Eyelid disorders

EYELID- INFECTION, INFLAMMATION, TUMORS AND DEFORMITIES

1. MEDICAL SURGICAL NURSING- II UNIT – II NURSING MANAGEMENT OF PATIENTS WITH DISORDERS OF EYE TOPIC : EYELID- INFECTION, INFLAMMATION, TUMORS AND DEFORMITIES PRESENTED BY Mrs. SOUMYA SUBRAMANI, M.Sc.(N) LECTURER, MSN DEPARTMENT CON- SRIPMS, COIMBATORE.

2. Hordeolum ( Stye ):

3. INTRODUCTION 1 . EYELIDS : Two movable folds with eyelashes. Layers present are skin, aerolar tissue; muscles- orbicularis oculi, levator palpebrae superioris & Muller’s muscle; thin sheet of dense connective tissue, tarsal plate; thin lining of palpebrae conjunctiva. 2 . EYELID MARGIN Covered with stratified squamous epithelium Anterior border is round, posterior is sharp & lies closely in contact with the eyeball. Eyelashes originate anterior to the grey line and ducts of meibomian are located posterior to the grey line.

4. 3. GLANDS OF EYELIDS Zeis’s Gland : Sebaceous gland situated on the margin of the eyelid Moll’s Gland : Sweat glands & lie on the margin of eyelid . Meibomian Gland : Enormously developed sebaceous gland embedded in tarsal plate, secretes oily secretion that lubricates the eye Palpebral Fissure : Space between the two lids when the eye is open Outer Canthus : Outer or lateral angle of palpebrae fissure Inner Canthus : Inner or medial angle of the palpebral fissure Blood supply : Opthalmic & lacrimal arteries & opthalmic vein Nerve supply : 7 th , 3 rd & 5 th cranial nerve.

5. EYELID INFECTIONS, TUMORS AND DEFORMITIES

6. DEFINITION An eyelid infection is an y infectious condition that effect eyelids. I n f e ction of a n o i l g l a nd o n t h e surf a ce o f the upper and lower parts of eyelids ,hair follicle or sweat gland.

7. INFLAMMATIONS AND INFECTION  It includes  1. Blepharitis  2. Hordeolum (stye)  3. Chalazion (tarsal or meimobian cyst )

8. BLEPHARITIS Is a common chronic bilateral inflammation of the eye lid margins, in which they become red, irritated and itching dandruff like scales f or m on the eyelashes .

9. 1. BLEPHARITIS  Squamous blepharitis  Ulcerative blepharitis  1. Squamous blepharitis it is due to abnormal metabolism & seborrhea usually associated with the dandruff of the scalp. Numerous white coloured small scales accumulate among the eyelashes . 2. ULCERATIVE BLEPHARITIS  it is an infective condition. The yellow crusts glue ( sticky) the lashes together. On removing the crust there are small ulcers seen around the bases of lashes.  Symptoms: itching, redness, soreness, lacrimation and photophobia.

10.  Treatment Local : -removal of scales , crusts & diseased lashes is done by bathing lid margin with 3% of NaHCO3 ( sodium bicarbonate ) lotion. - antibiotics & ointment are applied. General : Improvement of general health & personal hygiene. - Dandruff of the scalp is to be adequately treated.

11. 2. Hordeolum / Stye : is a localized infection or inflammation of the sebaceous glands ( meibomian gland) in the eye lid margin involving hair follicles of eyelashes .  Etiology : Associated with staphylococci infection, . Common in young adults & debilitated persons (very week person ).  Symptoms: Ac. Pain & tenderness over inflamed meibomian gland .  Signs: Localized Pain, redness & edema near the lid margin.  Treatment : Hot fomentation, ( to apply a warm compress o n eye) Evacuation of pus,  antibiotic eye drop = tobramycin  & ointment & broad spectrum antibiotics is useful. - Analgesics & anti-inflammatory drugs control pain & inflammation.

12. = 3 . Chalazion / Meibomian cyst: is a cyst in the eyelid due to a blocked mei-bomian gland in the eyelid.  Etiology : due to chronic irritation due to organism of low virulence ( The ability of bacteria to cause disease ) where the glandular tissue is replaced by granulation tissue containing giant cells. - more common in adults.  Symptoms  Signs : They are typically in the middle of the eyelid, red, and not painful.  Treatment : Warm moist compress Topical antibiotic eye drops or ointment (e.g., chloramphenicol or fusidic acid) Sx - removal of the lesion Inj ect the lesion with corticosteroids

13. TUMORS 1. Benign Tumors Nevus Capillary Hemangioma Xanthelasma Neurofibroma 2. Malignant Tumors Squamous cell carcinoma Basal cell carcinoma

14. Nevus A nevus is a common, colored growth on or in the eyes. Sometimes called a freckle of the eye A nevus (a benign tumor ) is commonly found on the skin of other parts of the human body. A nevus can also occur on the eyelid skin. These tumors are usually pigmented and have thickness . Patients typically notice a dark spot on their eyelid that is thickened. Treatments Large eyelid nevi can be a cosmetic problem that can be repaired by ophthalmic plastic surgery.

15. Capillary Hemangioma is a non-cancerous (benign) tumor caused by abnormal growth of blood vessels. May be bright, superficial, strawberry- red lesions or bluish or purplish deeper lesions.

16. Milia - are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Occurs as a result of lipid disorders.

17. TREATMENT Rarely indicated when visual function is affected. Corticosteroid injection to the haemangioma lesion is effective. Surgical excision or electrocautery is primarily performed for cosmetic reasons.

18. Malignant Tumors Occurs more frequently among fair complexion people who have a history of chronic exposure to the sun. Squamous cell carcinoma Basal cell carcinoma - most common tumor of eyelid

19. Squamous cell carcinoma Occurs less frequently but considered as the 2 nd most common malignant tumor . May resemble the BCC It spreads slowly and tends to ulcerate and invade the surrounding structures . Metastasis common

20. Basal cell carcinoma It is most common seen in lower lid near the inner canthus. Appears as a painless nodule that may ulcerate. The lesion spread to the surrounding tissues and grows slowly.

21. ETIO L O G Y  Environmental toxins such as exposure to radiation  Diet – deficiency of minerals and vitamins  Stress - excessive stress cause mutation in the cells of their developing eyes  Local trauma or injury- orbital trauma and bleeding  Inflammation or infection

22. CLINICAL MANIFESTATION  Bulging of one eye (protrusion)  Complete and partial loss of sight  Pain in or around the eye  Blurred vision  Change in the appearance of the eye  Edema  Redness  Itching  Burning

23. DIAGNOSIS  Ultrasound scans  CT SCAN  MRI  T h ey show t h e size , l oca t i o n , a nd sha p e o f the tumors and also show the enlarged or affected lymph node around the eye.

24. MEDICAL MAANAGEMENT Identify the cause & eliminate the cause control of symptoms antibiotics and anti inflammatory drugs . Maintain normal activity level ,including exercise . 6, Prevention foreign particles enter in eye  Use of sunglasses  To keep the eye clan ,wipe away the drainage from around the eye ‘ moisten or wash with warm water, from inner to the outer part the eye.

25. MANAGMENT Chemotherapy eye drops Mitomycin C –are used to treat different types of growths on the surface of the eye fluorouracil - Is used treatment pre-cancerous an d cancerous cell growth Radiation therapy uses high energy x- rays to kill the cancer cell . Surgical management Complete excision of carcinoma followed by reconstruction with skin grafting if the surgical excision is extensive .

26. ANOMALIES & POSITION OF EYELIDS It includes T richiasis Entropion Ectropion Sy m bl e pharo n Ankyloblepharon Able- pharon Micropharon Epicanthus Distichiasis : Lago-pthalamus , Ptosis

27. ANOMALIES & POSITION OF EYELIDS 1. TRICHIASIS : abnormally positioned eyelashes Few lashes or whole lid margin involved. Etiology : Recurrent stye, Ulcerative blepharitis, Tight bandaging, Scars of lid following burn, injury or operation. Symptoms : Foreign body sensation of photophobia due to corneal involvement Irritation, pain & lacrimation Treatment : Trichiasis treatment involves removing the eyelash or redirecting eyelash growth.

28. 2 . ENTROPION: Conditions in which the lid margin rolls inwards.  Etiology Spastic entropion : Due to the spasm of orbicularis oculi muscle as may occur after tight bandaging after operation of following irritative corneal condition Cicatricial entropion :, ulcerative blepharitis, burns, operations, diphtheritic membranous conjunctivitis.  Sign & symptoms : Same as for trichiasis  Treatment A. Spastic Basic cause of blepharospasm is treated If due to prolonged & tight bandaging, discontinue it. Antibiotics Anti inflammatory - corticosteroids

29. 3 . ECTROPION : It is a condition in which lid margin rolls outwards Symptom : Most common excessive watering of the eyes Signs : Conjunctiva become dry in appearance Chronic conjunctivitis & corneal ulcers. TREATMENT : Use of lubricating ointment or mild steroid several day and weeks to ectropion repair corneal epithelium

30. 4 . SYMBLEPHARON : It is a condition of the adhesions between lids and the globe. Etiology : burns, ulcers, diphtheria, operation Symptoms : Lagopthalamus: inability to close lids properly Diplopia : double vision T reatment : Lysis and removal of subconjunctival scar tissue

31. 5 . ANKYLOBLEPHARON  It is a condition of the adhesion of the margins of two eyelids. Adhesion may be partial or complete,  Etiology - Congenital or acquired due to chemical burn i.e. acid, alkali.  Treatment - Separation of lid margins along with mucus membrane or conjunctival grafting is recommended

32. 6. Able- pharon : Macrostomia syndrome Extremely rare, the lid is not developed autosomal recessive genetic disorder . 7. Micropharon : Rare, lids are abormally small

33. 8. Epicanthus : A vertical fold of skin on either side of the nose sometime covering the inner canthus. 9. Distichiasis : an additional row of lashers occupies the position of meibomian glands. abnormal growth of lashers.

34. 10 . LAGOPTHALAMOS  It is a condition of incomplete closure of palpebral aperture  Lagophthalmos is defined as the inability to close the eyelids completely. Blinking covers the eye with a thin layer of tear fluid,  Etiology  Loss of function of the facial nerve inhibits eyelid closure as well as the blinking reflex . - Conge n ital deformity of lids, e c tropion , proptosis (abno r mal protru s ion or displacement of an eye , paralysis , absence of reflex, blinking in extremely ill patient’s  Treatment Application of antibiotic eye ointment & bandage during sleep is recommended. Levofloxacin

35. 11 . PTOSIS  It is a condition in which there is drooping of the upper lid below its normal position .  Etiology Congenital Ptosis : Occurs in 80 % cases, due to maldevelopment of levator muscle; congenital weakness of superior rectus muscle. Acquired Ptosis : a). Neurogenic : partial/ complete paralysis of 3 rd nerve b) Mechanical : Due to increased weight of upper lid as a result of edema, hypertrophy or tumor formation. c) Myogenic : Due to trauma of levator muscle, muscular dystrophy (increasing weakening or breakdown of muscle) & myasthenia gravis . (neuromuscular disease weakness of skeleton muscle)  Symptoms : Visual disturbance  visible drooping of the upper eyelid

36. TRE A TMENT  high doses of opioid drugs such as morphine , Morphine is a narcotic pain reliever used to treat moderate to severe pain. ... 0.05 mg/kg IM, IV, or subcutaneously every 4 to 8 hours  oxycodone hydrochloride analgesic agents  heroin , or hydrocodone can cause ptosis.  Pregabalin (Lyrica), an anticonvulsant drug, has also been known to cause mild ptosis .

37. THANK Y OU