Mucous discharge upon palpation

management Palpate lacrimal sac Rule-out orbital cellulitis Hot compresses QID Oral antibiotics IV antibiotics if orbital
cellulitis co-exists

Entropian Inward turning of eyelid margins

Etiology: Involutional Cicatricial Congenital

Symptoms Irritation FB sensation Tearing redness

Signs Corneal abrasion Conjunctival injection Everted lid

Management Antibiotic ung for abrasion Evert lid and tape lid margin Will need surgical repair Epilate lashes while waiting for
surgery

Ectropian Congenital

Paralytic- CN 7 palsy Involutional Cicatricial

Symptoms Tearing Eyelid irritation

Signs Corneal scarring from desiccation Injection Corneal abrasion

management Look for orbicularis oculi weakness from 7th nerve palsy Artificial tears and ung Antibiotics ung Tape lids
Surgical repair

Dermatochalasis A.K.A. blepharochalasis Superior eyelid droops and hangs over eye May limit superior visual field Usually agerelated Surgical repair- blepharoplasty