Eye Adnexa Diseases: Catedra Oftalmologie

Catedra Oftalmologie
EYE ADNEXA DISEASES
Associate Professor
ALA PADUCA
Aim
• to provide students with a thorough grounding in

the major eyelids, conjunctiva and lacrimal system
diseases
PATHOLOGY OF THE LACRIMAL SYSTEM
1. Dacrioadenitis
2. Nasolacrimal duct obstruction
(dacriocystitis):
 Congenital (ocurs in about 5% of full-term
newborns)
 Adult
Dacryoadenitis is inflammation of the lacrimal
glands
Acute dacryoadenitis is most commonly due to

viral or bacterial infection. Common causes include
Epstein-Barr virus, staphylococcus, and
gonococcus.
Chronic dacryoadenitis is usually due to

noninfectious inflammatory disorders (ex.
sarcoidosis, thyroid eye disease)
SYMPTOMS
• Swelling of the outer portion of the upper lid (the

superotemporal orbit) with redness of the tissues
surrounding these glands.
• Pain in the area of swelling
• Excess tearing or discharge
• Swelling of lymph nodes in front of the ear
• Additional eye symptoms: - photophobia,
- tearing, or
- a foreign body sensation may also occur.
Treatment
• If the cause of dacryoadenitis is a viral
condition such as mumps, simple rest and
warm compresses may be all that is needed.
For other causes, the treatment is specific to
the causative disease.
Prognosis
• Most patients will fully recover from
dacryoadenitis.
Congenital nasolacrimal
duct obstruction
Caused by delayed canalization (a thin mucosal membrane at
the lower end of NLD)
SIGNS: On pressure over the lacrimal sac produces reflux of
purulent material from punctum
Kansky
• Epiphora (Tearing) • acute dacryocystitis

• Mucoid or mucopurulent discharge
Treatment of congenital nasolacrimal
duct obstruction
• Digital massage of nasolacrimal duct and antibiotic drops 4 times daily
• Improvement by age 2-3 months in 95% of cases
• If no improvement - probe at 12-18 months

• Results - 90% cure by first probing and 6% by second
Adult acute dacryocystitis
Usually secondary to nasolacrimal duct obstruction.
It is most commonly caused by Staphylococcus aureus and Streptococcus pneumoniae
• Pain, swelling, redness over the lacrimal sac at • May develop into abscess
medial canthus • The most common complication is corneal
• Tearing, crusting, fever
ulceration
• Digital pressure over the lacrimal sac may Treatment
extrude pus through the punctum • Systemic antibiotics and warm compresses
• In chronic cases, tearing may be the only • DCR after acute infection is controlled
Chronic dacryocystitis: catarrhal and suppurative
Epiphora and chronic or recurrent unilateral conjunctivitis
In chronic cases, tearing may be the Expressed mucopurulent material through the
only symptom punctum on digital pressure over the sac
Painless swelling at medial canthus
Treatment - DCR
DIAGNOSIS
ABNORMALITIES
OF EYELIDS POSITION
Ectropion
Entropion
Ptosis
ECTROPION AND ENTROPION
1. Ectropion
• Involutional
• Cicatricial
• Paralytic
• Mechanical
2. Entropion
• Involutional
• Cicatricial
• Congenital
Involutional
• Affects lower lid of elderly patients
• May cause chronic conjunctival inflammation

and thickening
Causes of cicatricial ectropion
• Contracture of skin pulling lid away from globe
• Unilateral or bilateral, depending on cause
Unilateral ectropion due to Bilateral ectropion due to severe

traumatic scarring dermatitis
Involutional entropion
Affects lower lid because upper lid If longstanding may result in corneal
has wider tarsus and is more stable ulceration
Classification
•Neurogenic ptosis which includes oculomotor nerve palsy,
Horner's Syndrome,
•Myogenic ptosis which includes myasthenia gravis, simple congenital ptosis
•Aponeurotic ptosis which may be involutional or post-operative.
•Mechanical ptosis which occurs due to edema or tumors of the upper lid
•Neurotoxic ptosis
1.Acquired ptosis is most commonly caused by aponeurotic ptosis

2.Congenital ptosis
Treatment
Surgical procedures:
Levator resection
Frontalis sling operation
Non-surgical modalities: glasses or special Scleral

contact lenses to support the eyelid.
Ptosis that is caused by a disease will improve if

the disease is treated successfully.
INFLAMMATION OF THE EYELIDS
Blepharitis
Hordeolum
Chalasion
MARGINAL BLEPHARITIS
chronic inflammation of the eyelid
The pathogenesis
• of anterior blepharitis is unclear
although staphylococcal infection play important
roles
SYMPTOMS:
 Redness of the lid margins
 Crusting at the lid margins
 Foreign body sensation
 Burning
 Mild photophobia
Staphylococcal blepharitis
• Chronic irritation worse in mornings • Hyperaemia of anterior lid margin

• Scales around base of lashes
(collarettes)
Seborrheic blepharitis
• Greasy scales
• Hyperaemia of lid margin
• Lashes stuck together
Treatment of Chronic Blepharitis
1. Lid hygiene - with 25% baby shampoo
2. Tear substitutes - for associated tear film instability
3. Systemic tetracyclines - for severe posterior blepharitis
4. Warm compresses - to melt solidified sebum

in posterior blepharitis
Acute hordeola
Internal hordeolum
( acute chalazion ) External hordeolum
• Staph. abscess of meibomian • Staph. abscess of lash follicle and

glands associated gland of Zeis or Moll
• Tender swelling within tarsal plate• Tender swelling at lid margin
• May discharge through skin
• May discharge through skin
or conjunctiva
Internal Hordeolum
• Internal styes aren’t contagious. You can’t catch a stye from someone
else. However, you can spread bacteria from an internal stye to your
eye. This can happen if you rub, pop, or squeeze a stye.
• Internal styes are usually more painful than external styes. They may
also last longer. A serious internal stye can sometimes become
chronic and return after it heals. It can also cause a hardened cyst, or
chalazion, on the inside of your eyelid.
• According to a medical review, if you get internal styes often you may
be a carrier of Staphylococcus bacteria in your nose passages. This
can increase the risk for other nose, sinus, throat, and eye infections.
Treatment
Until your sty goes away on its own, try to:

• Leave the sty alone. Don't try to pop the sty or squeeze the pus from a
sty. Doing so can cause the infection to spread !!!
• Clean your eyelid. Gently wash the affected eyelid with mild soap and
water.
• Place a warm washcloth over your closed eye.
• Keep your eye clean. Don't wear eye makeup until the sty has healed.
• Go without contacts lenses. Contact lenses can be contaminated with
bacteria associated with a sty. If you wear contacts, try to go without
them until your sty goes away.
BENIGN EYELIDS TUMOURS
Papilloma
Nevus
Haemangioma
MALIGNANT EYELID TUMOURS
1. Basal cell carcinoma

2. Squamous cell carcinoma
3. Meibomian gland carcinoma
4. Melanoma
Basal Cell Carcinoma - Important Facts
1. Most common human malignancy
2. Usually affects the elderly
3. Slow-growing, locally invasive
4. Does not metastasize
5. 90% occur on head and neck
6. Of these 10% involve eyelids
7. Accounts for 90% of eyelid malignancies

CONJUNCTIVAL INFECTIONS
1. Bacterial
2. Viral
3. Allergical
Bacterial conjunctivitis
Signs
• conjunctival hyperemia
• Foreing body sensation
• Usually bilateral
Mucopurulent discharge and crusted

eyelids
Treatment - broad-spectrum topical antibiotics

Adenoviral Keratoconjunctivitis
1. Pharyngoconjunctival fever
• Adenovirus types 3 and 7
• Typically affects children
• Upper respiratory tract infection
• Keratitis in 30% - usually mild
2. Epidemic keratoconjunctivitis
• Adenovirus types 8 and 19
• Very contageous
• No systemic symptoms
• Keratitis in 80% of cases - may be
severe
Signs of conjunctivitis
Highly contagious
Usually bilateral
Complaints:
Foreing body sensation, acute
watery
discharge and follicles (usually
abs. of purulent secretion)
Preauricular lymphadenopathy
Treatment - symptomatic
ALLERGIC CONJUNCTIVITIS
Vernal keratoconjunctivitis
Vernal keratoconjunctivitis
• Most commonly affects males
•
(children and young adults)
• Usually occurs in the spring
• Bilateral Recurent
Frequently associated
with atopy: asthma, Types Palbebral
hay fever and Limbal
dermatitis Mixed
Symptoms: photophobia and intens

itching, mucoid discharge
Treatment
 Topical: steroid; nonsteroidal
medication
 Mast cell stabilizer (cromolin
sodium) etc.
 General medication: antihistamines
Type of conjunctivitis ?
1 and 2
1? 2?
Bibliography
1. C. Nicula ; Ophthalmology University of Medicine and Pharmacy "Iuliu

Hatieganu, 2011
2. Jack J. Kansky; Brad Bowling Clinical ophthalmology. A systemic
approach.; 2011.
3. Bruce James, Chris Chew, Anthony Bron Ophthalmology Blackwell
Publishing; 2007.
4. American Academy of Ophthalmology. Basic and Clinical Science
Course. Lacrimal system disorders; 2017-2018.
5. www.freebookcentre.net/medical_text_books_journals/ophthalmolog
y_ebooks_online_texts_download_1.html

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Catedra Oftalmologie

EYE ADNEXA DISEASES

• to provide students with a thorough grounding in

Acute dacryoadenitis is most commonly due to

Chronic dacryoadenitis is usually due to

• Swelling of the outer portion of the upper lid (the

• Epiphora (Tearing) • acute dacryocystitis

• If no improvement - probe at 12-18 months

• Affects lower lid of elderly patients

• May cause chronic conjunctival inflammation

Unilateral ectropion due to Bilateral ectropion due to severe

1.Acquired ptosis is most commonly caused by aponeurotic ptosis

Non-surgical modalities: glasses or special Scleral

Ptosis that is caused by a disease will improve if

• Chronic irritation worse in mornings • Hyperaemia of anterior lid margin

1. Lid hygiene - with 25% baby shampoo

2. Tear substitutes - for associated tear film instability

3. Systemic tetracyclines - for severe posterior blepharitis

4. Warm compresses - to melt solidified sebum

• Staph. abscess of meibomian • Staph. abscess of lash follicle and

Until your sty goes away on its own, try to:

1. Basal cell carcinoma

2. Usually affects the elderly

3. Slow-growing, locally invasive

4. Does not metastasize

5. 90% occur on head and neck

6. Of these 10% involve eyelids

7. Accounts for 90% of eyelid malignancies

Mucopurulent discharge and crusted

Treatment - broad-spectrum topical antibiotics

Symptoms: photophobia and intens

1. C. Nicula ; Ophthalmology University of Medicine and Pharmacy "Iuliu

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