EYELID INFLAMMATION & TUMORS

July 7, 2012

LID INFLAMMATION

• Blepharitis

DEFINITION

• It is the inflammation of the lid margin

blepharitis

• Inflammation of the lid margin (crusting/redness of lids)

• Causes ‘gritty’/foreign body sensation, often concomitant with other ocular surface disease

• Associated with recurrent hordeolum (styes) or chalazia

• Improvement with warm compresses/lid hygeine, artificial tears, tetracycline

Types

1. Anterior a. Squamous b. Ulcerative

2. Posterior a. Meibomian seborrhoea b. Meibomianitis

ANTERIOR BLEPHARITIS

• It involves the outer parts of the eyelid• It is commonly caused by bacteria

SEBORRHEIC/SQUAMOUS

• It is characterized by the deposition of scales• Eyelashes fall• Hyperemic lid margin• Absence of ulcers

Squamous Blepharitis

Symptoms

• Burning, deposits / crusting along lid margins, grittiness , redness of lid margins, photophobia

• Symptoms are worse in the morning

ULCERATIVE

• It is characterized by the presence of infective materials such as yellow crusts or scales

• There is matting of the lashes• Presence of ulcers

Symptoms

• Redness of lid margins, burning, itching, watering and photophobia

• Signs: – Small ulcers at lid margins on removal of

discharge, this features differentiate it from conjunctivitis

Ulcerative Blepharitis

14- Ulcerative blepharitis

15- Ulcerative blepharitis

POSTERIOR BLEPHARITIS

• It involves the inner parts of the eyelids• It is due to problems in the oil glands

LID LUMPS

STYE

• It is a tender, painful red bump located at the base of an eyelash or inside the eyelid

• It is due to infection of the oil glands of the eyelid or from an infected hair follicle at the base of an eyelash

- It is an abscess in eyelash follicle.

painful -Most cases are

self limiting .

-Treatment requires the removal of the associated eyelash and application of hot compresses.

Internal hordeolum

an abscess in meibomian gland.

-Painful.

-May respond to topical antibiotics but incision by be necessary.

Hordeolum Internum

Chalazion -It is a granuloma

within the tarsal plate caused by obstructed meibomian gland.

-Painless.

-Symptoms are unsightly lid swelling which resolve within six months if the lesion persist we remove it surgically

Chalazion

-Is a viral infection of the skin or the mucous membranes, caused by pox virus.

-Can be presented with umbilicated lesion found on the lid margin.

-Cause irritation, redness, follicular conjuctivitis(small elevation of lymphoid tissue found on tarsal conjunctiva)

-Treatment requires excision of the lid lesion.

Molluscum contagiosum

• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis• May be multiple in AIDS patients • Occasionally superficial keratitis

Signs Complications

Histology of molluscum contagiosum

• Lobules of hyperplastic epithelium

• Circumscribed lesion• Surface covered by normal epithelium except in centre

• Intracytoplasmic (Henderson-Patterson) inclusion bodies• Deep within lesion bodies are small and eosinophilic• Near surface bodies are larger and basophilic

- Lipid containing bilateral lesions.

- Usually associated with hyperlipidemia .

- Removed for cosmetic reasons.

Xanthelasma

• Usually bilateral and located medially

• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid

Adenoma of Meibomian Gland

• Blepharitis– Anterior– Posterior– Staphylococcal– Seborrhoeic– Meibomianitis

• Treatment– Lid hygiene– Tears– Antibiotics– Warm compresses

Eyelids inflammation

• Allergy– Acute allergic

blepharoconjuctivitis– Allergic

dermatoblepharitis

Eyelids inflammation

• Chalazion– Focal inflammation of the eye

lids which result from obstruction of the meibomian glands

– Chronic lipogranulomatous inflammatory changes

– Treatment• Warm compresses• Local antibiotic• Excision

Eyelids inflammation

EYELID CYST

CYST OF MOLL

CYST OF ZEIS

SEBACEOUS CYST

HIDROCYSTOMA

BENIGN TUMORS

VIRAL WART

ACTINIC KERATOSIS

NAEVI

KERATOACANTHOMA

PYOGENIC GRANULOMA

HEMANGIOMA

• Basal cell carcinoma• Squamous cell carcinoma• Meibomian gland carcinoma• Melanoma• Kaposi sarcoma• Merkel cell carcinoma

Malignant eyelid tumors

Basal cell carcinoma• Most common malignancy(90%)

of the eyelid• Usually located on the lower lid

and medial canthus• Pearly nodules which ulcerate

and have telangiectasias• Treatment

– Surgical excision– Cryotherapy– Radiation therapy

Squamous cell carcinoma

• Less common than BCC• May arise de-novo or

from pre-existing actinic keratosis

• May metastasize

BENIGN EYELID LESIONS1. Nodules

• Chalazion • Acute hordeola

2. Cysts

•

• Cyst of Moll• Cyst of Zeiss• Sebaceous cyst• Hidrocystoma

3. Tumours

Xanthelasma

• Viral wart• Keratoacanthoma• Naevi• Capillary haemangioma• Port-wine stain• Pyogenic granuloma• Cutaneous horn

Molluscum contagiosum•

Signs of chalazion (meibomian cyst)

Painless, roundish, firm lesion within tarsal plate

May rupture through conjunctiva and cause granuloma

Histology of chalazion

Multiple, round spaces previously containing fat with surrounding granulomatous inflammation

Epithelioid Multinucleated cells giant cells

Treatment of chalazion

Injection of local anaesthetic Insertion of clamp Incision and curettage

Acute hordeola

• Staph. abscess of meibomian glands• Tender swelling within tarsal plate• May discharge through skin or conjunctiva

• Staph. abscess of lash follicle and associated gland of Zeis or Moll

• Tender swelling at lid margin

• May discharge through skin

Internal hordeolum ( acute chalazion )

External hordeolum (stye)

Viral wart (squamous cell papilloma)• Most common benign lid tumour• Raspberry-like surface

Pedunculated

Sessile

Histology of viral wart

Finger-like projections of fibrovascular connective tissue

Epidermis shows acanthosis (increased thickness) and hyperkeratosis

Rete ridges are elongated and bent inwards

Seborrhoeic

• Common in elderly• Discrete, greasy, brown lesion• Friable verrucous surface• Flat ‘stuck-on’ appearance

Actinic

• Most common pre-malignant skin lesion• Rare on eyelids

• Affects elderly, fair-skinned individuals

• Flat, scaly, hyperkeratotic lesion

Keratoses

Keratoacanthoma

• Uncommon, fast growing nodule• Acquires rolled edges and keratin-filled crater• Involutes spontaneously within 1 year

• Lesion above surface epithelium

• Central keratin-filled crater

• Chronic inflammatory cellular infiltration of dermis

Naevi• Appearance and classification determined by location within skin

• Tend to become more pigmented at puberty

• Elevated

Intradermal

• May be non-pigmented

• No malignant potential

• Flat, well-circumscribed

• Low malignant potential

Junctional

• Has both intradermal and junctional components

Compound

• Pigmented

Capillary haemangioma

• Rare tumour which presents soon after birth

• Starts as small, red lesion, most frequently on upper lid

• Blanches with pressure and swells on crying

• Grows quickly during first year

• May be associated with intraorbital extension

• Begins to involute spontaneously during second year

Periocular haemangioma

• Steroid injection in most cases• Surgical resection in selected cases

• High-out heart failure

Treatment options

Occasional systemic associations

• Kasabach-Merritt syndrome - thrombocytopenia, anaemia and reduced coagulant factors

• Maffuci syndrome - skin haemangiomas, endrochondromas and bowing of long bones

Histology of capillary haemangioma

Lobules of capillaries Fine fibrous septae Lobules under high magnification

Port-wine stain (naevus flammeus)

• Rare, congenital subcutaneous lesion

• Segmental and usually unilateral

• Does not blanch with pressure

• Ipsilateral glaucoma in 30%

• Sturge-Weber or Klippel-Trenaunay-Weber syndrome in 5%

Associations

Pyogenic granuloma

• Usually antedated by surgery or trauma• Fast-growing pinkish, pedunculated or sessile mass

• Bleeds easily

Cutaneous horn

• Uncommon, horn-like lesion protruding through skin• May be associated with underlying actinic keratosis or squamous cell carcinoma

PATHOLOGY OF THE LACRIMAL APPARATUS

CANALICULITIS

DACRYOCYSTITIS

DACRYOCYSTITIS

DACRYOADENITIS

NASOLACRIMAL DUCT OBSTRUCTION

• Translucent• On anterior lid margin

Cyst of Moll

• Similar to cyst of Moll • Not confined to lid margin

Eyelid cysts

• Opaque• On anterior lid margin

Cyst of Zeis

Eccrine sweat gland hidrocystoma

Sebaceous cyst

• Cheesy contents • Frequently at inner canthus