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Toronto Notes 2019 Lids and Lashes Ophthalmology OP11 Dacryocystitis
• acuteorchronicinfectionofthelacrimalsac
• mostcommonlyduetoobstructionofthenasolacrimalduct
• commonlyassociatedwithS.aureus,S.pneumoniae,Pseudomonasspecies
Clinical Features
• pain,swelling,rednessoverlacrimalsacatmedialcanthus
• epiphora,crusting,±fever
• digitalpressureonthelacrimalsacmayextrudepusthroughthepunctum • inthechronicform,epiphoramaybetheonlysymptom
Treatment
• warmcompresses,nasaldecongestants,systemicandtopicalantibiotics • ifchronic,obtainculturesbyaspiration
• onceinfectionresolves,considerdacryocystorhinostomy
Dacryoadenitis
• inflammationofthelacrimalgland(outerthirdofuppereyelid)
• acutecauses:S.aureus,mumps,EBV,herpeszoster,N.gonorrhoeae
• chroniccauses(oftenbilateral):lymphoma,leukemia,sarcoidosis,tuberculosis,thyroidophthalmopathy
Clinical Features
• pain,swelling,tearing,discharge,rednessoftheouterregionoftheuppereyelid
• chronicformismorecommonandmaypresentaspainlessenlargementofthelacrimalgland
Treatment
• supportive:warmcompresses,oralNSAIDs • systemicantibioticsifbacterialcause
• ifchronic,treatunderlyingdisorder
Lids and Lashes
Lid Swelling
Etiology
• commonlyduetoallergy,withshrivelingofskinbetweenepisodes • dependentedemaonawakening(e.g.CHF,renalorhepaticfailure) • orbitalvenouscongestionduetomassorcavernoussinusfistula
• dermatochalasis(looseskinduetoagingorheredity)
• lidcellulitis,thyroiddisease(e.g.myxedema),trauma,andchemosis
Ptosis
• droopingofuppereyelid
Etiology
• aponeurotic:disinsertionordehiscenceoflevatoraponeurosis(mostcommon)
■ associated with advancing age, trauma, surgery, pregnancy, chronic lid swelling
• mechanical
■ incomplete opening of eyelid due to mass or scarring
• neuromuscular
■ myasthenia gravis (neuromuscular palsy), myotonic dystrophy
■ CNIIIpalsy
■ Horner’s syndrome (see Constricted Pupil, Horner’s Syndrome, OP30)
• congenital
• pseudoptosis(e.g.dermatochalasis,enophthalmos,contralateralexophthalmos) • drugs(e.g.highdoseopioids,heroinabuse,pregabalin)
Treatment
• surgery(e.g.blepharoplasty,levatorresection,Müller’smuscleresection,frontalissling)