Lids and lashes

• Lids and lashes
• Adapted from presentation by N Naicker
• Superficial Corneal Disease


  • Corneal abrasion
  • SPK
  • Punctate Epithelial Keratitis
  • Punctate Epithelial Erosions
  • Neovascularization (superficial)
  • Pannus
• Corneal abrasion


  Breach of the epithelium
• Corneal abrasion


  • Stains well with fluorescein
  • If located over the pupillary area, vision may be decreased
  • Usually caused by the presence of a foreign body
• Treatment for corneal abrasion


  1. Removal of the foreign body

  2. Lubrication

  3. Bandage contact lens if required
• SPK (superficial punctate keratitis)

  Non-specific

  Any corneal epithelial disturbance in a dot-like formation
• Punctate epithelial keratitis


  • Opalescent in color

  Epithelial cells are swollen

  Filled with infiltrates (WBC)

  Can be seen without staining using slitlamp
• Punctate Epithelial Erosions


  Tiny epithelial defects

  Indicate underlying corneal compromise
• Causes of Punctate Epithelial Erosions

  • Inferior: Lagophthalmos, aberrant eyelashes and entropion
• Superficial neovascularization


  New blood vessel formation

  Due to chronic ocular surface irritation
• Pannus


  Superficial neovascularisation with associated degenerative subepithelial change

  Chronic progressive corneal disorder without a cure

  Usually results from chronic inflammation or chronic irritation
• Disorders of lid margins and lashes

  • Trichiasis
  • Madarosis
  • Poliosis
  • Distichiasis
  • Entropion
  • Ectropion
  • Ptosis
  • Blepharochalasis
  • Dermatochalasis
• Trichiasis


  Misdirection of lower and upper lashes
• Trichiasis


  • Corneal abrasion (scratch)

  Infection

  Ulceration

  Punctate keratopathy

  Scarring
• Management of Trichiasis


  Manual epilation

  Symptomatic treatment with lubricants

  Bandage contact lens

  Referral for cryoablation, electrolysis, argon laser or surgical excision
• Madarosis


  Loss of eyelid and eyebrow hair
• Poliosis


  Depigmentation of lashes loss of melanin in the hair shaft
• Associations of Poliosis


  • Blepharitis, sarcoidosis, herpes zoster, Vogt Koyanagi Harada Syndrome (VKH), Vitiligo
• Distichiasis


  Extra row of lashes from meibomian gland orifices

  Normal lashes that grow more anterior
• Characteristics of Distichiasis


  • Shorter

  Finer

  Misdirected
• Management of Distichiasis


  Similar to that of Trichiasis

  Symptomatic relief (temporary)

  Refer for long term treatment
• Ectropion


  Eversion of the lower lid - not appositional
• Signs of Ectropion


  • Hyperemia of the palpebral and bulbar conjunctiva

  Reflex tearing secondary to exposure of structures

  Epiphora due to lower lid punctum apposition

  Lagophthalmos
• Symptomatic Treatment of Ectropion (Optometrist)

  Moisture shields

  Pressure patch (non infectious)

  Ointment lubricant

  Tape adhesive/plaster
• Definitive Treatment of Ectropion (Ophthalmologist)

  Surgical repair
• Types of Ectropion


  • Involutional ectropion

  Cicatricial ectropion

  Paralytic ectropion

  Mechanical ectropion
• Entropion


  Inversion of lid towards the globe
• Signs of Entropion


  • Trichiasis

  Mucous discharge -eyelid crusting

  Bulbar hyperaemia

  Lagophthalmos
• Symptomatic Treatment of Entropion

  Moisture care

  Severe cases to prevent damage to cornea - bandage C/L or patch the eye

  Adhesive tape
• Definitive Treatment of Entropion

  Surgical repair
• Types of Entropion


  • Cicatricial Entropion

  Involuntional Entropion
• Ptosis


  Unilateral/bilateral drooping of upper eyelid
• Types of Ptosis


  • Aponeurotic

  Neurogenic

  Myogenic

  Cicatricial

  Mechanical

  Traumatic
• Examination of Ptosis


  • Patient's head posture (affecting functionality)

  Herring's Phenomenon

  Superior corneal pannus

  Slit lamp/IOP measurement challenges

  Myasthenia Gravis: ice pack test
• Management of Ptosis


  Recent onset non traumatic requires urgent referral for further investigation
• Blepharochalis


  Recurrent eye lid edema

  Intermittently stretching of skin
• Dermatochalasis


  Loose skin loss of elasticity in elderly individuals
• Management of Dermatochalasis


  Surgical intervention if affects vision and superior visual field
• Inflammatory conditions of the external adnexa

  • Blepharitis

  Anterior Blepharitis

  Posterior Blepharitis