Diseases of The Eyelids
Diseases of The Eyelids
Diseases of The Eyelids
1. CONGENITAL ABNORMALITIES
- Ankyloblepharon → adhesion between eyelids
- Ablepharon → absence of eyelids
- Coloboma → notching of upper lid
- Epichanthus → medial skin fold obscuring caruncle
- Epiblepharon → the pretarsal muscle and skin ride above the lid margin to form a
horizontal fold of tissue
- Ptosis
- Ectropion
- Entropion
2. EYELID INFLAMMATION
Bacterial infections:
- Impetigo → superficial skin lesion caused by S. aureus or S. pyogenes and cahracterized
by painful erythematous macules rapidly developing into blisters, which develop golden-
yellow crusts on rupturing
- Erysipelas (St. Anthony’s fire) → is an uncommon acute, potentially severe, dermal and
superficial lymphatic infection usually caused by S. pyogenes → an inflamed
erythematous plaque develops
- Necrotizing fasciitis → rare but very severe infection involving subcutaneous soft tissue
and skin, with associated rapidly progressive necrosis → commonly caused by S. pyogenes
- External hordeolum → acute staphylococcal abscess of a lash follicle and its associated
gland of Zeis → tender swelling in the lid margin pointing anteriorly through the skin
Staphylococcal blepharitis → crusting mainly located around the bases of the lashes, mild
papillary conjunctivitis.
Long-standing cases may develop scarring and notching of the lid margin and trichiasis.
Dry eye syndrome and atopic keratoconjunctivitis may be present
Seborrheic blepharitis → hyperaemic and greasy anterior lid margins with adherence of
lashes to each other
Treatments:
- Lid hygiene
- Topical antibiotics + steroids
- Lubricants
- Systemic antibiotics (severe cases)
- Acute allergic oedema → usually caused by exposure to pollen or by insect bites and
manifests with sudden onset of bilateral boggy periocular oedema, often accompanied by
conjunctival swelling
3. EYELID MALPOSITION
- Ptosis → abnormally low position of the upper lid, which may be congenital or acquired.
There are different type of ptosis:
1. Neurogenic ptosis → caused by an innervation defect, such as III nerve paresis and
Horner syndrome (lesion to the sympathetic pathways that supply head and neck,
including oculosympathetic fibres)
- Levator resection
Levator complex is shortened through either an anterior-skin or posterior-conjunctival
approach → extent of resection depends on severity of the ptosis and the amount of levator
function
- Brow suspension
Used for severe ptosis with very poor levator function → the tarsal plate is suspended from
the frontalis muscle with a sling consisting of non-absorbable material like silicone
- Ectropion → outward turning of the eyelid margin.
There are different types of ectropion:
1. Involutional ectropion → age-related ectropion affects the lower lid of elderly
individuals. It causes epiphora (tear overflow) and exacerbate ocular surface disease.
In long-standing cases, the tarsal conjunctiva may become chronically inflamed, thickened
and keratinized.
Main aetiological factors are horizontal lid laxity and orbicularis weakness.
3. Paralytic ectropion → cause by ipsilateral facial nerve palsy and is associated with
retraction of the upper and lower lids and brow ptosis.
Complications include exposure keratopathy and watering caused by malposition of the
inferior lacrimal punctum.
2. Cicatricial entropion → scarring of the palpebral conjunctiva can rotate the upper or
lower lid margin towards the globe.
Among aetiological factors we can find cicatrizing conjunctivitis, trachoma, trauma and
chemical injuries.
4. EYELID TUMOURS
BENIGN TUMOURS
MALIGNANT TUMOURS
- Basal cell carcinoma → is the most common malignant eyelid tumour (90% of cases),
frequently arising from the lower eyelid → one of the most important risk factor is hisotry
of chronic sun exposure.
The tumour is slowly growing and locally invasive (orbit, sinuses) but non-metastasizing
→ it arises from basal cells found in the epidermis, sometimes showing hyperkeratotic
type of BCC.
Nodular BCC is a shiny, firm, pearly nodule with small overlying dilated blood vessels.
Other types may be Nodulo-ulcerative BCC or Sclerosing BCC
- Squamous cell carcinoma → less common but more
aggressive tumour than BCC, with metastasis to
regional lymph nodes.
Histopathology shows dysplastic changes throughout the
thickness of the epidermis → important aspect is
surveillance of regional lymph nodes in initial stages.
Individuals with AIDS or following renal
transplantation are at increased risk → predisposition
for lower eyelid and the lid margin, in elderly with
history of chronic sun exposure.