Oculoplastics and Lacrimal Disorders

Epiphora Eyelid tumours Blepharitis Nasolacrimal duct occlusion Eyelid malposition Ectropion Entropion Eyelid tumours Basal cell carcinoma  Squamous cell carcinoma

Epiphora: Anatomy and Physiology

Blepharitis Blepharitis involving predominantly the skin and lashes tends to be staphylococcal and (or) seborrheic in nature, whereas involvement of the meibomian glands may be either seborrheic, obstructive, or a combination (mixed). The pathophysiology of blepharitis is a complex interaction of various factors, including abnormal lid-margin secretions, microbial organisms, and abnormalities of the tear film.

OMG- I’ve been diagnosed with blepharitis Management OMG- I’ve been diagnosed with blepharitis The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term Warmth Massage Cleansing Topical antibiotics are used to reduce the bacterial load. Topical corticosteroids and oral antibiotic preparations may be helpful in patients with marked inflammation with specialist monitoring

Nasolacrimal duct obstruction Occurs in approximately 5-6% of infants. A sticky, watery eye with positive regurgitation on pressure over the lacrimal sac confirms the diagnosis. As there is a high spontaneous rate of remission (60-90%) in the first year of life, probing should be delayed until 10-12 months of age. Parents can be instructed to undertake lacrimal sac massage during the intervening period. Earlier probing is only justified if their is severe recurrent infection.

Recanalisation: Probing to DCR Probing of the naso-lacrimal duct is the first line of treatments With persistent epiphora and recurrent infection, it may be necessary to perform a dacryocystorhinostomy (DCR). Bicanalicular silicone incubation with Crawford, Juneman or Ritleng tubes can be carried out

Eyelid malposition

Tumours: Benign

Steps to differentiating benign from malignant  Basal Cell Skin Cancer  Small raised bump Smooth, pearly appearance.  Central necrotic area Telangectasia Sometimes like a scar that is flat and firm to the touch.

Squamous Cell Carcinoma  Sun exposed areas of skin such as the ears, lower lip, and the back of the hands Skin that have been burned or exposed to chemicals or radiation Often appears as a firm red bump, may feel scaly or bleed or develop a crust

Sebaceous carcinoma Melanoma Chronic blepharitis Recurrent chalazion Melanoma Change Contour Colour Size