Oculoplastics and Lacrimal Disorders

EpiphoraBlepharitis

Nasolacrimal duct occlusionEyelid malposition

EctropionEntropion

Eyelid tumours Basal cell carcinoma

Squamous cell carcinoma

Epiphora: Anatomy and Physiology

Blepharitis• Blepharitis involving

predominantly the skin and lashes tends to be staphylococcal and (or) seborrheic in nature, whereas involvement of the meibomian glands may be either seborrheic, obstructive, or a combination (mixed).

• The pathophysiology of blepharitis is a complex interaction of various factors, including abnormal lid-margin secretions, microbial organisms, and abnormalities of the tear film.

Management• The mainstay of treatment is an

eyelid hygiene regimen, which needs to be continued long term– Warmth– Massage– Cleansing

• Topical antibiotics are used to reduce the bacterial load.

• Topical corticosteroids and oral antibiotic preparations may be helpful in patients with marked inflammation with specialist monitoring

OMG- I’ve been diagnosed with

blepharitis

Nasolacrimal duct obstruction• Occurs in approximately 5-6% of

infants. • A sticky, watery eye with positive

regurgitation on pressure over the lacrimal sac confirms the diagnosis.

• As there is a high spontaneous rate of remission (60-90%) in the first year of life, probing should be delayed until 10-12 months of age.

• Parents can be instructed to undertake lacrimal sac massage during the intervening period. Earlier probing is only justified if their is severe recurrent infection.

Recanalisation: Probing to DCR• Probing of the naso-lacrimal

duct is the first line of treatments

• With persistent epiphora and recurrent infection, it may be necessary to perform a dacryocystorhinostomy (DCR).

• Bicanalicular silicone incubation with Crawford, Juneman or Ritleng tubes can be carried out

Eyelid malposition

Tumours: Benign

Steps to differentiating benign from malignant

Basal Cell Skin Cancer

Small raised bump Smooth, pearly

appearance. Central necrotic area Telangectasia Sometimes like a scar that is

flat and firm to the touch.

Squamous Cell Carcinoma Sun exposed areas of skin

such as the ears, lower lip, and the back of the hands

Skin that have been burned or exposed to chemicals or radiation

Often appears as a firm red bump, may feel scaly or bleed or develop a crust

Sebaceous carcinomaChronic blepharitisRecurrent chalazion

MelanomaChange

ContourColourSize