SEMINAR ON

EYELIDS : INFECTION , TUMOUR AND

DEFORMITIES
PRESENTED BY
ECHIBENI PATTON
BSC N 3RD YEAR
ROLLNO 7
 CONTENT
Introduction of eyelids
Definition
Epidemiology
Anatomy and physiology of eyelids
Infection of eyelids
~ Blepharitis ( squamous and ulcerative )
~ External hordoleum
~ Chalazion
~ Internal hordoleum
Tumour of eyelids
1. Benign
~ Papilloma
~Angioma
~Naevus
~Xanthelasma/ Xanthoma
2. Malignant
~Rodent ulcer
~Epidermoid carcinoma
~Malignant melanoma
Deformities of eyelids
~Entropion
~Ectropion
~Symblepharon
~Ankyloblepharon
~Lagophthalmos
~Blepharospasm
~Ptosis
Clinical manifestation
Diagnostic evaluation
Complication
Treatment
Nursing management
Nurses’ role
Journal review
Conclusion
Bibliography
 INTRODUCTION
Eyelids serve as an impotant role in
protecting the eye .
They provide a physical barrier to dust
and particles .
The eye is further protected by the
surrounding bony orbit and by fat pads
located below and behind the globe
or , eyeball .
The upper eyelids and lower eyelids
join at the medial and lateral canthi ,
the upper eyelids blinks spontaneously
approximately 15 times a minute .

Blinking distributes tears over the

anterior surface of the eyeball and
helps control the amount of light
entering the visual pathway.
The eyelids open and close through
the action of muscles innervated by
cranial nerve VII , which is the facial
nerve . Muscular action also helps
hold the eyelids against the eyeball .
DEFINITION
Eyelids are the mobile tissue
curtains , that act as shutters
protection of the eye and spread
the tear film over the cornea and
conjunctiva .
EPIDEMIOLOGY
South china
A total of 5146 cases of eyelid lesions
were reviewed from 2000-2018
being classified by histogenesis and
pathologic diagnosis , being
compared with data from previous
literature containing different races .
Benign tumours accounted for
85.08% (4378) of all cases , among
which nevus was the most common
(33.07%) .
Eight of top 10 benign lesions had
higher occurrence in upper eyelids .
America and Europe , is the most
malignant tumour of the eyelid is
basal cell carcinoma , accounting for
80-95% of eyelid malignancies .
In Asia , BCC is less common (11-
65%) while SCC (5-48%) and SGC
(7-56%) occur more frequently in
the west . However , there are no
longer case series of malignant
eyelid tumours from an Asian
Indian Population .
The eye is made up of four layers
1. Cutaneous layer
2. Muscle layer
~ orbicularis oculi muscle
~palpebral muscle
i. palpebral muscles of muller
ii. Levator palpebrae superious
3. Fibrous layer
~ septum orbitale
~ tarsal plates
4. Mucous layer
~ meibomian gland
~ glands of zeis
~ glands of moll
INFECTION OF THE EYELIDS
A.Blepharitis –
It is a subacute or chronic
inflammation of the lid margin . The
lid margin , being the meeting place
of the skin and the conjunctiva ,
tends to share in the affection of
ether .

Cause – positive staphylococcus

 Cont...
Two types :

1. Squamous blepharitis - it is not

essentially an infective condition .
Metabolic causes , hygienic factors ,
eye strain and seborrhoea of the scalp
usually lead to the development of this
condition
Cont...
2.Ulcerative blepharitis – this
condition is due to infection of the lid
margin with coagualase positive
staphylococcus , superimposed on
predisposing conditions . There is
suppurartive inflammation of the
ciliary follicles along with the glands
of zies and moll.
Cont...
B. External hordoleum or Stye
It is a suppurative inflammation of the
follicle of the eyelash including the
gland of zies .

Course : the pus point burst outside

and pain and swelling subsides .
Cont...
C. Chalazion / tarsal cyst / meibomian
cyst
It is a chronic inflammatory granuloma
of the meibamiam cyst .

Pathology
Age incidence : young and young
adults
Cont...
D. Internal hordoleum
It is the suppurative inflammation of a
meibomiam gland due to
staphylococcus . It is also often called
a suppurating chalazion . Sometimes
it may be also due to the secondary
infection of a chalazion .
TUMOUR OF THE EYELIDS
Benign tumour
Malignant tumour
 BENIGN TUMOUR
Papilloma : it is the most common
tumour of the eyelids .
It appear as a warty growth which may
be sessile or pedunculated . There are
papillae on the surface .
Histologically , a papillae consists of a
fibrous tissue core with blood vessels
covered by proliferated epithelium .
The basement membrane of the
epithelium remains same .
Angiona
It may occur as a localized capillary or
cavernous angioma or the lid may
be affected along with the facial
angioma as in sturge – webers’
syndrome .
Naevus
It is a benign pigmented tumour ,
composed of pigment producing cells
, usually affecting the lid margin .
It originates either from sensory nerve
end – organ or from the basal layer
of epidermis .
Xanthelasma –
It is a slightly raised yellow plaque ,
commonly situated in the skin of the
upper and lower lid near the inner
canthus and may be bilateral . These
tumours are more frequent in females
and sometimes are associated with
diabetes and excessive blood
cholesterol.
Neurofibroma –
usually the plexiform type of
neurofibroma affects the lid , mostly
the upper one . The lid becomes
hypertrophied and droops down and
hypertrophied nerves can be felt
through the skin , along with the upper
lid , the temporal side of the face may
also be affected .
MALIGNANT TUMOURS
Rodent ulcer or basal – celled
carcinoma
Epidermoid carcinoma or squamous
celled carcinoma
Malignant melanoma
Basal celled carcinoma
Squamous cell carcinoma
 DEFORMITIES OF EYELIDS
A. Entropion : the lid margin rolls inward .
Causes :
a. Congenital : rare and is usually
associated with microphthalmos and
anopthalmos .
b. Acquired :
i. Spastic entropion
ii . Mechanical entropion
iii. Sensile entropion
iv. Cicatricial entropion
B. Ectropion : the lid margins rolls
outward i.e. Becomes everted , it
may occur in various degrees.
Causes :
a. Spastic ectropion
b. Sensile ectropion
c. Paralytic ectropion
d. Mechanical ectropion
e. Cicatrical ectropion
C. Symblepharon –
The lid becomes adhered to the eyeball ,
due to adhesion between the palpebral
and bulbar conjunctiva .occurs in case
of the lower lid .
2 types :
i. Anterior symblepharon
ii. Posterior symblepharon
D. Amkyloblepharon –
The lid margin adhere together . The
adhesion may be complete or partial
and is usually associated with
symblepharon .

Cause : either congenital or acquired

due to burn .
E. Lagophthalmos : the eyelids cannot
be closed properly when the eyes are
shut .

Cause :
a. Congenital deformity of the lid .
b. Acquired causes
F. Blepharospasm –
The lids are firmly closed , due to
forcible contraction of the orbicularis
muscle . The spasm of the muscle is
involuntary and may last for a few
moments to a few weeks or months .
Causes :
i. Reflex sensory stimulation through
the branches of the trigeminal
nerve commonest .
ii. Excessive stimulation of retina –
exposure to dazzling light .
iii. Stimulation of the facial nerve
iv. Hysteria
G. Ptosis :
There is drooping of the upper lid below
its normal . This condition can be
bilateral or unilateral and partial or
complete .
Causes :
A. Congenital ptosis
B. Acquired ptosis
C. Lack of support of the upper lid
D. Mechanical ptosis
E. Myogenic ptosis
 CLINICAL MANIFESTATION
a. Squamous blepharitis :
~ accumulation of white scales like
dandruff on the lid margin
~ on removing the scales , the lid margin
appears hyperaemic but there is no
ulceration .
~ falling of eyelashes , but they are
replaced quickly without distortion.
~ the lid margin may be thickened .
b. Ulcerative blepharitis
~ yellow crusts are deposited at the roots
of the eyelashes by which the lashes
are glued together .
~ on removing the crusts , small ulcers
appear around the base of the lashes
which bleed freely .
~ falling of the eyelashes , which are
either not replaced or when replaced
become misdirected.
c. External hordoleum or stye
~ swelling , redness and marked oedema
of the affected lid .
~ marked tenderness at the point of
inflammation on the lid margin .
~ chemosis of the bulbar conjunctiva may
occur .
~ finally a white pus point becomes
visible on the lid margin in relation to
the root of a cilia
~enlargement of the corresponding pre
auricular lymph gland .
d. Chalazion
~ small , cystic or hard sweeling of the
size of a pea on the lid , alittle
distance away from the lid margin .
In multiple chalazia , there is more
than one sweeling .
~ the swelling is fixed to the torsus ,
with the skin freely moving over it
and it is not tender .
~ no signs of any inflammation .
Cont...
~ on everything the lid , the tarsal
conjunctiva over the swelling
appears velvety red or purple .
~ the regional glands are not palpable .
e. Internal hordoleum :
The point of maximum tenderness is
away from the lid margin . Other
clinical signs are similiar to those for
external hordoleum , but the pus
points on the tarsal conjunctiva and
not on the root of an eyelash .
f. Ectropion
~ chronic conjunctivitis due to
exposure
~ In long continued cases , the
conjunctiva becomes dry and
thickened .
~ corneal ulcer may develop due to
exposure .
g. Symblepharon
~ prononunced adhesion may cause
diplopia due to the limitation of the
movements of the eyeball . The lids
may not be closed properly and in
that case consequences due to
exposure may occur .
h. Ptosis
~ the margin of the upper lid covers more
of the cornea than normal .
~ palpebral fissure is narrower than
normal.
~ there is no fold , in the skin of the upper
lid .
~ on an attempt to evaluate the upper
lid , there is elevation of the eyebrow
and wrinkling of the skin of the
forehead due to hyperaction of the
frontalis muscle .
DIAGNOSTIC EVALUATION
Ultrasound scans
CT scan
MRI
They show the size , location and
shape of the tumours and also show
the enlarged or affected lymphs
node around the eye .
COMPLICATION
Chalazion
Chronic pink eye
Injury to the cornea
Excess tearing or dry eyes
Eyelashes problem
Eyelid skin problem.
TREATMENT
a. Blepharitis – both types
1. Improvement of general health in
children .
2. Judicious and balanced diet with vitamins
, particularly vitamin A .
3. Removal of septic focus like bad tonsils .
4. Correction of any error of refraction .
5. Treatment of seborrhoea of scalp .
6. Treatment of associated conditions like
chronic conjunctivitis , chronic
dacryocystitis or louse infection.
Local treatment :
1. Removal of scales and crusts from the lid
margin with 3% sodibicarb lotion .
2. Application of broad spectrum antibiotic
ointment to the lid margin like
gentamycine or chloromycetin ointment
3 times a day .
3. After healing of the ulcers ,
hydrocortisone ointment 1% has to be
applied to the lid margin 3 times a day to
remove congestion and any allergic
factor .
b. External hordoleum
~ hot compress 2-3 times a day .
~ gentiayn eye drop 4 times daily .
Genticyn eye oint at bed time .
~ ampicillin 250 mgm . 4 times a day by
mouth for 5 days .
~ when the pus points the pus should be
drained either by pulling out the
affected eyelash or by a tiny horizontal
incision with a knife .
c. Chalazion
~ A course of antibiotic ointment like
chloromycetin oint may be applied to
expect a resolution .
~ bigger chalazia should be incised
vertically through the tarsal
conjunctivia , after application of
local anaesthesia and the granulation
tissue should be scooped out .
d. Internal hordoleum
~ hot compress and board spectrum
antibiotic by mouth as in case of a
stye .
~ incision on the tarsal conjunctiva in a
vertical direction to drain the pus .
e. Entropion
The spastic entropion is cured when
the cause of blepharospasm is
treated . The sensile entropion can
be treated by keeping the lower lid
pulled downwards by a strip of
adhesive plaster .
Cont...
If bandaging is the cause , it should be
discontinued . Sensile entropion
which is not cured by application of
adhesive plaster , should be treated
by plastic operation .
Simplest operation is “skin muscle”
operation .
Here an eliptical area of loose skin and
the underlying orbicularis oculi
muscle are resected .
f. Ectropion
In case of spastic ectropion the cause
of blepharospasm has to be treated .
For other types of ectropion , plastic
operation is needed .
g. Symblepharon
Prevention is most important . A soft
contact lens should be used which
covers the eyeball and prevents the
adhesion . When the condition is
already established , operative
procedure is necessary .
h. Ankyloblepharon
Separation of lid margins by
operation .
i. Lagophthalamus
~ application of a bland ointment or
liquid paraffin during sleep to keep
the cornea moist .
~ operative procedure in the form of
tarsorraphy , by which the palpebral
aperture is narrowed by uniting the
margins of the lids on the lateral
side .
even a central tarsorrpapy may be
done .
NURSING MANAGEMENT
Hot compress
Topical antibiotic eye drops
Oral anti inflammatory drugs
Intra lesional injection of long acting
steriod (triamcinolone)
Incision and currettage
Diathomy
Eye hygiene
Chemotherapy

NURSES ‘ ROLE
Assess the general condition of the
eye of the client .
Identify the cause of the infection
Maintain sterility of the eye
droppers , tubes of medication and
other items . Then reduces the risk of
eye infection .
Use aseptic technique while doing
dressing of surgical site to prevent
infection .
Advice the client not to use dirty
clothes to clean the eye .
Demonstrate the proper
administration of eye drops or
ointment .
 JOURNAL REVIEW
Eye and eyelid infection among females
using kajal and mascara .

Authors : syeda salbia shereen naqvi ,

waqas akaram yasir mehmood, irfan
bashir , novaira saleem .

Year of publication : 2017 ; journal of

contemporary pharmacy , volume 1,
issue 1
OBJECTIVE : The primary aims of
cosmetic surgery is to identify the
prevalence of use of kajal and
mascara in our community , to
highlight the eye and eyelids
infection among females using kajal
and mascara to identify the
prevalence of cosmetic – induced eye
infections .
METHODS : A 30 questionnaire
quantitative and qualitative (mixed
approach ) method is used . Data of 100
participants is used to describe the
variables . Each participants ‘ score will
be summed and calculate the possible
points for each answer determing the
prevalence of eye infection in females .
The frequency of eye cosmetics use is
examined and correlated with % age of
cosmetics induced eye and eyelids
infection
RESULTS : 28% females have developed
eyelid infection after using mascara and
kajal . 87% females suffered from cosmetic
eye infection for 1 day b, 10% for 3 days
and 3% for 5 days . 80% females view in
cosmetics infection occurs due to others
eye cosmetic use , 13% due to the use of
low branded eye cosmetic & 7% due to use
of contaminated cosmetic . 40% females
treated eye infection with home remedies ,
28% females visit the ophthalmologist and
32% shows carelessness .
CONCLUSION
The incidence of cosmetic eye
infection will be reduced by use of
branded eye cosmetic , removing eye
makeup carefully at the end of the
day , splashing of water and cleaning
of eye regularly . Allergic
conjunctivitis . Iritis / eye
inflammation , eye dermatitis and
blepharitis are commonly the
cosmetic induced eye infection.
 Recap ..
List the types of blepharitis ?
Name the benign tumours ?
Name one deformities of the eyelids ?
 CONCLUSION
Inflammation and infections of eye
structures are common . Eye infection is
a leading cause of blindness worldwide .
Proper diagnosis and categerization can
lead to effective treatment .
So , particular attention must be paid to
visual clues , exposures and other
historical factors , in the work up of
patients with eyelid edema .
 BIBLIOGRAPHY
Phillips , long woods (2019) , medical
surgical nursing , 7th edition , published
in new delhi , publishjed by B. I .
Publication pvt ltd , pageno.
281,282,294,302.
Lewis (2011) medical surgical nursing ,
india , published by elsevier pvt ltd ,
pageno 395,401,403,417,418.
Brunners & suddarth , textbook of
medical surgical nursing , 12th edition ,
new delhi , published by wolters
kluwer , lotus , pvt ltd , pageno 1791
BM. Chatterjees’ (1997), handbook of
ophthalmology , 6th edition revised &
enlarged , new delhi , published by
satish kumar jain and produced by VK
jain for CBS publishers & distributors
pvt ltd , pageno. 253-271
Syeda saliba sherren naqvi , waqas
akaram , yasir mahmood, irfan bashir ,
novaira saleem (2017) , eye and eyelid
infection among females using kajal and
mascara , volume 1 , issue 1 , journal of
contemporary pharmacy .