Eyelids diseases- non-malignant: chalazion hordeolum cutaneous horn xanthelasma molluscum contagiosum

Chalazion- a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland Meibomiam glands produce an external (sebaceous) part of tears film Treatment: antibiotic locally, surgery

Hordeolum- an acute focal infection of the eyelid (usually staphylococcal) involving either the glands of Zeiss and Moll(external) or, less frequently, the meibomian glands (internal hordeolum). Symptoms Treatment: antibiotic locally, warm compresses

Cutaneous horn- relatively rare, most often on sun-exposed skin, usually after the 5th decade. The tumor is often conical. This lesion can be caused by primary underlying processes –benign or malignant, thus the importance of accurate determination of the nature of the conditions at the base of the lesion. Surgery is the treatment of choice.

Xanthelasma- yellow plaques, occur most commonly near the inner canthus of the eyelid Deposits of lipids underneath the skin Often: symmetrical; four lids are involved, tendency to progress Treatment: surgery, YAG laser

Molluscum contagiosum-a viral infection that affects the skin, most commonly children and youth, although it can occur at any age. Small spots or nodules; not painful, but can be itchy. Often associated with chronic conjunctivitis  Treatment: (if any): kriotherapy  

Malignant eyelid tumors Basal cell carcinoma Squamous cell carcinoma Malignant melanoma

Basal cell carcinoma, BCC The most common malignant tumor of skin 90% of all malignant tumors of eyelids More often – lower lid Slow growth, infiltration, no metastasizes Infiltration of nasal sinus, orbit recurrences

BCCs often look like open sores, red patches, or scars BCCs often look like open sores, red patches, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure

Squamous cell carcinoma, SCC often look like red patches, open sores or elevated growths with a central depression; they may crust or bleed. SCC is mainly caused by cumulative UV exposure over a lifetime. Sometimes it can become deadly if allowed to grow (metastases).

Malignant melanoma it was uncommon, but nowadays the annual incidence has increased dramatically over the past few decades. Early melanomas may be differentiated from benign nevi as follows: A - Asymmetry B - Border irregularity C - Color that tends to be very dark black or blue and variable D - Diameter ≥ 6 mm

Treatment: Surgery 1/3 1/2 free grafts pedunculated grafts Advanced tumors: Chemotherapy radiotherapy Evisceration of orbit

Entropion- the eyelid (usually the lower lid) folds inward Entropion- the eyelid (usually the lower lid) folds inward. The eyelashes constantly irritate the cornea. Causes: Congenital Aging ( loose skin and stretched and loose ligaments and muscles) Scarring Spasm

Symptoms: Redness and pain Sensitivity to light and wind Sagging skin around the eye Decreased vision, especially if the cornea is damaged

Treatment: a relatively simple surgery in which excess skin of the outer lids is removed or tendons and muscles are shortened with one or two stitches. Protection of cornea

Ectropion- the lower eyelid turns outwards Causes: Congenital Aging Scarring Facial nerve (VII) palsy Surgery treatment Protection of cornea

Eyelid drooping (ptosis): constant, progressive, intermittent Causes: natural aging process N.III palsy (Horner syndrome) Hereditary-idiopathic or Marcus-Gunn syndrome (unproper innervation, n.III) Treatment: levator muscle resection (when affects vision or appearance)

Orbital diseases Common symptoms: Exophthalmus Pain Eye movements disorders Double vision Decreased visual acuity Diagnoses: usually CT or MRI

Graves orbitopathy Antibody-mediated reaction against the thyroid-stimulating hormone (TSH) receptor with orbital fibroblast modulation of T-cell lymphocytes. It may precede, coincide, or follow the systemic complications of dysthyroidism. Women are affected 2.5-6 times more frequently than men Most patients are aged 30-50

Symptoms: eyelid retraction, proptosis, chemosis, periorbital edema, and disfunction of external muscles Risk factors: smoking radioactive iodine 2 phases: active inflammatory and cicatritial Can cause vision-threatening keratopathy, troublesome diplopia, and compressive optic neuropathy.

Treatment: active phase- steroids in pulses intravenous (eg, methylprednisolone 1 g every other day for 3-6 cycles) Approximately 5% require surgical intervention (multiple-staged procedures) Surgery is usually performed during the cicatricial phase. Orbital decompression Strabismus surgery Lid-lengthening surgery

Congenital nasolacrimal duct obstruction is a blockage of a tear duct that has failed to open properly at birth (Hasner valve). It occurs in about 6 percent of infants and is characterized by persistent watery eyes. Most cases of congenital nasolacrimal duct obstruction resolve within first weeks/months after birth. Treatment: massage-to put pressure on the lacrimal sac to open the membrane at the bottom of the tear duct. dilation, probing and irrigation

Acquired nasolacrimal duct obstruction- blockage of a tear duct that typically develops in adulthood. tumor, inflammation, injury or nasal and sinus diseases. Treatment: Surgery- Dacryocystorhinostomy creates a new connection between lacrimal sac and nose. Stents or intubation are placed in the new route while it heals, and then removed three-six months after surgery.  

Dacryocystitis is an acute infection of the nasolacrimal sac that is generally caused by a nasolacrimal duct obstruction. It is associated with swelling, pain and redness. Treatment: antibiotic orally and locally + incision and drainage (superficial skin abscess). Fistula is healing well. To avoid chronic cases, a dacryocystorhinostomy (DCR) is performed.

Conjunctivitis Symptoms: redness, pain, increased sensitivity to light, increased lacrimation, discharge Causes: bacteria (antibiotics locally) Viruses (usually clears within a week) Allergy (itching, mast cell stabilizers, antyhistamines locally)

Dry eye syndrome (keratoconjunctivitis sicca) (KCS)- tear film evaporation is too high or tear production is too low. The patient's eyes dry out and become inflammed. Between 17% and 30% of people have dry eyes at some time in their life. Tear film should remain stable for ten seconds after each blink. A stable tear film prevents the eyes from becoming dry.

Schirmer tests Small strips of blotting-paper-like material are placed under the patient's eyelid. A few minutes later they are removed to see how wet they are. 5 min, 5 mm, 15 mm

An imbalance in the tear mixture (three layers - oil, water and mucus), unsufficient tears production . Other causes of dry eye syndrome include eyelid problems (ectropion, entropion), some drugs (antihistamines, diuretics, morphine), and environmental factors (lower blinking rate). Artificial tears, better without preservatives

Pterygium refers to a benign growth of the conjunctiva, commonly grows from the nasal side. The exact cause is unknown, but it is associated with excessive exposure to wind, sunlight, or sand. Symptoms: persistent redness, inflammation,foreign body sensation, tearing Treatment: surgery when it covers the pupil (excision, conjunctival auto-grafting or amniotic membrane transplantation)

Scleritis Anterior/posterior Limited/diffuse Necrotic/non-necrotic SLE, Polyartheritis nodosa, rheumatoid arthritis-assiociated Treatment: corticosteroids and NSAIDs used locally and systemically.

Posterior scleritis Symptoms: pain and blurred vision, lid-edema, exophtalmos, limited eye movement Optic nerve edema, macular edema, serous retinal detachment, vitritis Thicker posterior sclera in ultrasound examination

Anterior necrotic scleritis Most severe Exposure of the choroid Inflammation may involve the whole eye ball Complications: cataract, keratopathy, secondary glaucoma Treatment: steroids, immunosuppressive agents systemically

Molluscum contagiosum- MC: viral infection Sign and symptoms Chronic Conjunctivitis

Basal cell carcinoma the most common skin cancer 90% of all malignant tumors of eyelid The lower eyelids are involved in more than 70% of cases Rarely metastatizes, invade surrounding tissues, semimalignant BCC can arise in the sinuses, orbit Can recur

Nodular basal-cell carcinoma Rodent ulcer (also known as a "Jacobi ulcer" ??? za wiki Cicatricial basal-cell carcinoma (also known as "morpheaform basal-cell carcinoma"

Squamous cell carcinoma 5% malignant eyelid's cancers More malignant than BCC Usually occurs in elder people Hard plaque or tumor, often ulcerated