Ординатура / Офтальмология / Английские материалы / Oculoplasty and Reconstructive Surgery Made Easy_Garg,Touky, Nasralla_2009
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STYE (HORDEOLUM EXTERNUM)
Introduction
•Stye is an acute purulent infection (abcess) of Lash follicles and its associated gland of Zeiss or Moll.
•It is mainly Staphylococcal infection.
•Stye is generally seen in patients with staphylococcal blepharitis.
Clinical Signs and Symptoms (Figures 1 and 2)
•Stye presents as a painful inflamed swelling in lid margin pointing anteriorly through the skin.
•Symptoms are out of proportion to the diseae process.
•Redness and heat are present. After this a pus point develops at the root of the cilium and gets evacuated spontaneously.
•One lesion present can infect the surrounding follicles leading to a crop of lesions (Multiple minute abcesses).
Investigations
•Subjective ocular examination is sufficient to make the diagnosis and no specific investigations are indicated.
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Figures 1 and 2: Hordeolum externum (Stye)
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Differential Diagnosis
•International hordeolum
•Cyst of Zeiss and Moll.
Treatment
•Most styes either resolve spontaneously or evacuates anteriorly close to the eyelash roots.
•Resolution may be supported by removing the eyelash associated with the infected follicle followed by hot compresses helps in localization of the lesion and relief of symptoms.
•Application of local antibiotic ointment to the lid margin prevent the spread of the disease to the surrounding area.
•Systemic antibiotics and anti-inflammatory drugs are also advocated for reduction of infection and inflammation and relief of pain which in advanced stage is quite severe.
•Pus can also be evacuated once the lesion is localized and points on the surface under the cover of systemic broad spectrum antibiotics.
•Surgical incision is required only in case of large abcess under local anesthesia.
•Recurrence is prevented by the treatment of chronic blepharitis.
Prognosis
• Good
CHALAZION (MEIBOMIAN CYST)
Introduction
•Chalazion is a chronic inflammatory lipogranuloma of the tarsal glands.
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•It is caused by infection of retained sebaceous material inside the neibomian gland due to obstruction of duct.
•Chalazion are common in patients with meibomian gland dysinfection.
•Chalazion is truly not a cyst as it’s walls consist of granulomatous tissue and are not lined by epithelium.
Clinical Signs and Symptoms (Figures 3 to 6)
Clinically it starts slowly and without symptoms. In the beginning it is small and hard free from overlying skin.
•It is more common in upper lid and seen frequently in adults.
•Chalazion present as a painless, slowly enlarging roundish, firm lesion in the tarsal plate.
•Mostly the lesions remain stationary after growing to a certain size but sometimes spontaneous regression or secondary infection can take place.
Figure 3: Marginal chalazion lower lid
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Figures 4 and 5: Chalazion lower lid
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Figure 6: Incision and curettage for chalazion upper lid (1st day postoperative)
•Sometimes Chalazion of upper lid presses on the cornea causing blurred vision from induced astigmatism.
•Pathologically, there is a unique inflammation of the meibomian glands producing granulation tissue. It affects the area around the acini and leads to fibrosis. There is infiltration of lymphocytes, plasma cells and epitheloid cells. In the center of the mass there is deposition of lipid producing a picture of lipogranuloma.
•There is a chronic low grade infection producing accumulation of sebaceous material in the acini which results in development of granulation tissue due to toxic irritation.
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Investigations
•Subjective ocular examination is adequate to clinch diagnosis.
•Eversion of the eyelid may show the presence of an external conjunctival granuloma in the region of the cyst.
Differential Diagnosis
•Stye
•Cyst of Zeiss and Moll.
Treatment
•If chalazion is small and asymptomatic, it can be left alone.
•Medical management includes hot compresses and expressing out the material by massaging the lid.
•Intralesional injection of 1 mg triamcinolone is successful in mild to moderate cases.
•In majority of cases incision and curettage under local anesthesia is required.
•The lid is then everted with a special chalazion clamp.
•An incision is then made through the conjunctiva into the cyst, the contents are curetted and any associated external granulomatous tissue is excised with scissor. Evacuation of the granulation tissue is done with scoop.
•After proper evacuation, an antibiotic ointment is instilled and the eye is padded for about 6 hours. Systemic broad spectrum antibiotic and anti-inflammatory drugs are given.
Prognosis
•Generally prognosis is good.
•Recurrently occurring Chalazia should be closely watched and tissue must be examined for any malignancy.
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BLEPHARITIS
Introduction
•Blepharitis is chronic inflammatory condition of the eyelid margin which leads to secondary changes in the conjunctiva and cornea.
•It is quite common but most of the time patient ignore it and goes undiagnosed.
•Etiology is varied one, but the most common causes are staphylococcal infection, seborrhea and meibomian gland dysfunction.
Clinical Signs and Symptoms (Figures 7 to 11)
•Itching in the eye specially at the lid margin is most common complaint of the patient.
•Red eye with watering and burning sensation may also be present.
Figure 7: Seborrheic blephritis
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Figures 8 and 9: Blephritis (after thermal burns)
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Figure 10: Blephritis (after injury)
Figure 11: Blephritis