Blepharitis refers to inflammation of the eyelid margins.
It causes a gritty, itchy, dry sensation in the eyes. It can be associated with dysfunction of the Meibomian glands, which are responsible for secreting meibum (oil) onto the surface of the eye. It can lead to styes and chalazions.
Management is with warm compresses and gentle cleaning of the eyelid margins to remove debris (e.g., using a cotton bud and baby shampoo).
Stye
Hordeolum externum is an infection of the glands of Zeis or glands of Moll. The glands of Moll are sweat glands at the base of the eyelashes. The glands of Zeis are sebaceous glands at the base of the eyelashes. A stye causes a tender red lump along the eyelid that may contain pus.
Hordeolum internum is infection of the Meibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.
Styes are treated with hot compresses and analgesia. Topical antibiotics (e.g., chloramphenicol) may be considered if it is associated with conjunctivitis or if symptoms are persistent.
Chalazion
A chalazion occurs when a Meibomian gland becomes blocked and swells. It is often called a Meibomian cyst. It presents with a swelling in the eyelid that is typically not tender (however, it can be tender and red).
Treatment is with warm compresses and gentle massage towards the eyelashes (to encourage drainage). Rarely, surgical drainage may be required.
Entropion
Entropion refers to when the eyelid turns inwards with the lashes pressed against the eye.
This causes pain and can result in corneal damage and ulceration.
Initial management is by taping the eyelid down to prevent it from turning inwards. Definitive management is surgical. A same-day referral to ophthalmology is required if there is a risk to sight.
When the eyelid is taped down, it is essential to prevent the eye from drying out by using regular lubricating eye drops.
Ectropion
Ectropion refers to when the eyelid turns outwards, exposing the inner aspect.
It usually affects the bottom lid. This can result in exposure keratopathy, as the eyeball is exposed and not adequately lubricated and protected.
Mild cases may not require treatment. Regular lubricating eye drops are used to protect the surface of the eye. More significant cases may require surgery to correct the defect. A same-day referral to ophthalmology is required if there is a risk to sight.
Trichiasis
Trichiasis refers to inward growth of the eyelashes. It results in pain and can cause corneal damage and ulceration.
Management involves removing the affected eyelashes. Recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent them from regrowing. A same-day referral to ophthalmology is required if there is a risk to sight.
Periorbital Cellulitis
Periorbital cellulitis (also known as preseptal cellulitis) is an eyelid and skin infection in front of the orbital septum (in front of the eye). It presents with swollen, red, hot skin around the eyelid and eye.
It must be differentiated from orbital cellulitis, a sight and life-threatening emergency. Patients are referred urgently to ophthalmology for assessment. A CT scan can help distinguish them.
Treatment is with systemic antibiotics (oral or IV). Preorbital cellulitis can develop into orbital cellulitis, so vulnerable patients (e.g., children) or severe cases may require admission for monitoring.
Orbital Cellulitis
Orbital cellulitis is an infection around the eyeball involving the tissues behind the orbital septum. Symptoms include pain with eye movement, reduced eye movements, vision changes, abnormal pupil reactions, and proptosis (bulging forward of the eyeball).
Orbital cellulitis requires emergency admission under ophthalmology and intravenous antibiotics. Surgical drainage may be needed if an abscess forms.
Last updated October 2023
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