Eyelid disorders

• Epidermis


  • Keratin (horny) layer is very thin and consists of flat cells devoid of nuclei
  • Granular cell layer consists of one or two layers of diamond-shaped or flattened cells containing kerato hyaline granules
  • Stratum spinosum layer is approximately five cells in thickness. The cells are polygonal and have abundant eosinophilic cytoplasm
  • Basal cell layer comprises a single row of columnar shaped cells that give rise to more superficial cells
• Dermis


  • Sebaceous glands are located in the caruncle and within eyebrow hairs
  • Meibomian glands are modified sebaceous glands located in the tarsal plates. They empty through a single row of about 30 openings on each lid
  • Glands of Zeis are modified sebaceous glands that are associated with lash follicles
  • Glands of Moll are modified apocrine sweat glands which open either into a lash follicle
  • Eccrine sweat glands are distributed throughout the eyelid skin and are not confined to the lid margin, unlike glands of Moll
• Terminology


  • Macule
  • Papule
  • Vesicle
  • Pustule
  • Crust
  • Cyst
  • Plaque
  • Scale
  • Papilloma
  • Ulcer
• Terminology


  • Hyperkeratosis
  • Acanthosis
  • Dysplasia
  • Dyskeratosis
  • Parakeratosis
  • Carcinoma in situ
• General Considerations


  • Classification
  • Diagnosis
  • Treatment Options
• Chalazion


  Gradually enlarging painless nodule. Very occasionally a large upper lid chalazion may press on the cornea, induce astigmatism and cause blurred vision
• Other Cysts


  • Epidermal inclusion
  • Epidermoid
  • Dermoid
  • Sebaceous cysts
  • Cysts of Zeis
  • Cysts of Moll
  • Milia
  • Comedones
• Squamous cell papilloma


  • Finger-like projections of fibrovascular connective tissue covered by irregular acanthotic and hyperkeratotic squamous epithelium
• Basal Cell papilloma


  • Seborrhoeic keratosis, seborrhoeic wart, senile verruca. Common, slow-growing condition found on the face, trunk and extremities of elderly individuals
• Actinic Keratosis


  • Solar, senile keratosis. Common slow-growing lesion that rarely develops on the eyelids
• Freckle


  • Brown macule due to increased melanin in the epidermal basal layer, generally in sunlight-exposed areas
• Congenital melanocytic nevus


  • Uncommon and histologically resemble their acquired counterparts
• Acquired Melanocytic nevus


  • Classification, clinical appearance and potential for malignant transformation of naevi are determined by their histological location within the skin
• Capillary hemangioma


  • Strawberry naevus, although rare, is one of the most common tumours of infancy and presents shortly after birth
• Port-wine stain


  • Naevus flammeus, cavernous haemangioma. Rare congenital, subcutaneous lesion consisting of large ectatic vessels of varying calibre
• Xanthelasma


  • Common, frequently bilateral condition which is usually found in middle-aged and elderly individuals
• Keratoacanthoma


  • Rare tumor that usually occurs in fair-skinned individuals with a history of chronic sun exposure
• Sebaceous gland carcinoma


  • Very rare slowly growing tumor which most frequently affects the elderly, with a predisposition for females
• Merkel cell carcinoma


  • Fast-growing tumor which typically affects the elderly
• Kaposi sarcoma


  • Vascular tumor which typically affects patients with the acquired immune deficiency syndrome (AIDS)
• Trichiasis


  Characterized by posterior misdirection of lashes arising from normal sites of origin
• Congenital distichiasis


  Partial or complete second row of lashes emerging at or slightly behind the meibomian gland orifices
• Acquired distichiasis


  Metaplasia and dedifferentiation of the meibomian glands to become hair follicles
• Trichomegaly


  Excessive eyelash growth
• Madarosis


  Loss or decrease of eyelash/es
• Poliosis


  Whitening of eyelash/es
• Acute allergic edema


  Usually caused by pollen or by insect bites
• Contact dermatitis


  Inflammatory response that usually follows exposure to a medication or preservative, cosmetics or metals
• Atopic dermatitis


  Very common idiopathic condition, typically associated with asthma and hay fever
• External hordeolum


  Acute staphylococcal abscess of a lash follicle and its associated gland of Zeis
• Impetigo


  Uncommon superficial skin infection caused by S. aureus or S. pyogenes which most frequently affects children
• Erysipelas


  Uncommon, acute subcutaneous spreading cellulitis, usually caused by S. pyogenes through a site of minor skin trauma
• Molluscum contagiosum


  Skin infection caused by a human specific double-stranded DNA poxvirus which typically affects otherwise healthy children, with a peak incidence between 2 and 4 years
• Herpes zoster ophthalmicus


  Common, unilateral infection caused by varicella-zoster virus. It typically affects the elderly but may occur at an earlier age
• Herpes simplex


  Primary infection or rarely reactivation of herpes simplex virus previously dormant in the trigeminal ganglion
• Chronic anterior blepharitis


  Affects the area surrounding the bases of the eyelashes and may be staphylococcal or seborrhoeic
• Chronic posterior blepharitis


  Caused by meibomian gland dysfunction and alterations in meibomian gland secretions
• Phthiriasis palpebrarum


  Crab louse Phthirus pubis is adapted to living in pubic hair. An infestation of lashes which typically affects children living in poor hygienic conditions
• Angular blepharitis


  Infection usually caused by Moraxella lacunata or S. aureus although other bacteria, and rarely herpes simplex, have also been implicated. Signs: Often unilateral red, scaly, macerated and fissured skin at the lateral and medial canthus. Associated papillary and follicular conjunctivitis may occur. Treatment involves topical chloramphenicol, bacitracin or erythromycin
• Ptosis


  Abnormally low position of the upper lid which may be congenital or acquired