6. CATEGORIES, COMMON INFECTIVE AND INFLAMMATORY DISORDERS
DR. NAILA ALI
Assistant Professor
OPHTHALMOLOGY

7. Categories. Congenital Anomalies Inflammations Disorders of position.
Trauma
Tumours

8. Inflammations/ Infections
Stye
Chalazion
Lid cellulitis
Preseptal orbital cellulitis
Blephritis
Anterior
Posterior

9. Treatment Options for Trichiasis
1. Epilation - but recurrences within few weeks
2. Electrolysis - but frequently repeated treatments required
3. Cryotherapy - for many lashes
4. Laser ablation - for few scattered lashes
5. Surgery - for localized crop resistant to other methods

10. Stye (Common Boil)
Small abscess, staph infection of the eyelash, gland of Zeis or Moll
Tender, inflammed swelling in lid margin, single or multiple, may involve entire lid margin– preseptal cellulitis
Treat with hot compresses, removal of eyelash or systemic antibiotics in severe cases
Drain if puss points

11. Chalazion (Tarsal cyst or mebomian cyst)
Chronic inflammatory granuloma of mebomian gland—blockage and accumulation of secretions
One or more glands involved, mainly children and young adults involved
Swelling, heaviness, irritation
blurring if large- induced astigmatism

12. Chalazion (Tarsal cyst or mebomian cyst)
Small, cystic, hard swelling a little away from the lid margin, fixed to tarsus, non-tender
No signs of inflammation,no lymphadanopathy
Small may resolve, may remain the same,
may burst on skin- fistula
may infect- internal hordeolum.
treatment
Surgery
steroid injections
Leave alone the small ones.

13. Signs of chalazion (meibomian cyst)
Painless, roundish, firm lesion
within tarsal plate
May rupture through conjunctiva
and cause granuloma

14. Histology of chalazion
Epithelioid Multinucleated
cells giant cells
Multiple, round spaces previously
containing fat with surrounding
granulomatous inflammation

15. Treatment of chalazion
Injection of local anaesthetic
Insertion of clamp
Incision & curettage

16. Acute hordeola Staph. abscess of Meibomian glands
Internal hordeolum
( acute chalazion )
External hordeolum (stye)
Staph. abscess of
Meibomian glands
Staph. abscess of lash follicle
and gland of Zeis or Moll
Tender swelling
Tender swelling at lid margin
May discharge through skin
or conjunctiva
May discharge through skin

17. Lid cellulitis Etiology whole of the lid is involved tender induration
Multiple styes
Insect bites
Trauma
Clinical features
whole of the lid is involved
tender induration
may lead to abscess formation/ skin necrosis
Treatment
Systemic antibiotics
Drainage

20. CHRONIC MARGINAL BLEPHARITIS
1. Anterior
Staphylococcal
Seborrhoeic
2. Posterior
Meibomianitis
Meibomian seborrhoea

21. Blephritis Usually chronic infection of the lid margin
Common external eye disease
Causes—not clear but staph infection and sebhorrea play a part
Associated with tear film instability
Anterior and posterior variety
Anterior blephritis—staph or ulcerative and Sebhorroeic or squamous

22. Staph Anterior Blephritis
Chronic infection of the bases of the lashes resulting in tiny intrafollicular abscesses
Secondary dermal and epidermal ulceration and tissue distruction
More common in children but may affect any age group
Females more affected than males
Unhygienic conditions and dietary factors involved

23. Staph Anterior Blephritis—Cont.
Symptoms:
Sourness of lid margin
Lacrimation, itching and photophobia
Signs:
Yellow crusts at the roots of the lids
On removing the crusts, small ulcers may appear
Fall of the lashes—either not replaced or abnormal replacement

24. Poliosis, madarosis, trichiasis, tylosis Treatment: General:
Complications
If not treat may lead to
Poliosis, madarosis, trichiasis, tylosis
Treatment:
General:
Improvement in general health
Balanced diet
Correction of refractive errors
Local:
Broad spectrum antibiotic ointment, steroid ointment
Artificial tears.
Treat the sequlae.

25. Staphylococcal blepharitis
Chronic irritation worse in mornings
Hyperaemia and telangiectasia of anterior
lid margin
Scales around base of lashes
(collarettes)
Scarring and hypertrophy if longstanding

26. Sebhorroeic Ant Blephritis
Disorder of the glands of Zeis and Moll
Sebhorreoa may involve scalp, eyebrows, nasolabial folds, retroauricular area and sternum.
Oily type and dry type (true seborrheoa)

27. Sebhorroeic Ant Blephritis
Symptoms:
less severe, discomfort in the eyes, lacrimation, tear film instability (stinging)
Signs:
Shiny, waxy appearance of the anterior lid margin, dandruff like desquamation lid epidermis (yellow, greasy scales)
Treatment:
Lid hygiene— artificial tears
Scalp treatment with antidandruff lotion

28. Seborrhoeic blepharitis
Shiny anterior lid margin
Greasy scales
Hyperaemia of lid margin
Lashes stuck together

29. Posterior Blephritis May present as:
*Dysfunction of the mebomian glands.
*Isolated mebomian seborrhoea and primary mebomenitis.
*Combination of ant. Seb. Blephritis and meibominitis

30. Primary Mebominitis Diffuse inflammation around glands
Associated with acne rosacea (2/3rd) or Seb. Dermatitis (1/3rd)
Signs:
*Pouting of gland orifices with dome of secretions—may become solid. (tooth-past like)
*Obliteration of ducts—dilatation (thick, round, vascularised, notched Posterior border)
*Secondary changes include papillary conjunctivitis, punctate epitheliopathy, and tear film instability (stinging)

31. Meibomianitis
Meibomian cyst formation
Thickened posterior lid margin

32. Mebomian Seborrheoa Dilated mebomian glands—easily expressed
Tear film is oily and foamy
In severe cases—mebomian foam at medial canthus.

33. Meibomian seborrhoea Oily and foamy tear film
Oil globules over meibomian gland
orifices

34. Treatment:
A: Systemic antibiotics
Tetracycline, Doxocycline, Erythromycin
B: Others:
Lid hygiene, topical steroids, artificial tears.
C: Local measures:
Warm compresses, mechanical expressions of secretions

35. Complications trichiasis, madarosis , poliosis Recurrent styes
Marginal keratitis
Tear film instability

36. Trauma
Lid margin
Lid tissue
Loss of lid tissue

37. Eyelid haematoma Orbital roof fracture if associated with
Usually innocuous but exclude
associated trauma to globe or orbit
Orbital roof fracture if associated with
subconjunctival haemorrhage without
visible posterior limit
Basal skull fracture - bilateral ring
haematomas (‘panda eyes’)