INFLAMMATION & INFECTIONS OF EYELIDS.ppt

INFLAMMATION & INFECTIONS OF EYELIDS

2. Inflammations and Infections of Inflammations and Infections of
the Eyelidsthe Eyelids
Dr. M KASHIF HANIF
Assistant Professor of Ophthalmology
BUMDC

3. Congenital anomaliesCongenital anomalies
Coloboma
Epicanthus
Distichiasis
Blephrophimosis syndrome
Anchyloblephron
Congenital ectropion
Telecanthus

4. Coloboma of the EyelidColoboma of the Eyelid

5. EPICANTHIC FOLDSEPICANTHIC FOLDS
BILATERAL
VERTICAL FOLDS
OF SKIN THAT
EXTEND FROM
UPPER OR LOWER
LID TOWARDS
MEDIAL CANTHUS.
MAY GIVE RISE TO
PSEUDO-ESOTROPIA

6. Congenital DystichiasisCongenital Dystichiasis

7. Blephrophimosis SyndromeBlephrophimosis Syndrome

8. AnkyloblephronAnkyloblephron

9. Congenital EctropionCongenital Ectropion
Aetiology
Clinical features
Treatment

10. TELECANTHUSTELECANTHUS
UNCOMMON
INCREASED DISTANCE
BETWEEN THE MEDIAL
CANTHI AS A RESULT OF
ABNORMALLY LONG MEDIAL
CANTHAL TENDONS
TREATMENT
◦SHORTENING AND
REFIXATION OF
MEDIAL CANTHAL
TENDONS

11. EPIBLEPHARONEPIBLEPHARON
COMMON IN ORIENTALS
EXTRA HORIZONTAL FOLD
OF SKIN STRETCHES
ACROSS ANT. LID MARGIN
& LASHES ARE DIRECTED
VERTICALLY
TREATMENT
◦RECOVER
SPONTANEOUSLY
◦PERSISTENT CASES
REQUIRE HOTZ
PROCEDURE

12. Categories.Categories.
Congenital Anomalies
Inflammations
Disorders of position.
Trauma
Tumours

13. INFLAMMATIONS OF EYE LIDINFLAMMATIONS OF EYE LID
ALLERGIC DISORDERS
◦Acute allergic oedema
◦Contact dermatitis
◦Atopic dermatitis
INFECTIONS
◦Herepes zoster ophthalmicus
◦Impetigo
◦Erysipelas
◦Stye
◦Internal hordeolum
CHRONIC MARGINAL BLEPHARITIS
◦Anterior blepharitis
◦Posterior blepharitis
MISCELLANEOUS

14. ACUTE ALLERGIC OEDEMAACUTE ALLERGIC OEDEMA
INSECT BITES,
ANGIOEDEMA,
URTICARIA, DRUGS
SUDDEN ONSET OF
PAINLESS, PITTING
PERIORBITAL AND
LID OEDEMA
TREATMENT
◦SYS. ANTI-HISTAMINES

15. CONTACT DERMATITISCONTACT DERMATITIS
ANY SENSITIVITY TO
TOPICAL MEDICATION
LID OEDEMA
ERYTHEMA
TEARING
ITCHING
TREATMENT
◦REMOVAL OF CAUSE
◦TOPICAL STEROIDS

16. Patient with a
nail polish
allergy,
otherwise known
as eczematoid
allergy.

17. Atopic dermatitisAtopic dermatitis
Common idiopathic skin
condition
Associated with asthma
and hay fever
Presentation:
◦Chronic irritation and
itching
◦Associated with more
generalized skin lesions

18. Close-up of a patient
with atopic dermatitis
of the face
demonstrating
darkening of the lids

19. Signs:
◦Bilateral thickening , crusting and
fissuring
Treatment:
◦Emollients such as oily cream
◦Mild topical steroid such as
hydrocortisone 1%
◦Secondary infection require antibiotic
therapy.

20. ErysipelasErysipelas
Acute subcutaneous spreading cellulitis caused by strep
pyogens causes eyelid necrotization and secondary eyelid
contracture
Signs: Red well defined indurated expanding subcutaneous
plaque
Treatment:
◦Oral phenoxymethylpencillin

22. Herpes simplexHerpes simplex
Unilateral condition effects children
Sign: crops of small vesicles associated with mild
lid oedema associated with ipsilateral follicular
conj and keratitis
Treatment:
◦Acyclovir or penciclovir cream

24. HERPES ZOSTER OPHTHALMICUSHERPES ZOSTER OPHTHALMICUS
VARICELLA-ZOSTER VIRUS
ELDERLY AND
IMMUNOCOMPRISED
PRESENTS WITH PAIN IN THE
DISTRIBUTION OF 5 NERVE
MACULOPAPULAR RASH OVER
FOREHEAD
PROGRESSION THROUGH
VESICLES, PUSTULES TO
CRUSTING & ULCERATION

25. HERPES ZOSTER OPHTHALMICUSHERPES ZOSTER OPHTHALMICUS
TREATMENT
◦SYSTEMIC
VALACYCLOVIR OR FAMCYCLOVIR FOR 7 DAYS
◦TOPICAL,
◦ACYCLOVIR
◦STEROID-ANTIBIOTIC COMBINATION
◦TALC & CALAMINE TO BE AVOIDED

26. IMPETIGOIMPETIGO
UNCOMMON
SUPERFICIAL SKIN INF.
CAUSED BY Staph. aureus OR
Strep. Pyogenes
MACULES THAT RAPIDLY
DEVELOP INTO VESICLES &
BULLAE TO PRODUCE
YELLOWISH CRUSTS
TREATMENT
◦TOPICAL ANTIBIOTICS
◦ORAL CLOXACILLIN /
ERYTHROMYCIN

27. STYESTYE
EXTERNAL HORDEOLUM
AN ACUTE STAPH.
INFECTION OF LASH
FOLLICLE AND ITS
GLAND OF ZEIS OR
MOLL
TREATMENT
◦HOT COMPRESSES
◦EPILATION OF LASH

28. INTERNAL HORDEOLUMINTERNAL HORDEOLUM
AN ABSCESS
CAUSED BY AC.
STAPH INFECTION
OF MEIBOMIAN
GLAND
TREATMENT IS
INCISION AND
CURETTAGE

29. CHALAZIONCHALAZION
MEIBOMIAN CYST
CH. STERILE LIPO-
GRANULOMATOUS
INFLAMMATORY LESION
BLOCKADE OF GLAND
ORIFICES AND
STAGNATION OF
SECRETIONS
NON TENDER, ROUND,
FIRM LESION
EVERSION OF LID MAY
SHOW AN ASSOCIATED
CONJ. GRANULOMA

30. CHALAZIONCHALAZION
TREATMENT
◦SURGERY
◦STEROID INJECTION
◦SYSTEMIC
TETRACYCLINE

31. BLEPHARITISBLEPHARITIS

32. BLEPHARITISBLEPHARITIS
Inflammation or infection of the eyelid
margins
One the most common ophthalmological
complications as well as one of the most
difficult conditions to treat.

33. CLASSIFICATIONCLASSIFICATION
TRADITIONAL

◦STAPHYLOCOCCAL
◦SEBORRHEIC
◦MIXED

34. CLASSIFICATIONCLASSIFICATION
McCulley’s
◦STAPHYLOCOCCAL
◦SEBORRHEIC
◦SEBORRHEIC WITH STAPH. SUPER-INFECTION
◦SEBORRHEIC WITH MEIBOMIAN SEBORRHEA
◦SEBORRHEIC WITH SECONDARY SPOTTY MEIBOMIANITIS
◦PRIMARY MEIBOMIANITIS

35. CLASSIFICATIONCLASSIFICATION
◦STAPHYLOCOCCAL
◦SEBORRHEIC
◦MEIBOMITIS
LOCALIZED
GENERALIZED
◦ACNE ROSACEA

36. HISTORYHISTORY
Duration of ocular symptoms
Unilateral or bilateral presentation
Association with potential exacerbating
conditions
◦Smoke
◦Allergens
◦Wind
◦contact lenses
◦low humidity
Recent exposure to an infected individual
(e.g., pediculosis)

37. HISTORYHISTORY
Ocular history
◦previous ophthalmic surgery
◦Trauma (including radiation and chemical trauma)
Systemic history
◦dermatological diseases, such as acne, rosacea,
eczema, allergies)
Use of ocular medications or retinoids.

39. EXAMINATIONEXAMINATION
Visual acuity
Careful external examination of facial skin,
eyelids, and eyelashes.
Slit lamp biomicroscopy
◦Tear film
◦Anterior eyelid margin, eyelashes, posterior
eyelid margin, tarsal conjunctiva, bulbar
conjunctiva, and cornea.
Tests
◦Lissamine green
◦Rose bengal
◦Tear break-up time
◦Schirmer testing
◦Cochet-Bonnet esthesiometry to check corneal
sensation for a unilateral case

40. STAPHYLOCCAL BLEPHARITISSTAPHYLOCCAL BLEPHARITIS
ALSO CALLED INFECTIVE BLEPHARITIS
Staphylococcus Aureus And Epidermidis
80% ARE YOUNG WOMEN
◦USE OF COSMETICS
USUALLY UNILATERAL IN CHRONIC CASES
MAY BE BILATERAL
SYMPTOMS
◦BURNING, ITCHING, STINGING
◦EYESTRAIN
◦PHOTOPHOBIA
◦FOREIGN BODY SENSATION
◦WORSE IN THE MORNING

41. SIGNSSIGNS
BRITTLE, HARD SCALES
WITH COLLARETTES
AROUND CILIA
STERILE CORNEAL
INFILTERATES 1mm
FROM THE LIMBUS
SMALL ULCERATIONS
PANNUS
MADAROSIS
POLIOSIS
TRICHIASIS
Patient with chronic Patient with chronic
staphylococcus blepharitis.staphylococcus blepharitis.

42. STAPHYLOCCAL EXOTOXINSSTAPHYLOCCAL EXOTOXINS
STAPHYLOCCAL EXOTOXINS HAVE
BEEN IMPLICATED AS A CAUSATIVE
AGENT FOR BOTH MARGINAL
INFILTRATES AND PHLYCTENULAR
DISEASE ASSOCIATED WITH
BLEPHARITIS

43. TREATMENTTREATMENT
AGGRESSIVE EYELID HYGIENE
◦WARM COMPRESSES
◦EYELID SCRUBS
TOPICAL ANTIBIOTIC
◦ERYTHROMYCIN
◦BACITRACIN
TOPICAL CORTICOSTEROIDS
◦IN MARGINAL INFILTRATES AND PHLYCTENULAR DISEASE

44. SEBORRHEIC BLEPHARITISSEBORRHEIC BLEPHARITIS
GENERALIZED SEBACEOUS GLAND ABNORMALITY
EXTENDING ONTO EYELID MARGIN
USUALLY BILATERAL
SYMPTOMS
◦ARE USUALLY OUT OF PROPORTION TO PHYSICAL
FINDINGS

45. CLINICAL FINDINGSCLINICAL FINDINGS
MAY REVEAL MILD
INFLAMMATION OF
ANTERIOR LID MARGIN
ERYTHEMA
EDEMA
TELANGIECTASIA AT LID
MARGIN
SCALING & CRUSTING
AT LID MARGIN OFTEN
EXTENDING ONTO
LASHES “SCURF”

46. TREATMENTTREATMENT
EYELID HYGIENE
◦WARM COMPRESSES
◦EYELID SCRUBS
LOCAL ANTIBIOTICS
◦IF SUPERINFECTION IS SUSPECTED
SELENIUM SHAMPOO
◦FOR CONCURRENT SCALP SEBORRHEA

47. STAPHYLOCOCCALSTAPHYLOCOCCAL SEBORRHEICSEBORRHEIC
AGEAGE mean 42 yrsmean 42 yrs mean 50 yrsmean 50 yrs
FINDINGSFINDINGS Hard Adherent Scales, Hard Adherent Scales,
Crusts Pierced By Cilia, Crusts Pierced By Cilia,
“collarettes”“collarettes”
Greasy, less adherent Greasy, less adherent
scales “scurf”scales “scurf”
CORNEACORNEA Marginal infilterates, Marginal infilterates,
inferior SPEE, inferior SPEE,
PhlyctenulosisPhlyctenulosis
inferior SPEEinferior SPEE
Tear FilmTear Film Unstable, rapid break-Unstable, rapid break-
up timeup time
Aqueous tear Aqueous tear
deficiency in 1/3 deficiency in 1/3
TreatmentTreatment Topical antibiotics, Topical antibiotics,
Eyelid scrubs, warm Eyelid scrubs, warm
compressescompresses
Eyelid scrubs, warm Eyelid scrubs, warm
compresses, compresses,
selenium shampooselenium shampoo

48. MEIBOMIANITISMEIBOMIANITIS
MEIBOMIAN GLAND INFLAMMATION
LOCALIZED MEIBOMITIS
◦CHALAZION
◦INTERNAL HORDEOLUM
GENERALIZED MEIBOMITIS
◦MEIBOMIAN SEBORRHEA
◦MEIBOMIAN KERATOCONJUNCTIVITIS

49. CHALAZION
STYE
MEIBOMITIS

50. MEIBOMIAN SEBORRHOEAMEIBOMIAN SEBORRHOEA
BUILD UP OF
EXCESSIVE
MEIBOMIAN
SECRETIONS
MILD
INFLAMMATION OF
ANTERIOR LID
MARGIN
TELANGIECTASIA

51. EXCESSIVE
MEIBOMIAN
SECRETIONS
GROSSLY
ABNORMAL MEIBUM
EXPRESSED FROM
GLAND ORIFICE

52. TREATMENTTREATMENT
DAILY LID MASSAGE
WARM COMPRESSES TO SOFTEN MEIBUM
EXPRESSION OF EXCESS SECRETIONS

53. MEIBOMIAN KERATOCONJUNCTIVITISMEIBOMIAN KERATOCONJUNCTIVITIS
MORE SEVERE FORM
SEMI-SOLID, WHITE
SECRETIONS VISIBLE AS
“BRUSH MARKS”
ENLARGED GLANDS THAT
LATER ON DEVELOP ATROPHY
RAPID TEAR BREAKUP DUE
TO ABSCENT MEIBOMIAN
SECRETIONS
CORNEAL PUNCTATE
EPITHELIAL EROSIONS
PANNUS
MARGINAL INFILTERATES
CORNEAL THINNING

54. TOOTH PASTE LIKE SECRETIONS

55. TREATMENTTREATMENT
AGGRESSIVE EYELID HYGIENE
◦WARM COMPRESSES
◦EYELID SCRUBS
TOPICAL ANTIBIOTICS
ORAL TETRACYCLINE
◦REDUCES PRODUCTION OF FFA BY INHIBITING BACTERIAL
ENZYMES AND CAUSE STABILIZATION OF TEAR FILM

56. ACNE ROSACEAACNE ROSACEA
COMMON CHRONIC
INFLAMMATORY DISEASE WITH
OCULAR &SKIN MANIFESTATIONS
SEBACEOUS GLAND
DYSFUNCTION
30-50 YEARS
TYPE IV HYPERSENSITIVITY
REACTION
SYMPTOMS
◦RANGE FROM IRRITATION TO
BURNING TO FOREIGN BODY
SENSATION

57. CLINICAL FEATURESCLINICAL FEATURES
CHRONIC BLEPHARITIS
CONJUNCTIVAL
HYPEREMIA
RECURRENT CHALAZIA
KERATITIS
TEAR FILM INSTABILITY
ROSACEA KERATITIS
◦PERIPHERAL CORNEAL
VASULARIZATION
◦TELANGIECTASIA
◦THINNING
◦ULCERATION
◦EVEN PERFORATION

58. TREATMENTTREATMENT
ORAL TETRACYCLINES
TOPICAL METRONIDAZOLE
◦REDUCES FACIAL REDNESS
WARM COMPRESSES
EYELID SCRUBS
TOPICAL STEROIDS
◦ROSACEA KERATITIS

59. MEIBOMITISMEIBOMITIS ACNE ROSACEAACNE ROSACEA
AGEAGE All AgesAll Ages 30-50 yrs30-50 yrs
FINDINGSFINDINGS Irregular posterior Irregular posterior
margin, plugged gland margin, plugged gland
orifices “brush marks”orifices “brush marks”
Marginal Marginal
Telangiectasia, Telangiectasia,
meibomitis, meibomitis,
Recurrent chalaziaRecurrent chalazia
CORNEACORNEA Inferior SPEE, Marginal Inferior SPEE, Marginal
infiltrates, Pannus, infiltrates, Pannus,
Corneal thinningCorneal thinning
Pannus, thinning, Pannus, thinning,
ulceration and ulceration and
perforationperforation
TEAR FILMTEAR FILM Unstable, foamyUnstable, foamy Unstable Unstable
TREATMENTTREATMENT Eyelid Scrubs, Eyelid Scrubs,
antibiotics, warm antibiotics, warm
compresses, daily compresses, daily
massage, oral massage, oral
tetracyclinetetracycline
Tetracycline, topical Tetracycline, topical
metronidazole for metronidazole for
facial rednessfacial redness

60. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
INFECTIOUS
◦STAPHYLOCCAL
◦DEMODEX FOLLICULORUM
◦CANDIDA
◦PHTHIRUS
INFLAMMATORY
◦SEBORRHEIC
◦MEIBOMITIS

61. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
DERMATOLOGIC/ALLERGIC
◦ACNE ROSACEA
◦ATOPIC KERATOCONJUNCTIVITIS
◦ATOPIC DERMATITIS
◦PSORIASIS
◦PITYRIASIS
◦COSMETIC USE
SYSTEMIC
◦LUPUS ERYTHEMATOSUS
◦ACQUIRED IMMUNODEFICIENCY SYNDROME
◦CONGENITAL ERYTHROPOITIC PORPHYRIA

62. Picture
demonstrating
thinning of eyelids
secondary to
corticosteroid use.
Note sleeves and
scurf

63. Patient with
Pthirus pubis
with critters on
eyelashes.

64. DOMEDEX FOLLICULORUM ADJACENT TO AN EYELASH

65. MEIBOMIAN GLAND DYSFUNCTIONMEIBOMIAN GLAND DYSFUNCTION
NUTRITIONAL TREATMENT OPTIONS
◦OLEIC ACID
◦OIL OF EVENING PRIMROSE
◦OMEGA 6 F.A
◦FLAVONOIDS
RESVERATROL
SILYMARIN
BILBERRY EXTRACT
HORMONAL TREATMENT OPTIONS
◦ROLE OF ANDROGENs
*Ophthalmol Clin N Am 16 (2003) 37-42

66. Infrared Warm Compression Device Infrared Warm Compression Device
Wave length peak, 940 nm
Treatment of non-inflamed obstructive meibomian gland
dysfunction
Improved tear stability
Associated with release of meibum
Effective and safe
British Journal of Ophthalmology 2002;86:1403-1407

67. Fusidic Acid Gel For Recurrent Fusidic Acid Gel For Recurrent
Blepharitis And Rosacea Blepharitis And Rosacea
Topical fusidic acid gel (Fucithalmic)
Patients with blepharitis & concomitant
Rosacea respond well to therapy.
*Ann. Pharmacother., January
 1, 2005;
39(1): 86 - 94.

68. Role of Ceramide Gel Role of Ceramide Gel
In Atopic blepharitis
Ceramide comprises about 30% of stratum corneum lipids
Role in both the water retention and barrier function of the skin
Better patient compliance than ointments containing petrolatum
useful supplementary therapy during periods of relatively light
inflammation
*British Journal of Ophthalmology 2003;87:362-363

69. Dark pink bougainvilleaDark pink bougainvillea

70. THANK YOU

72. INFECTIVE DISORDERSINFECTIVE DISORDERS
HZO
◦Common unilateral condition effects elderly pts
◦Severe immunodeficiency states
◦Presentation : Pain
Signs:
◦Maculopapular rash on the forehead , vesicles ,
pustules and crusting ulceration .

73. Hutchison sign
Periorbital oedema
Treatment:
◦Systemic : Valaciclovir 1 gm tds
for 7 days or famciclovir 250
mg tds for 7 days

74. Topical :
◦Acyclovir or famciclovir
cream
◦Steroid antibiotic
combination such as fucidin
H , Hydrocortisone and
fusidic acid

75. ImpetigoImpetigo
Superficial skin infection caused by staph
aureus or b.hemolytic sterp
Occurs in children
Associated with inf of the face
Signs: Erythematous macules vesicle
formation and bullae – yellow crust
Treatment:
◦Topical antibiotic
◦Systemic flucloxacillin or erythromycin

77. Necrotizing fasciitisNecrotizing fasciitis
Cutaneous gangrene which usually effects
the trunk ,perineum and legs caused by
strep pyogens and staph aureus
Effects elderly and debilitated pts
following trauma
Signs: Bilateral lid oedema and erythema
rapidly progress to gangrene
Treatment: High doses of parental benzyl
pencillin and surgical debridement of
necrotic tissues.

79. Internal hordeolum Internal hordeolum
Acute staph
infection of
meibomian glands
Signs: Tender
inflamed swelling
with in tarsal plate,
discharge ant or
post .
Treatment: I&C

80. External hordeolumExternal hordeolum
Stye
Acute staph abscess of lash follicle
and associated with gland of Zeis
or Mole
Signs:
◦Tender inflamed swelling in the lid
margin , more than one lesion may be
present and minute abscess may
involve the entire lid margin

81. In severe cases
mild preseptal
cellulitis .
Treatment:
◦Hot compresses
◦Epilation
◦Systemic
antibiotic

82. Molluscum contagiosumMolluscum contagiosum
 Skin infection caused by pox virus
Immunocompromised pts mainly
effected
Signs: Single or multiple
pale ,waxy , umbilicated nodules
Causes follicular conj , superficial
keratitis .
Treatment: Shave excision and
cauterization , cryo, laser.

84. ChalazionChalazion
Chronic lipogranulomatous
inflammatory lesion caused by
blockage of gland orifices and
stagnation of sebaceous secretions
Presentation : Painless nodule ,
Astigmatism .
Signs: Painless round firm lesion in
the tarsal plate , polypoid
granuloma , associated chr post
blepharitis.

86. Treatment:
Surgery
Steroid injection: 0.1 to 0.2 ml
triamcinolone diacetate diluted with
lignocaine to a conc. of 5mg per ml .
Second inj after 2 wks
Systemic tetracycline in pts with
recurrent chalazion.

87. BlepharitisBlepharitis
Blepharitis refers to
a family of
inflammatory
disease of the
eyelids (chronic
inflammation)
It is usually bilateral
,symmetrical and is
more common in
the older age group

88. TypesTypes
Anterior
Posterior
Mixed.

89. PathogenesisPathogenesis
Most common causes of Blepharitis are
Staphylococcal infection and irritation from
oily Mebomian gland secretion
Pathophysiology involves bacterial
colonization of eyelids resulting in direct
mirobial invasion of tissues ,immune system
mediated damage ,or damage caused by
bacterial toxins ,waste product and enzymes
Seborrhic Blepharitis may be associated with
seborrhic dermatitis

90. AssociationAssociation
SYSTEMIC DISEASES
Rosacae
Seborrhic dermatitis
Herpes simplex dermatitis
Varicela Zoster dermatitis
Staphylococcal dermatitis
•OCULAR DISEASES
Dry eyes syndromes
Chalazion
Conjunctivitis , Keratitis

91. SymptomsSymptoms
Burning
Watering
Foreign body sensation
Crusting and matting of eyelashes
Photophobia
Redness of lids and eyes
Pain and defective vision

92. SignsSigns
Gross examination shows erythema and crusting of
eyelashes and lid margins
Slit lamp examination may show
madarosis,poliosis,trichiasis crusting of lashes and
Mebomian orifices, eyelid margin ulcers, Telengectiasis and
tylosis
Papillary conjunctival reaction
Aqueous tear deficiency
Posterior Blepharitis may be related to Mebomian gland
dysfunction.

95. ComplicationsComplications
Chronic conjunctivitis
Keratitis
Phlyctenulosis
External hordeolum
Tear film instability
trichiasis

96. TreatmentTreatment
Lid hygiene
Topical antibiotics
Topical steroids
Tear substitutes
Systemic antibiotics
Treatment of complication