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GalvestonTexas City
League City
Cataract and Premium IOLsBlepharoplastyLid SurgeryBotox and Facial FillersLaser Refractive Surgery
PterygiumDry EyesDiabeticGlaucomaClinical Studies
Irritation, burning, tearing Foreign body sensation Redness Decreased vision Double vision in advanced cases May be asymptomatic
Pterygium Symptoms
Yellow-white flat or slightly raised conjunctival lesion
Usually in the interpalpebral fissure, nasal to the limbus
Not involving the cornea
Pingueculum Signs
Wing-shaped fold of fibrovascular tissue Elevated at the interpalpebral fissure of the
conjunctiva Nasal > temporal to the limbus Can be bilateral, usually asymmetric Extending onto the cornea – loss of corneal
transparency and irregular astigmatism
Pterygium Signs
May be vascularized and injected May be associated with superficial punctate
keratitis or dellen (thinning of the cornea due to uneven tear pooling and drying)
Stocker’s line (iron line) may be seen on the leading edge of the pterygium on the cornea
Other Signs
Conjunctival intraepithelial neoplasia (CIN)◦ Unilateral jelly-like, velvety, leukoplakic (white)
mass◦ Often elevated, vascularized, and not wing-
shaped
Pterygium Differential Diagnosis
Dermoid◦ Congenital white lesion◦ Usually inferotemporal limbus◦ Occasionally associated with deformity of the ear,
preauricular skin tags, and/or vertebral skeletal defects (Goldenhar’s syndrome)
Pterygium Differential Diagnosis
Pannus◦ Blood vessels growing on to the cornea, often
associated with contact lens wear, trachoma, phlyectenular keratitis, atopic disease, blepharitis, ocular rosacea, herpes keratitis, or others
Pterygium Differential Diagnosis
Elastoid degeneration of collagen and the subepithelial fibrovascular tissue
UV sun, dust, wind… repeated exposure Chronic irritation – contact lenses, welding Higher prevalence with proximity to the
equator
Pterygium Pathogenesis
Conservative therapy, unless◦ Reduce vision due to induced astigmatism or
encroachment onto the visual axis◦ Cosmetic◦ Marked discomfort and irritation, unrelieved by
conservative treatment◦ Restricted ocular motility◦ Progressive growth toward visual axis
Pterygium Treatment
Protect eye from sun – wear sunglasses Mild - topical lubricants Moderate - topical
antihistamine/vasoconstrictor Mod. to severe - topical corticosteroid
Pterygium Treatment - Conservative
Recurrence rate is very high 10% - 90% No single approach is universally successful Recurrence rate is reduced with grafting
approach
Pterygium Treatment - Surgery
Excise pterygium – head and body Clean conjunctiva to bare sclera Avoid damage of underlying rectus muscle Polish with diamond burr Mitomycin C application – antifibroblast Harvest autograft – limbus to limbus Tisseel fibrin glue
Pterygium Treatment – Surgery
Abnormal eversion or turning out of the lid margin away from the globe.
Usually involves lower lids Usually has a horizontal lid laxity Co-morbidity: associated with
corneal/conjunctival exposure
ECTROPION
Red and irritated eye with tearing. Pain, gritty feeling, crusting of lids Constantly wiping their eyes, exacerbating
the lid laxity. History of chronic eye drop use, especially
in glaucoma pts. History of facial or eye
trauma/cancer/surgery. Facial skin pathology
Ectropion symptoms
Congenital ◦ Rare◦ May be associated with other orbital
abnormalities Blepharophimosis Microphthalmos Buphthalmos Down syndrome
Ectropion Etiology
Scarring of anterior lamella ◦ Facial burns◦ Trauma◦ Chronic dermatitis◦ Chronic use of eye drops - glaucoma◦ Excessive lower lid blepharoplasty
Ectropion - Cicatricial
Lubrication Wipe only superiorly and nasally to avoid
conjunctival irritation Antibiotic ointment, especially at night
Ectropion -Treatment - Medical
Lateral tarsal strip procedure – for horizontal lid laxity/involutional ectropion
Medial conjunctival spindle procedure – for mild medial ectropion with punctum ectropion
Anterior lamella graft may be necessary in cicatricial ectropion
Ectropion -Treatment – Surgical
Conjunctival and corneal exposure – keratinization and perforation
Retrobulbar hemorrhage, hematoma, infection, wound dehiscence, poor positioning of tarsal strip, and rounded lateral canthus
Ectropion - Complications
Horizontal lower lid laxity of medial and /or lateral canthal tendons
Snap test Tight squeeze test
Entropion - Involutional
Scarring of palpebral conjunctiva – trauma, chemical burns, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, infections, or topical medication
Snap test is difficult
Entropion - Cicatricial
Epiblepharon – pretarsal orbicularis muscle and skin override the lid margin and push the eyelashes inward.◦ Asymptomatic◦ Common in Asians◦ Spontaneously resolves as face matures
Trichiasis Distichiasis
Entropion Differential Diagnosis
Quickert sutures◦ Temporary fix◦ Good for spastic entropion
Tarsal wedge resection◦ Successful◦ In-office procedure
Horizontal or vertical lid shortening
Entropion Treatment - Surgical
Retrobulbar hemorrhage Wound dehiscence Infection Corneal injury Recurrence Consecutive ectropion
Surgical Complications