121. BARLEY, CLINIC, TREATMENT .

Barley, or stye, is a painful abscess of the eyelash follicle caused by bacteria, often Staphylococcus
aureus. It can occur on the edge or inside the eyelid.

Clinical Features :
*A small, red, painful bulge, on the anterior lid margin, usually pointing through the skin.

* Localized swelling and redness of the eyelid.

*A yellowish pus pocket formation at the center of the swelling.

*Itching, tearing, and sensitivity to light.

*Mucous or purulent discharge from the eye.

*Heaviness, warmth, and tenderness in the affected area.

Treatment :
* Apply a warm, moist washcloth to the affected eye for 5 to 10 minutes, 3 to 6 times a day. This helps the
stye drain and heal faster.

*Removal of the associated lash and hot bathing.

* Use topical ointments to soothe irritation. Antibiotic eye drops or creams may be prescribed.

*For large or persistent styes, surgical drainage may be performed to drain the pus.

122. PHLEGMON OF THE CENTURY , CLINIC , TREATMENT, COMPLICATIONS .

Preseptal cellulitis, also known as periorbital cellulitis, is an infection of the eyelid and the skin
around the eye, located anterior to the orbital septum. This condition is characterized by inflammation
and infection of the tissues in front of the orbital septum, which separates the eyelid from deeper orbital
structures.

>Often caused by bacteria, which can spread from adjacent infections like sinusitis or from external
trauma. Less commonly caused by viruses or fungi.

Clinical Features :
*Swelling and redness of the eyelid and surrounding tissues.

*Warmth and tenderness in the affected area.

*A low-grade fever may be present.

*Eyelid swelling that prevents the eyelid from opening easily.

*General Malaise.

*Absence of Orbital Signs: Unlike orbital cellulitis, preseptal cellulitis does not cause proptosis, impaired
vision, or restricted eye movements.

Treatment:
*IV Antibiotics
*Analgesics for pain relief.

*Topical decongestants used to reduce swelling.

*If an abscess forms, surgical drainage may be necessary to prevent further complications.

Complications:
•Orbital Cellulitis: The infection can spread behind the orbital septum, leading to orbital cellulitis, which
can cause vision loss, proptosis, and impaired eye movement.

•Subperiosteal Abscess leading to complications like intracranial infections.

•Cavernous Sinus Thrombosis: Rarely, the infection can spread to the cavernous sinus, causing
thrombosis, which is life-threatening.

• In severe cases, it can lead to meningitis or brain abscesses.

•Less common complications include lagophthalmos (inability to close the eyelids) and lid necrosis.

•Necrotizing Fasciitis: A rare but severe complication caused by β-hemolytic Streptococcus, leading to
potential toxic shock syndrome.

123. E YELID ABSCESS , CLINIC, TREATMENT, COMPLICATIONS .

Eyelid abscess is a localized collection of pus within the eyelid, often resulting from infections
such as styes (hordeolum) or chalazion that become infected. It can also arise from sinus infections,
trauma, or retained foreign bodies.

Clinical Features:
*Swelling and Redness of the eyelid.

*Painful swelling, often tender to touch.

*A visible or palpable collection of pus.

*Mucous or purulent discharge from the eyelid.

*Vision disruption due to swelling or pressure on the eye.

*Systemic Symptoms like fever or chills may occur if the infection spreads.

Treatment :
*Antibiotic therapy like vancomycin or linezolid may be used.

*Keeping the area clean and using warm compresses can help manage symptoms.

*Surgical incision and drainage is often necessary to relieve pressure and remove pus.

*Removing dead tissue promotes healing and prevent further infection.

Complications:
*The infection can spread to the orbit, causing orbital cellulitis, which is a serious condition that can lead
to vision loss, proptosis, and central nervous system complications like cavernous sinus thrombosis or
meningitis.
*Fistula Formation in cases, especially following trauma, fistulas can form between the eyelid and
sinuses, leading to recurrent infections.

*Untreated or severe infections can impair vision due to increased pressure on the eye or direct damage
to ocular structures.

124. CHALAZION, CLINIC, TREATMENT.

Chalazion a chronic lesion consisting of lipogranulomatous inflammation in the eyelid centred
on a dysfuctional meibomian gland.

Clinical features:
*Extremely common, particularly in patients with posterior blepharitis.

*A chronic, usually solitary, painless, firm swelling in the tarsal plate.

*Can follow an acute meibomian gland infection.

* May be assosiated with Secondary conjunctival granuloma.

Management :
*Spontaneous resolution may occur, although usually only if the lesion is small.

*Conservative Treatment: Warm compresses can be applied to the eyelid three to six times a day to
resolve the condition. Massaging the eyelid after applying the compress helps in unblocking the gland.

*Surgical incision and curettage is often required. This involves making a small incision on the inner
eyelid to drain the cyst.

125. MEIBOMEITIS , CLINIC AND TREATMENT .

Meibomeitis is a chronic inflammation of the meibomian glands, which are small oil glands located
in the eyelids. These glands produce meibum, an oily substance that helps lubricate the eyes and prevent
tear evaporation.

Clinical Features :
*Eye Irritation, gritty sensation, redness, and swelling of the eyelids.

*Dry eyes and irritation due to reduced tear quality.

*Vision Disruption or Blurry vision due to irregular tear film.

*Discomfort, painful, itchy, or burning sensations in the eyes.

* Photophobia.

*Excessive Watering of eyes due to irritation.

*Crusting at the base of the eyelashes, often associated with blepharitis.

Treatment :
*Applying warm compresses and gently massaging the eyelids can help unclog the glands and improve
meibum flow.

*Lid Hygiene: Cleaning the eyelids with a mild cleanser to remove debris and bacteria.
*Using lubricating eye drops to soothe dryness and irritation.

* Topical or oral antibiotics like azithromycin can reduce bacterial colonization and inflammation.

* Steroid eye drops may be prescribed for severe inflammation.

*Omega-3 Supplements can help improve symptoms by reducing inflammation.

*Intense Pulsed Light (IPL) Therapy: Helps improve gland function by softening meibum.

126.E VERSION OF THE EYELIDS , CAUSES , TREATMENT.

Eversion of the eyelid (Ectropion) is an outward turning of the lower lid. If severe and prolonged, it
may cause conjunctival keratinisation.

Causes:
•Involutional: due to age related tissue laxity

• Cicatricial: scarring resulting from burns or surgery.

•Mechanical : excessive lid weight by lid mass, e.g. tumour

• Paralytic :associated with facial nerve palsy

• Congenital : rare

Treatment:
*Short term- Lubricants, taping of lids to keep the eyes moist and reduce the irritation.

*Long term -Surgical correction by eyelid tightening or mucous membrane grafts.

*Procedures like lateral tarsal strip helps to tighten the lower eyelid.

127. INVERSION OF THE EYELIDS , CAUSES , TREATMENT AND COMPLICATIONS .

Inversion of the eyelids (Entropion) is an inward turning of the upper or lower

eyelid.

CAUSES :

• Involutional: most common form; results from age related changes and laxity in the
lower lid.

•Cicatricial: seen in trachoma, Steven Johnson syndrome, ocular pemphigoid, chemical

burns and trauma. Caused by scarring and contraction of lid.

•Spastic: caused by spasm of orbicularis secondary to ocular irritation

•Congenital: very rare.

Treatment:

*Short term : Using Lubricants, taping of the eyelids, soft contact lenses.

* Long term : Surgical correction by eyelid tightening or mucous membrane grafts.

Complications:

•Corneal Damage: Chronic irritation can cause corneal ulcers or scarring, potentially
leading to vision loss.

•Persistent irritation and discomfort.

• Increased risk of eye infections due to compromised corneal surface.

•Vision Impairment: Untreated cases may result in decreased vision quality due to
prolonged corneal exposure and irritation.

128. PTOSIS, CAUSES , DEGREES AND TREATMENT

Ptosis is the condition of drooping of the eyelid. It can be unilateral or bilateral.

ETIOLOGY:

• Congenital : Caused by weakness of the Levator muscle. Surgical correction is indicated

for visual or cosmetic reasons.
• Acquired :
1. Neurogenic (3rd nerve palsy, Horner's syndrome )
2. Aponeurotic : Dehiscence of Levator Palpebrae Superioris, could be age related
(senile), traumatic or post operative.
3. Myogenic : Myasthenia gravis, Myotonic dystrophy, ocular myopathies.
4. Mechanical : Due to inflammation, tumor, vascular abnormality of upper lid.

Degrees:

*Mild Ptosis: The upper eyelid droops by 1-2 mm.

*Moderate Ptosis: The drooping is between 3-4 mm.

*Severe Ptosis: The eyelid droops more than 4 mm.

Treatment :
• TREAT THE UNDERLYING CONDITION.

•OXYMETAZOLINE DROPS CAN TEMPORARILY IMPROVE EYELID ELEVATION .

•USE OF SCLERAL CONTACT LENSES .

• SURGICAL CORRECTION

129. LAGOPHTHALMOS , CAUSES AND TREATMENT .

Lagophthalmus is the incomplete closure of the eyelids due to 7th nerve palsy. It can be paralytic
and mechanical.

*Results in exposure keratitis.

Causes:
*Stroke, tumors, and autoimmune disorders (e.g., Guillain-Barré syndrome) can impair facial nerve
function, affecting eyelid closure.

*Möbius syndrome, a rare congenital disorder affecting facial nerve.

*Eyelid Scarring from burns, injuries, or diseases like Stevens-Johnson syndrome can restrict eyelid
movement.

*Excessive skin removal during blepharoplasty can lead to lagophthalmos.

*Conditions like floppy eyelid syndrome or exophthalmos can lead to lagophthalmos.

Treatment :
➢ LUBRICANTS
➢ TAPING OF LIDS
➢ LATERAL TARSORRAPHY.

130. TRICHIASIS , CAUSES, COMPLICATIONS AND TREATMENT .

Trichiasis is the condition of abnormal inward growth of eyelashes to the eye

which causes irritation and discomfort. This misalignment leads to the eyelashes
rubbing against the cornea, conjunctiva, and inner eyelid surfaces.

Causes:

• Eye infections caused by staphylococcus,herpes zoster, trachoma, and other

bacterial infections can lead to trichiasis.
• Conditions like chronic blepharitis, conjunctival scarring from diseases like
Stevens-Johnson syndrome, and autoimmune disorders can cause trichiasis.
• Physical trauma or burns to the eye.
• Congenital Conditions like Epiblepharon and distichiasis.
• As skin elasticity decreases with age, eyelashes may become misdirected.

Complications:

➢ Corneal Damage: Misdirected eyelashes can cause corneal abrasions,

ulcers, and scarring, potentially leading to vision loss or blindness.
➢ Persistent irritation and discomfort, foreign body sensation, redness and
tearing.
➢ Increased risk of eye infections due to compromised corneal surface.
➢ Chronic irritation can lead to decreased vision quality and blindness.

Treatment :

*Epilation

* Lubricating eye drops

* Cryotherapy
* Electrolysis

* Laser ablation

131.BENIGN EYELID TUMORS .

Benign eyelid tumors are non-cancerous growths that can cause various
symptoms depending on their type and location. Common benign eyelid tumors
include:

•Papilloma: Typically painless, but can be itchy and cause discomfort if large in size.
They may interfere with vision depending on their location.

•Nevus: Painless and pigmented, rarely affecting vision unless they grow significantly.

•Seborrheic Keratosis: Often appears as a small, benign growth that may cause
cosmetic concerns but usually does not cause symptoms.

•Hydrocystoma: Slow-growing, rounded, and soft to the touch, typically the same color
as the eyelid skin. They may cause misdirection of eyelashes.

Symptoms:

> visible lumps or growths

> skin changes

> occasional irritation or discomfort.

Treatment:

*Biopsy: To confirm the benign nature of the tumor.

*Surgical removal of the tumor.

*Laser treatment techniques can be used for precise removal with minimal scarring.

*Cryotherapy.

*Topical Steroids to reduce swelling and inflammation.

132. MALIGNANT TUMORS OF THE EYELIDS .

Malignant eyelid tumors are cancerous growths in the eyelids which can lead to significant
vision impairments.

Causes:

•Sun Exposure: Prolonged exposure to UV radiation increases the risk of tumors, particularly in
fair-skinned individuals.

•Genetic Factors
•Immune System Suppression: Weakened immune systems can increase tumor risk.

Symptoms:

*Visible Lesions: Tumors often appear as lumps, bumps, or ulcers on the eyelids.

*Skin Changes: Scaling, crusting, or ulceration may occur.

*Loss of Eyelashes: Tumors near the lash line can cause eyelash loss.

*Eye Discomfort: Redness, swelling, or discomfort in the affected area.

>>Common malignant eyelid tumors include basal cell carcinoma, squamous cell carcinoma,
sebaceous carcinoma, melanoma, and Merkel cell carcinoma.

Treatment:

•Surgical Excision: This is the gold standard, often performed using techniques like Mohs
surgery or excision with frozen-section control to confirm tumor-free margins.

•Reconstructive Surgery: Following tumor removal, reconstructive surgery is necessary to

restore eyelid function and appearance.

•Adjuvant Therapies: For advanced cases, radiotherapy, chemotherapy, or targeted therapies

may be used.

•Alternative Options: Cryotherapy or local chemotherapy.

133. ACUTE DACRRYOCYSTITIS , CLINIC, TREATMENT .

Acute dacryocystitis is an infection of the lacrimal sac, typically caused by a blockage in

the nasolacrimal duct. This condition leads to stagnation of tears, creating an environment
conductive to bacterial growth, often involving staphylococcal or streptococcal species.

Symptoms:

•Pain and Swelling: Painful redness and swelling in the inner corner of the eye, near the nose.

•Pus or Discharge: Presence of pus or thick discharge from the eye.

•Fever: High temperature may occur.

•Watery Eyes: Excessive tearing due to blocked tear ducts.

•Conjunctivitis, causing redness and irritation of the eye.

Treatment:

>Oral / IV Antibiotics.

>Applying warm compresses to the affected area helps relieve symptoms and promote
drainage.

>Pain relievers or analgesics.

Surgical Treatment-
 1. Abscess Drainage: Percutaneous drainage may be necessary for abscesses.
2. Dacryocystorhinostomy (DCR): After the acute infection resolves, DCR surgery is often
performed to bypass the blockage and prevent recurrence.
3. Translacrimal Canalicular Drainage: Minimally invasive techniques using a lacrimal
probe and D-silicone intubation are also effective.

134. CHRONIC DACRYOCYSTITIS , CLINIC , TREATMENT.

Chronic dacryocystitis is a long-standing infection or inflammation of the lacrimal sac,

resulting from chronic obstruction of the nasolacrimal duct. This condition leads to stagnation
of tears, predisposing the area to infection.

Symptoms:

•Watery Eyes : Excessive tearing due to impaired tear drainage.

•Conjunctival Hyperemia: Redness and inflammation of the conjunctiva.

• Swelling over the lacrimal sac, which may be tender or non-tender.

•Chronic Conjunctivitis: Recurrent episodes of conjunctivitis.

•Mucoid Discharge: Pressure on the lacrimal sac may extrude a mucoid or pus-like material
through the punctum.

Treatment:

* Broad-spectrum antibiotics.

*Warm Compresses and Massages helps relieve symptoms and promote drainage.

*Topical Antibiotic ointments or drops may be used for mild cases.

Surgical Treatment-

*Dacryocystorhinostomy (DCR): This surgery creates a new pathway for tear drainage and is the
primary treatment for chronic dacryocystitis.

*Lacrimal Duct Probing, performed to clear obstructions, especially in congenital cases.

*Dacryocystectomy : removal of the lacrimal sac may be considered.

135. ORBITAL PHLEGMON, CLINIC, TREATMENT.

Orbital phlegmon is a serious infection of the tissues surrounding the eye leading to the
inflammation of the eye socket.

Clinical Features :
*Painful swelling of the eyelids, possibly extending to the eyebrow and cheek.

*Chemosis.

*Proptosis: Bulging or forward displacement of the eyeball.

*Decreased visual acuity, blurred vision, or double vision (diplopia).

*Limiting of the eye movement, Pain with ocular motility.

* Swelling and redness of the eyelids and surrounding tissues.

*Systemic symptoms like Fever, malaise, and headache.

*Signs like optic disc edema, papilloedema, central vein occlusion may indicate optic nerve involvement.

Treatment :
*Incision of orbit with abscess drainage.

*IV antibiotics systemically (ceftriaxone, vancomycin)

*Osmotherapy.

136.DISEASES OF THE LACRIMAL ORGANS AND THEIR CLASSIFICATION .

The lacrimal system which is responsible for tear production and drainage, can be
affected by various diseases.

Classification by Location:

1. Proximal Obstructions: These involve the punctum and canaliculi, including

conditions like punctal stenosis and canaliculitis.
2. Distal Obstructions: These involve the nasolacrimal duct, often caused by
trauma, surgery, or tumors.

Diseases of Lacrimal Organs:

•Dacryocystitis: Infection of the lacrimal sac, which can be acute or chronic, causing
pain, swelling, and discharge.

•Nasolacrimal Duct Obstruction: Blockage of the tear duct, common in infants but also
occurring in adults due to inflammation or trauma.

•Canaliculitis: Infection of the canaliculi, presenting with a painful, swollen eyelid and
discharge.

•Punctal Stenosis: Narrowing of the punctum, leading to impaired tear drainage.

•Dacryoadenitis: Inflammation of the lacrimal gland, which can be acute or chronic,

often associated with systemic diseases like sarcoidosis or Crohn’s disease.

•Epiphora : Excessive tearing due to impaired drainage.

•Lacrimal Gland Tumors: Include pleomorphic adenoma and adenoid cystic

carcinoma.

137.TEAR FILM, STRUCTURE AND ITS SIGNIFICANCE .

The tear film is a thin, complex layer covering the ocular surface, crucial for
maintaining eye health and vision clarity. It consists of three main layers:
 1. Lipid Layer: The outermost layer, produced by the meibomian glands, prevents
tear evaporation and maintains surface tension.
2. Aqueous Layer: The middle layer, primarily produced by the lacrimal gland,
provides hydration and nutrients to the cornea.
3. Mucin Layer: The innermost layer, secreted by goblet cells in the conjunctiva,
helps spread tears evenly and stabilize the tear film.

Significance:

•Protective Barrier: The tear film protects the eye from pathogens and foreign particles.

•Lubrication: It facilitates smooth eye movement and maintains a clear visual surface.

•Nutrient Supply: Provides essential nutrients to the avascular cornea.

•Stability and Refraction: Maintains a stable refractive surface for clear vision.

138. ACUTE DACRYOADENITIS , CAUSES, CLINIC, TREATMENT

Acute dacryoadenitis is an inflammation of the lacrimal gland, which can be caused by
infections or systemic diseases.

>Viral Infections: Common causes include mumps, Epstein-Barr virus, and influenza.

>Bacterial Infections: Staphylococcus and gonococcus are common bacterial causes.

Symptoms

•Swelling and Redness of the outer upper eyelid.

•Pain in the area of swelling.

•Excess tearing or discharge and possible presence of pus.

•Swollen lymph nodes near the ear.

Treatment

*For viral causes : Rest and warm compresses.

*For bacterial causes: Systemic and topical antibiotics are used. If an abscess forms, drainage
is necessary.

*Supportive Care: Pain management and monitoring for complications like orbital cellulitis.

139. CHRONIC DACRYOADENITIS (MIKULICH ’S DISEASE ), CAUSES , CLINIC, TREATMENT.

Chronic dacryoadenitis is primarily caused by non-infectious inflammatory disorders,

including:

•Sarcoidosis: A systemic disease causing inflammation in various parts of the body.

•Thyroid Eye Disease: Inflammation associated with thyroid disorders.

•Orbital Pseudotumor: A condition mimicking a tumor due to inflammation.

•Autoimmune Diseases: Such as Sjögren’s syndrome and IgG-related disease.

Symptoms:

>Painless Swelling of the lacrimal gland, which may be bilateral.

>Systemic symptoms related to the underlying disease.

>Dry eye due to reduced tear production.

Treatment:

Treatment focuses on managing the underlying condition:

*Steroids: Often used to reduce inflammation.

*Immunosuppressive Medications: For autoimmune diseases.

*Supportive Care: To manage symptoms and prevent complications.

140. DACRYOCYSTITIS , TYPES AND COMPLICATIONS .

Dacryocystitis is an infection or inflammation of the lacrimal sac, typically resulting from a

blockage in the nasolacrimal duct. This blockage leads to stagnation of tears, predisposing the
area to infectio.

Types:

•Acute Dacryocystitis: Sudden onset, often caused by bacterial infections like Staphylococcus
aureus or Streptococcus pneumoniae. Symptoms include pain, redness, swelling, and
discharge.

•Chronic Dacryocystitis: Long-standing inflammation, often linked to systemic or autoimmune

conditions. Symptoms may be milder but persistent, including tearing and chronic
conjunctivitis.

Complications:

>Corneal Ulceration: A serious complication, especially with S. pneumoniae infections.

>Orbital Cellulitis: Infection spreading to the orbit, potentially leading to severe complications
like proptosis or vision loss.

>Abscess Formation: Pus accumulation in the lacrimal sac, which may require drainage.