Blepharitis Dacryocystitis Stye (Hordeolum) & Chalazion

Dacryocystitis
An infection and inflammation of the nasolacrimal sac Caused by nasolacrimal duct (tears) obstruction Acute dacryocystitis Severe inflammation Painful, redness, and swelling over the lacrimal sac region Tearing Digital pressure over the lacrimal sac severe tenderness and extrudion of pus through the punctum Staphylococcus aureus (MC), Beta-hemolytic streptococcus

Chronic dacryocystitis Less severe inflammation, tearing may be the only symptom Streptococcus pneumoniae Complication : if not good or no treatment
Mucocele Corneal ulcer : MC complication, frequently associated with S. pneumoniae Orbital cellutis

Dacryocystitis
Management Acute dacryocystitis
In severe inflammation stage : Do not irrigate or probing ! Warm compression Oral or IV antibiotics : depend on severity Incision and drainage if there is pyocele or mucocele If recurent Dacryocystorhinostomy (DCR) when inflammation is resolved

Chronic dacryocystitis
Irrigation or probing for diagnosis, find site obtruction and plan for surgery DCR for relief of nasolacrimal duct obstruction If occur frequently and lacrimal sac is in not good condition Dacryocystectomy

Blepharitis
Chronic inflammation of eyelid usually bilateral Associated with other skin disease particulary acne rosaccea 2 main type : Staphylococcal/ Seborrheic blepharitis But mixed form is more common Itching, irritation and redness of the eyelids Crusting, scale at the lid margins and eyelash this is generally worse on waking Seborrhaic greasy scale Staph. dry scale

Blepharitis
Management The single most important treatment principle is a daily routine of lid margin hygiene clean lid margin lid scrub mechanical removal of lid margin debris Topical anti-staphylococcal antibiotic to reduction of lid margin bacteria Avoid the use of eye make-up until symptoms subside

Hordeolum
An acute focal infection (usually staphylococcal) Associated with blepharitis and acne rosacea External hordeolum or stye Glands of Zeis, glands of Moll Shallow small painful warm red bumps on eyelid, eyelid swelling and tenderness Internal hordeolum Meibomian glands More eyelid swelling, deeper and larger red bump on inner eyelid and prior eyelid pain On the outside only generalized redness and swelling visible The eyelid lump may also induce corneal astigmatism and cause blurring of vision.

Hordeolum
Management Warm compression for 10-15 min > bid Topical antibiotic q 2-3 hr, oral if progress to severe Incision and curettage surgical therapy if abcess formation or persists for 3-4 weeks
Internal hordeolum
transconjunctival approach - vertical incision

External hordeolum
trans cutaneous approach - horizontal incision

Chalazion
Chronic granulomatous inflammation of the meibomian gland, also known as a meibomian gland lipogranuloma Usually on the upper eyelid Associated with history of chronic blepharitis and prior excision of chalazia If recurrent biopsy for rule out meibomain gland carcinoma Firm, painless and nontender Large chalazion Pressure on the orbit abnormal curve of cornea Astigmata

Chalazion
Management Incision and curettage Antibiotics If recurrent biopsy for rule out meibomain gland carcinoma (It is rare that a chalazion will recur.)

Corneal abrasion & Foreign body

Corneal abrasion & foreign body

A scraping away or denuding of the corneal surface surface epithelium sloughed off.
History Accident trauma Foreign body Prolong contact lens use Symptoms Usually monocular Irritation Eye pain Tearing foreign-body sensation Photophobia with blepharospasm Normal eye sight or blurred vision (central cornea decreased VA)

Corneal abrasion & foreign body

Signs Diffuse conjunctival injection Conjuctival hyperemia Swollen eyelids Diagnosis Direct inspect find FB Slit lamp FB and epithelial defect Fluorescien dye Abrasion will appear green

Corneal abrasion & foreign body

Management Remove foreign body Topical anesthetic Remove corneal FB by cotton buds or 30-gauge needle Short acting cycloplegic Antibiotic ointment Pressure patch 24 hr to promote wound healing (if no hx of CL) Analgesic Follow up 24 hr