Page 902 - TNFlipTest

OP12 Ophthalmology
Lids and Lashes Toronto Notes 2019
Testing for Entropion
Forced lid closure: Ask patient to tighten lid then open. In entropion, lid rolls inwards
Trichiasis
Definition
• eyelashesturnedinwards
Etiology
• mayresultfromentropion,involutionalagechange,chronicinflammatoryliddiseases(e.g.blepharitis), trauma, burns
Clinical Features
• patientcomplainsofredeye,foreignbodysensation,significantdiscomfort,tearing • mayresultincornealulcerationandscarring
Treatment
• topicallubrication,repeateyelashepilation,electrolysis,andcryotherapy
Entropion
Definition
• lidmarginturnsintowardsglobecausingtearing,foreignbodysensation,andredeye • mostcommonlyaffectslowerlid
• maycausecornealabrasionswithsecondarycornealscarring
Etiology
• involutional(aging)
• cicatricial(herpeszoster,surgery,trauma,burns) • orbicularisoculimusclespasm
• congenital
Treatment
• lubricants,evertlidwithtape,andsurgery
Ectropion
• lidmarginturnsoutwardfromglobecausingtearingandpossiblyexposurekeratitis
Etiology
• involutional(aging)
• paralytic(CNVIIpalsy)
• cicatricial (burns, trauma, surgery)
• mechanical(lidedema,tumour,herniatedfat) • congenital
Treatment
• topicallubrication,eyelidtapingovernight,andsurgery
Hordeolum (Stye)
• acuteinflammationofeyelidgland:eitherMeibomianglands(internallid),glandsofZeis(modified sweat gland) or Moll (modified sebaceous gland in external lid)
• infectiousagentisusuallyS.aureus
• painful,redswellingoflid
Treatment
• warmcompresses,lidcare,gentlemassage
• topicalantibioticsaretypicallyineffective
• usuallyresolveswithin2wk,butmayrequireincisionanddrainage
Chalazion
• chronicgranulomatousinflammationofMeibomianglandoftenprecededbyaninternalhordeolum • acuteinflammatorysignsareusuallyabsent
• differentialdiagnosis:basalcellcarcinoma,sebaceouscelladenoma,Meibomianglandcarcinoma
Treatment
• warmcompresses
• ifnoimprovementafter1mo,considerincisionandcurettage
• chronicrecurrentlesionmustbebiopsiedtoruleoutmalignancy
Testing for Ectropion
Snapback test: Pull eyelid inferiorly. In ectropion, lid remains away from globe
Hordeolum vs. Chalazion
Hordeolums are due to an infectious etiology, whereas chalazions are granulomatous inflammation