Lash Disorders Trichiasis: primary (metaplastic lashes and distichiasis) or secondary (entropion). Madarosis: local or systemic. Poliosis: Local (blepharitis) or systemic (vkh). Allergic Disorders

M.D., M.Sc (Ophth.), FRCS

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  Trichiasis: primary (metaplastic lashes and distichiasis) or secondary (entropion).
  
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  Madarosis: local or systemic.
  
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  Poliosis: Local (blepharitis) or systemic (VKH).
  

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  Acute allergic edema: insect bit, angioedema or urticaria.
  

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  Contact dermatitis: Sensitivity to topical medications.
  

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  Elderly people or those with hypercholesterolemia.
  
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  Cholesterol and lipid subcutaneous plaques.
  
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  Treatment: surgical excision or CO2 laser evaporation.
  

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  Blepharitis.
  
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  Hordeolum:
  

2) Internum (Acute chalazion)

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  Viral infections.
  
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  Trachoma.
  

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  Anterior, posterior or mixed.
  
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  Symptoms: burning, grittiness, mild photophobia, crusting and redness of lid margin.
  
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  Signs: lid margin (hyperemia, telangiectasia and tiny abscesses) scales and lashes (greasy and stuck together).
  
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  Complications: Stye, Tear film instability, Hypersensitivity to staph. toxins, trichiasis, madarosis and poliosis.
  
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  Treatment:
  

2) Antibiotic ointment

3) Systemic tetracycline

4) Lubricants

5) Weak topical steroid.

External Hordeolum (Stye)

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  Acute staph. infection of hair follicles and associated glands.
  
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  Signs
  
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  Mild preseptal cellulitis.
  
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  Treatment: Hot compresses, Epilation, Topical antibiotics and even systemic if associated with preseptal cellulitis.
  

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  Acute staph. infection of meibomian gland.
  
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  Signs: tender inflamed swelling within the tarsal plate. It may discharge anteriorly through the skin or posteriorly through the conjunctiva.
  
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  Treatment: Control of infection then curettage if residual mass.
  

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  Chronic lipogranulomatous inflammation caused by obstruction of the gland orifice.
  
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  Most common lid mass.
  
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  Symptoms
  
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  Signs
  
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  D.D. of recurrent chalazion
  
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  Treatment:
  

2) Steroid injection

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  Herpes simplex:
  

Treatment with acyclovir

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  Unilateral condition, usually affect elderly people.
  
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  Vesicles, pustules and crusting ulceration.
  
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  Hutchinson sign
  
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  Treatment: systemic and topical acyclovir
  

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  Adult Chlamydial Keratoconjunctivitis:
  

-Subacute onset, unilateral or bilateral mucopurulent discharge.

-Follicular conj. Reaction and corneal involvement is uncommon.

-Non-tender lymphadenopathy.

-Treatment: Topical tetracycline

Systemic tetracycline, deoxycycline or recently azithromycin.

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  Infection caused by Chlamydia trachomatis (serotypes A, B, Ba & C).
  
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  Obligate intracellular bacteria.
  
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  The common fly is a major vector in the transmission of the disease.
  
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  It is the leading cause of preventable blindness allover the world.
  
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  Symptoms: During childhood with redness, and mucopurulent discharge.
  
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  Signs:
  

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  follicular conjunctivitis.
  
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  Limbal follicles.
  
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  Keratitis.
  

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  Lab. Investigations:
  

2) ELISA

4) Giemsa stain (inclusion bodies)

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  Complications:
  

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  Progressive conjunctival scaring (Arlt line, PTDs and entropion).
  
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  Herbert pits.
  
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  Corneal pannus.
  

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  TF = trachomatous follicles.
  
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  TI = trachomatous inflammation.
  
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  TS = trachomatous scar.
  
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  TT = trachomatous trichiasis.
  
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  CO = corneal opacity.
  

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  Types:
  

1. 
   Involutional
   
2. 
   Cicatricial
   
3. 
   Spastic
   
4. 
   Congenital
   

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  Complications
  
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  Treatment
  

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  Types:
  

1. 
   Involutional
   
2. 
   Cicatricial
   
3. 
   Paralytic
   
4. 
   Mechanical
   

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  Complications
  
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  Treatment
  

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  Benign: Naevus, Capillary haemangioma, Port-wine stain …etc
  
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  Malignant: BCC, SCC, SGC and Melanoma.
  

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  Drooping of the upper lid.
  
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  Pseudoptosis
  
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  Classification:
  

1. 
   Neurogenic
   
2. 
   Myogenic
   
3. 
   Aponeurotic
   
4. 
   Mechanical
   

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  History:
  

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  Exclusion of Pseudoptosis.
  
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  Associated signs.
  

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  Measurements:
  

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  Preferable age for surgical correction?
  
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  Type of surgery
  

1. 
   Levator Resection
   
2. 
   Frontalis Suspension
   
3. 
   Mullerectomy
   

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  Postop. Complications and patient expectation.
  

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  Lacrimation: reflex over-production of tears.
  
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  Epiphora: mechanical obstruction of tear drainage.
  
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  Lacrimal pump failure.
  

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  The eyelids.
  
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  The dynamics of eyelid closure.
  
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  The puncta.
  
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  The marginal tear strip.
  
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  The lacrimal sac.
  
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  Dye Disappearance Test.
  
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  Probing and irrigation.
  
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  Jones dye test
  
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  Radiography
  

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  Symptoms
  
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  Signs
  
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  DDT
  
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  Complications
  
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  Management:
  

Probing

DCR
Infections of The Lacrimal Passages

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  Acute dacryocystitis:
  

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  Symptoms
  
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  Signs
  
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  Complications
  
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  Treatment:
  

Stab incision

DCR

Chronic Dacryocystitis:

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  Symptoms: epiphora + mucopurulent discharge
  
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  Signs: painless swelling
  

probing and irrigation

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  Treatment: DCR
  

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  Symptoms
  
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  Signs: Tear meniscus, Tear BUT test, Schirmer test, SPK and Rose Bengal stain.
  
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  Treatment: Preservation of tear
  

Punctal plugs

Permanent occlusion


Orbital Diseases

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  Inflammatory: Orbital cellulites
  

Treatment: admition, Iv antibiotics, CT-scan and fever chart.

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  Graves Ophthalmopathy
  

Symptoms (active and inactive)

Signs

Treatment

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  Orbital Blow-out fracture
  

Signs

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  Tumors
  

Lymphoma