Eyelid infection

Nursing Students

1. EYELID INFECTIONS, TUMORS AND DEFORMITIES Mrs Dipali Dumbre Msc Nursing Medical Surgical Nursing SCON

2. INTRODUCTION 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.

3. GLANDS OF EYELIDS Zeis’s Gland: Sebaceous gland situated in close association with cilia. Moll’s Gland : Sweat glands & lie between the cilia. 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: 7th , 3rd & 5th cranial nerve.

4. EYELID INFECTIONS, TUMORS AND DEFORMITIES

5. Infection DEFINITION = An eyelid infection is any abnormal condition that effect eyelids. Infection of an oil gland on the surface of the upper and lower parts of eyelids A bacterial infection of an oil gland, hair follicle or sweat gland are caused drooping, twitching (F), inflammation , itching, burning , crustiness, redness , edema ,tearing , irritation .

6. CLASSIFICATION OF EYELIDS INFECTIONS CONGENITAL ANOMALIES EDEMA INFLAMMATIONS ANOMALIES & POSITION OF EYELIDS TUMORS

7. CONGENITAL ANOMALIES Able- pharon : Macrostomia syndrome Extremely rare,the lid is not developed autosomal recessive genetic disorder . Micropharon : Rare, lids are abormally small Cryptopharon :: Rare anomaly in which a fold of skin passes from the eyebrow over the malformed eye to the cheek. Ptosis: Common, drooping of eyelid

8. Epicanthus : A vertical fold of skin on either side of the nose sometime covering the inner canthus. (the outer or inner cornea of the eye Distichiasis : an additional row of lashers occupies the position of meibomian glands .abnormal growthof lashers. Coloboma : condition where normal tissue in or around the eye is missing from birth.

9. EDEMA A swelling eyelid occurs when there is inflammation or excess fluid ( edema) in the connective tissue surrounding the eye. Common due to looseness of tissues Inflammatory Edema: Found in conjunctivitis, tarsitis ,( infl of gland and lasher ) dacryo -cystitis, ( inflammation of lacrimal sac )orbital cellulitis, ( infl of eye tissue ) drug allergy(atropine ). Passive edema: common feature of cavernous sinus thrombosis ( formation of blood clot with in the cavernoussinus a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart ),

10. INFLAMMATIONS It includes 1. Blepharitis 2 . Hordeolum ( stye ) 3 . Chalazion (tarsal or meimobian cyst) 4 . internal . Hordeolum

11. BLEPHARITIS Is an inflammation of the eye lids in which they become red, irritated and itching dandruff like scales from on the eyelashes …

12. 1 . Squamous blepharitis it is due to abnormal metabolism ( abnormal chemical in body ) & seborrhea usually associated with the dandruff of the scalp.Numerous white coloured small scales accumulate among the eyelashes.

13. ULCERATIVE BLEPHARITIS it is an ineffective condition. The yellow crusts glue ( sticky) the lashes together. On removing the crust there are small ulcersseen around the bases of lashes. Symptoms: itching, redness, soreness, lacrimation and photophobia.

14. 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.

15. Hordeolum ( Stye ): It is a localized infection or inflammation of the eye lid margin involving hair follicles of eyelashers or meibomian gland (supply of meibumian , an oily substance ) Etiology : Associated with staphylococci infection, . Common in young adults & debilitated persons( very weekperson ). Symptoms: Ac. Pain & tenderness over inflamed Zeis’s gland. Signs: Localized Pain, redness & edema near the lid margin. Treatment : Hot fomentation,Evacuation of pus, antibiotic eye drop = tobramycin = it is killing or slow the growth of certain type of bacteria. ointment & broad spectrum antibiotics is useful. Analgesics & anti-inflammatory drugs control pain & inflammation.

16. Chalazion It is chronic granulomatous inflammation (produced in response to infection, inflammation,) or the presence of a foreignsubstance . of mei-bomian gland.  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 . - Occur in crops, more common in adults. Symptoms : No pain unless secondary infected

17. Signs : Small non tender hard swelling slightly away from and swelling lid margin ,swelling is red or purple, can be grey in later stages, yellow when secondary infected with pyogenic organisms . Treatment : Inj. Triameinolone directly into the chalazion cause complete resolution. It prevents the release of substances in the body that cause inflammation.

18. Internal Hordeolum It is an acute Supportive inflammation ( formation of pus )of mei-bomian glands Etiology: Occurs due to secondary infection (occurs during or after treatment for another infection .) of chalazion . Symptoms : More violent than stye because the gland is larger & embedded deeply in the dense fibrous tissue. Sign : Yellow spot (pus) seen shining through the conjunctiva on averting ( remaining) the lid ; TREATMENT Warm compresses an d massages of the lesions for 10 minutes 4 times per day Tropical anti biotic ointment Amoxicillin Doxycycline Erythromycin

19. ANOMALIES & POSITION OF EYELIDS

20. It includes 1.Trichiasis, abnormally positioned eyelashes 2.Entropion, the lid margin rolls inwards 3.Ectropion, lid margin rolls outwards 4. Symblepharon , the adhesions between lids and the globe. 5. Ankyloblepharon , adhesion of the margins of two eyelids 6. Lago- pthalamus , inability to close the eyelids completely. 7. Ptosis. drooping of the upper lid

21. TRICHIASIS A bnormally 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 a) Foreign body sensation of photophobia due to corneal involvement b) Irritation, pain & lacrimation Treatment Trichiasis treatment involves removing the eyelash, follicle or both, or redirecting eyelash growth.

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

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

24. SYMBLEPHARON It is a condition of the adhesions between lids and the globe. Etiology : due to - burns, ulcers, diphtheria, operation Symptoms 1. Lagopthalamus : inability to close lids properly 2. Diplopia : double vision T reatment Lysis and removal of subconjunctival scar tissue

25. ANKYLOBLEPHARON It is a condition of the adhesion of the margins of two eyelids. Adhesionmay 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

26. LAGOPTHALAMOS It is a condition of incomplete closure of palpebral aperture when eyes 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 . - Congenital deformity of lids, ectropion , proptosis (abnormal protrusion 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. 2 . Levofloxacin

27. PTOSIS It is a condition in which there is drooping of the upper lid below its normal position . Etiology 1. Congenital Ptosis: Occurs in 80 % cases, due to maldevelopment of levator muscle; congenital weakness of superior rectus muscle . 2. 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 )

28. Symptoms : Visual disturbance visible drooping of the upper eyelid TRETMENT 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 O xycodone hydrochloride analgesic agents H eroin , or hydrocodone can cause ptosis. Pregabalin (Lyrica), an anticonvulsant drug,has also been known to cause mild ptosis .

29. TUMORS

30. Benign Tumors Nevus Heman-gioma Papilloma Xanthe-lasma ( jenthelasma ) Neurofibroma Malignant Tumors Squamous cell carcinoma Basal cell carcinoma

31. Nevus( mole on the skin red patches) A choroidal nevus is a flat, benign pigmented area that appears in the back of the eye Heman-gioma Hemangioma is a non-cancerous ( benign) tumor caused by abnormal growth of blood vessels . cavernous hemangioma occurs in the deeper layers of the skin or aroundthe eye .

32. PAPILLOMA a benign tumor derived from epithelium . Papillomas may arise from skin, mucous membranes, or glandular ducts Xanthelasma ( jenthelasma ) are yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Xanthelasma

33. NEUROFIBROMA It is a generalized disease that may involve the lid & cause mechanical ptosis. It is associated with unilateral infant glaucoma. Small, multiple tumors are distributed along the hypertrophied nerves.

34. Malignant Tumors Squamous cell carcinoma Basal cell carcinoma

35. Squamous cell carcinoma Seen at the edge of the lid (transition zone) where the epithelium changes. It starts as a nodule that ulcerate. The preauricular lymph nodes are enlarged. It spreads slowly the surrounding structures and are painless. Metastasis ( spread of cancer cells to new area of the body ) common ,

36. Basal cell carcinoma It is most common seen in lower lid near the inner canthus. It is locally malignant. Epithelial growth spreads under the skin in all direction .

37. ETIOLOGY Environmental toxins such as exposure to radiation Genetics Diet – deficiency of minerals and vitamins Stress excessive stress cause blockingmutation in the cells of their developing eyes Local trauma or injury- orbital trauma and bleeding Inflammation or infection

38. 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

39. DIAGNOSIS Ultrasound scans CT SCAN MRI They show the size , location ,and shape of the tumors and also show the enlarged or affected lymph node around the eye.

40. MEDICAL MAANAGEMENT 1.Identify the cause & eliminate the cause 2. Achieve and maintain control of symptoms 3. Avoid adverse effects of medication. 4. to give antibiotics and anti inflammatory drugs . 5. 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 and clan cotton ball or wash cloth with warm water, from inner to the outer part the eye.

41. 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 cancerous cell growth Radiation therapy uses high energy x- rays or other types of radiation kill the cancer cell.