Eyelid inflammation & tumors
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EYELID INFLAMMATION & TUMORS
July 7, 2012
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LID INFLAMMATION
• Blepharitis
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DEFINITION
• It is the inflammation of the lid margin
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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
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Types
1. Anterior a. Squamous b. Ulcerative
2. Posterior a. Meibomian seborrhoea b. Meibomianitis
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ANTERIOR BLEPHARITIS
• It involves the outer parts of the eyelid• It is commonly caused by bacteria
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SEBORRHEIC/SQUAMOUS
• It is characterized by the deposition of scales• Eyelashes fall• Hyperemic lid margin• Absence of ulcers
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Squamous Blepharitis
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Symptoms
• Burning, deposits / crusting along lid margins, grittiness , redness of lid margins, photophobia
• Symptoms are worse in the morning
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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
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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
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Ulcerative Blepharitis
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14- Ulcerative blepharitis
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15- Ulcerative blepharitis
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POSTERIOR BLEPHARITIS
• It involves the inner parts of the eyelids• It is due to problems in the oil glands
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LID LUMPS
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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
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- 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.
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Internal hordeolum
an abscess in meibomian gland.
-Painful.
-May respond to topical antibiotics but incision by be necessary.
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Hordeolum Internum
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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
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Chalazion
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-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.
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Molluscum contagiosum
• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis• May be multiple in AIDS patients • Occasionally superficial keratitis
Signs Complications
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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
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- Lipid containing bilateral lesions.
- Usually associated with hyperlipidemia .
- Removed for cosmetic reasons.
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Xanthelasma
• Usually bilateral and located medially
• Common in elderly or those with hypercholesterolaemia• Yellowish, subcutaneous plaques containing cholesterol and lipid
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Adenoma of Meibomian Gland
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• Blepharitis– Anterior– Posterior– Staphylococcal– Seborrhoeic– Meibomianitis
• Treatment– Lid hygiene– Tears– Antibiotics– Warm compresses
Eyelids inflammation
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• Allergy– Acute allergic
blepharoconjuctivitis– Allergic
dermatoblepharitis
Eyelids inflammation
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• 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
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EYELID CYST
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CYST OF MOLL
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CYST OF ZEIS
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SEBACEOUS CYST
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HIDROCYSTOMA
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BENIGN TUMORS
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VIRAL WART
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ACTINIC KERATOSIS
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NAEVI
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KERATOACANTHOMA
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PYOGENIC GRANULOMA
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HEMANGIOMA
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• Basal cell carcinoma• Squamous cell carcinoma• Meibomian gland carcinoma• Melanoma• Kaposi sarcoma• Merkel cell carcinoma
Malignant eyelid tumors
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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
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Squamous cell carcinoma
• Less common than BCC• May arise de-novo or
from pre-existing actinic keratosis
• May metastasize
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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•
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Signs of chalazion (meibomian cyst)
Painless, roundish, firm lesion within tarsal plate
May rupture through conjunctiva and cause granuloma
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Histology of chalazion
Multiple, round spaces previously containing fat with surrounding granulomatous inflammation
Epithelioid Multinucleated cells giant cells
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Treatment of chalazion
Injection of local anaesthetic Insertion of clamp Incision and curettage
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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)
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Viral wart (squamous cell papilloma)• Most common benign lid tumour• Raspberry-like surface
Pedunculated
Sessile
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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
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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
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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
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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
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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
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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
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Histology of capillary haemangioma
Lobules of capillaries Fine fibrous septae Lobules under high magnification
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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
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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
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PATHOLOGY OF THE LACRIMAL APPARATUS
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CANALICULITIS
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DACRYOCYSTITIS
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DACRYOCYSTITIS
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DACRYOADENITIS
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NASOLACRIMAL DUCT OBSTRUCTION
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• 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