Diseases of the Eyelids

Inflammatory Diseases

Diseases of the palpebral skin. Diseases of the palpebral skin practically don't differ from the diseases of the face skin. Palpe­bral oedema that is frequently observed is the result of their ana­tomical structure — friable junction of the skin with a muscle. Ec­zema, lupus, vaccine pustules are observed on the palpebral skin. Treatment is given by a dermatologist.

Palpebral abscess. It develops more often after trauma compli­cated by infection. The eyelid swells up, skin becomes tense, pain­less, and then fluctuation develops. After a cut or arbitrary open­ing of abcess these signs calm down quickly.

Blepharochalasis. In this process the drooping skin becomes so thin that it forms numerous small folds; as a result of dilation of _the superficial veins the skin becomes red. Blepharochalasis devel­ops after frequent palpebral oedema, for example, after recurrent angioneurotic oedema (Quincke's disease). Treatment is surgical.

Angioneurotic palpebral oedema (Quincke's oedema) manifests itself by limited oedema in the palpebral tissue. Oedema develops and disappears very quickly. The disease depends on disturbance of the vessel innervation, autoimmune disturbances. Treatment should be directed at the improvement of activity of the central and vegetative nervous system, decrease of permeability of ves­sels and organism's desensitisation.

Blefaritis is the inflammatory disease of the palperbral edge.

Etiology. The uncorrected anomalies of refraction especially hyperopia and astigmatism are the main reasons of this disease. Avitaminoses, diseases of teeth, nasopharynx, digestive tract (gas­tritis, colitis, gastric ulcer) also can entail inflammation of the palpebral edge. Unhygienic conditions, working in the dusty apart­ment, in the wind can favour the development of blefaritis. There are following blefaritis forms: simple, ulcerative, squamous, mei­bomian, angular and demodicous.

Simple and squamous blepharitis. Palpebral edges are slightly hyperemic, thickened. The tender greyish squamae are visible near the base of eyelashes. The disease has a chronic course and quite often leads to shedding of cilia. Slight pruritus, increased sensitivi­ty of the eyes, which water easily, especially during evening work, are registered. The eyes are sensitive to light, dust, smoke and get tired quickly. Blepharitis is usually combined with chronic inflam­mation of the mucosa manifesting as slight hyperemia and sensa­tion of "sand" in the eyes.

Ulcerative blepharitis. The eyelids are oedematous, their edges are very thickened and covered with yellow crusts, under which there is pus. After removal of the crusts weeping, hemorrhagic ul­cers remain on their places. In a prolonged course the process dif­fuses on the hair follicles of the eyelashes. If treatment is insuffi­cient or is not carried out ulcerative blepharitis can lead to incom­plete closing of the eyelids, their shortening up to their loss (ma-darosis). There may be wrong growth of the eyelashes (trichiasis).

The course is chronic. When treatment is insufficient, ulcerative blefaritis can result in shortening of the lids, smoothing of edges and ectropion.

Angular blefaritis is characterized by considerable hyperemia of the palpebral skin, mainly in the corners of palpebral fissure, appearence of fissures, ulcers, wetting, great amount of mucous secretion and itch.

Meibomian blepharitis. Palpebral inflammation is quite often supported by the disease of the meibomian glands, in which great amount of liquid is accumulated. In meibomian blepharitis the palpe­bral edges are red, thickened; there is a foamy secretion in the eye angle (secretion of the meibomian glands is beaten up into foam by intensified winking). When pressing the palpebral cartilage, the yellow liquid secretion is excreted from the meibomian glands.

In demodectic blepharitis the patients' complaints are the same as in other forms of blepharitis. Objective examination reveals the same picture as in squamous blepharitis. Thinning, shortening and intense falling out of eyelashes are frequently observed. To detect the tick Demodex microscopic investigation is made under the low (7x10) and then by high (7x40) magnification of the eyelid epithe­lium, the secretion of the meibomian glands.

Treatment of blepharitis is etiological, general and local. Local treatment is made as follows. Refraction anomalies are corrected (if they are). The eyelid edges are treated with antiseptic solutions (furacillin solution 1:5000, etc), massage of the eyelids with a glass stick, treatment of the eyelid edges with mixture of alcohol and ether or 1% solution of brilliant green. 30% sodium sulfacyl is in­stilled or 0.25% zinc sulfate in angular blepharitis 5-6 times a day. The eyelid edges are smeared with antibiotic ointment (1% tetra­cycline or erythromycin ointment).

In ulcerative blepharitis the scales are removed together with the eyelashes (depilation), and in torpid course of the disease au-tohemovitamin therapy is given.

Surgical intervention includes separation of the eyelids by the eyelash edge, treatment with 1% solution of brilliant green, dia-thermocoagulation of the meibomian glands. The course of treat­ment has to be repeated periodically.

In demodectic blepharitis it is used zinc-ichtiol or butadion oint­ment, solution of amitrazin on the eyelid edges.

Hordeolum (sty).The hordeolum is an acute purulent inflamma­tion of the hair follicle or sebaceous gland near the root of the eye­lash. A painful swelling is formed on the limited space of the palpe­bral edge; it is frequently accompanied by palpebral oedema, and sometimes by oedema of the eyeball mucosa (chemosis). 3-4 days later the yellowish point (a pustule, which bursts out soon) appears ₀n the external palpebral rib, near the root of the eyelash.

Sometimes the hordeola appear one after another. It is caused by a decrease of stability of the organism. In these cases the horde­ola are combined with the general furunculosis. Disturbance of the physiological activity of the gastrointestinal tract is very impor­tant.

Treatment: application of desensitizing drops (decametoxin, nor-_max, sulfacetamide), treatment of the hordeolum head by 1% solu­tion of brilliant green, 70% alcohol, use of 1% tetracycline ointment, dry warmth, UHF. Bandage, compress are contraindicated. Squeez­ing out is contraindicated due to a possibility of diffusion of the in­fection into the orbit and cranial cavity (orbital phlegmon, empye­ma of the cerebral sinuses, thrombosis of the cavernous sinus).

Meibomitis is an acute purulent inflammation of the meibomian gland, it gives the same clinical picture as the hordeolum. The dif­ference consists in more distant localization of the inflammatory process from the anterior palpebral edge; when the focus of sup­puration is opened not near the external palpebral rib, but on the internal palpebral surface, from the conjunctiva side.

Treatment is the same as in the hordeolum.

Chalazion. Chalazion is a limited tumor formed in the palpebral cartilage. It usually develops without any visible inflammatory signs and painless; it often develops after meibomitis. Fast increasing chalazion becomes visible from the skin side. The palpebral skin is mobile over the tumor. Chalazion is translucent with greyish col­our from the conjunctiva side. Sometimes chalazion is opened on the conjunctival surface and the granular tissue develops around it.

Treatment. Small chalazion resolves after the injection of dexa-sone, sometimes UHF. If the tumour is growing in size, it is neces­sary to extract chalazion in capsule through the incision from the conjunctival side.

Date: 2014-12-21; view: 1508