Eyelid conditions

Previous ocular or eyelid surgery Loose sutures Previous corneal surgery Ocular Surface Disease Misdirection of eyelashes Abnormal lid anatomy or function Tear film deficiencies Ocular infection such as conjunctivitis or blepharitis Systemic Conditions Diabetes mellitus... 

Signs and Symptoms Has a highly variable clinical picture. It has acute and chronic forms, and virulence varies from severe, with high mortality, to mild or even subclinical. The severe acute form is characterized by fever, lack of appetite, depression, constipation followed by diarrhea. May progress to incoordination or convulsions. Conjunctivitis is frequent and is manifested by encrustation of the eyelids and the presence of dirty streaks below the eyes caused by the accumulation of dust and feed particles. In the chronic form of the disease, pigs often survive more than 30 days. After an initial acute febrile phase, pigs may show apparent recovery but then relapse, with anorexia, depression, fever, and progressive loss of condition. 

Blepharitis is a topical inflammation of the eyelid margins that should be treated using topical antibacterial agents. Gentamicin eye ointment is preferred to the fusidic acid drops since the ointment is a better formulation to be used where the condition involves the eyelid margins. Chloramphenicol eye drops is the third option since it is an antibiotic with a wider spectrum of activity. A combination of corticosteroid and antibiotic is not recommended because of the side-effects associated with the steroid. The use of oral tablets is not usually recommended since blepharitis can easily be managed with topical drops. The use of dexamethasone eye drops, monotherapy steroid, could clear the inflammation but mask persistence of infection. 

Neuroleptics may also cause blepharospasm, which is a forcible closure of the eyelids and when severe can interfere with activities such as driving this condition can also be socially disabling and disfiguring. In addition, there are a few cases indistinguishable from idiopathic Meighs syndrome, which presents with blepharospasm and oromandibular dystonia (470). Of interest, clozapine has been reported to be beneficial for these symptoms. 

In 1991 the FDA approved the use of botulism toxin (BT) for the treatment of an "orphan" condition called blepharospasm. A victim of this syndrome will experience uncontrollable winking caused by spasms of the eyelid muscles. Use of botulism toxin will cause abatement of the symptoms in 90% of patients for 2 to 4 months. 

Edema of the eyelids (Rao and Brown 1974) has been reported. It is not known if the edema is related to phosphoms exposure, or due to a pre-existing condition. No evidence of eye irritation was observed in animals exposed to white phosphorus in peanut oil placed on the eye (Lee et al. 1975). The peanut oil vehicle may have been protective against the potential irritating effects of white phosphorus. 

But, in reality, it s even easier than that. For anyone to observe REM sleep behaviour directly, it can be done with bed partners, especially in the wee hours of the morning, most conveniently on vacation, in the summer time when the hillock of the cornea can be seen in the early dawn light to glide to and fro under the closed - or perhaps half-open - eyelids. The eyelids themselves dance and twitch sporadically and, when they do, one has only to give a light tap on the shoulder and ask what is going on in the mind. Informed consent is as admirable in these informal conditions as it is in university sleep labs, but don t let that stop you. 

Q2 Patients with myasthenia gravis suffer from extreme muscle weakness and fatigue, particularly after repeated muscle contraction. A noticeable feature of myasthenia gravis is that the upper eyelids droop (ptosis) because of the unconscious and repeated use of the muscles involved in blinking, and these eyelid muscles show fatigue and weakness before any other skeletal muscle is affected. Weakness of other muscles innervated by the cranial nerves is usually also visible early, resulting in a loss of the person s normal facial expression. Their vision is affected, their jaw may drop and their speech may become slurred. The condition occurs mostly in women, with a peak incidence in the third decade. 

The combination of active drug, preservative, and vehicle usually results in a hypotonic formulation (< 290 mOsm). Simple or complex salts, buffering agents, or certain sugars are often added to adjust osmolarity of the solution to the desired value. An osmolarity of 290 mOsm is equivalent to 0.9% saline, and this is the value sought for most ophthalmic and intravenous medications.The ocular tear film has a wide tolerance for variation in osmotic pressure. However, increasing tonicity above that of the tears causes immediate dilution by osmotic water movement from the eyelids and eye. Hypotonic solutions are sometimes used to treat dry eye conditions and to reduce tear osmolarity from abnormally high values. 

Ideally the effective dose should be used for the shortest time necessary to secure the desired clinical response. The dosage should be individualized as much as possible to the patient and the severity of the condition. The patient s general health must be considered and close supervision maintained to assess the effects of steroid therapy on the course of the disease and possible adverse effects. With ocular disease the route of steroid administration is an important determinant of the pharmacologic and therapeutic effects observed. Topical ocular therapy is usually satisfectory for inflammatory disorders of the eyelids, conjimctiva, cornea, iris, and ciliary body. In severe fiarms of anterior uveitis, topical therapy may require supplementation with systemic or periocular (local injection) steroids. Chorioretinitis and optic neuritis are most often treated with systemic steroids. 

The goals of OSD treatment are to relieve symptoms, heal the ocular surface, and prevent serious complications. Treatment of dry eye generally Ms into one of three categories—tear supplementation, tear conservation, or tear stimulation—in an attempt to reestablish the tear film quantitatively and qualitatively (Box 14-1). When possible, it is important to diagnose and treat coexistent or ancillary conditions that provoke or aggravate dry eye (e.g., blepharitis, meibomian gland disease, eyelid abnormalities). 

Because sympathetically innervated smooth muscle fibers also exist in the lower eyelid, oculosympathetic paresis can produce elevation of the lower lid (so-called upside-down ptosis). This condition is often subtle. However, this sign, along with ptosis of the upper lid, contributes to a narrowing of the palpebral fissure, giving the appearance of enophthalmos. 

Preseptal or periorbital cellulitis is an infectious process involving lid structures anterior to the orbital septum. The condition generally occurs due to one of three clinical scenarios (1) secondary to a localized infection or an inflammation of the eyelids or adjacent structures (i.e., sinusitis, conjunctivitis, blepharitis, and/or internal hordeolum), (2) secondary to eyelid or fecial trauma, and (3) after an upper respiratory tract infection. 

CeUulitis can pose a significant risk for morbidity and mortality if undiagnosed. For this reason the practitioner needs to differentiate preseptal celluUtis from the more serious orbital ceUulitis (Table 23-1). Chemosis, conjunctival injection, and pain on eye movement occur more often in orbital ceUulitis both conditions present with redness and swelling of the eyelid. When a swoUen Ud... 

As previously stated,//, influenzae is no longer a major cause of cellulitis in children. However, when present, the condition is characterized by significant fever, leukocytosis, and unilateral hyperemia and edema of the eyelids. There is a sharply demarcated dark purple discoloration of the eyelid skin and adnexal area. Mild conjunctival hyperemia and chemosis may also occur. Unless the patient has received antibiotics, blood cultures are the most effective means of establishing the diagnosis. If meningeal signs are present, a lumbar puncture should be performed, because 12% to 25% of patients with Haemophilus preseptal or orbital cellulitis have concomitant meningitis. 

Lagophthalmos is a common condition in which the eyelids do not fully close, either with a blink or during sleep. 

Eyelid myokymia or benign eyelid twitching is a common localized form of facial myokymia. It is a transient condition in which mild to moderate fine undulating contractions of the orbicularis muscle occurs, causing an annoying... 

Banik R, Miller NR. Chronic myokymia Mmited to the eyelid is a benign condition.J Neuro Opthahnol 2004 24 290-292. 

Under normal conditions the various components of the tear film are continually produced in sufficient quantity, not only to cover the ocular surfece but also to supply a reservoir of tears that is stored at the margin of the upper and lower eyelids. The movement of the upper eyelid distributes this reservoir, called the tear river or tear meniscus, during blinking or voluntary lid closure. As the tear film thins and breaks up, the blink reflex is stimulated. The down-phase of each blink compresses the superficial lipid layer, and the up-phase redistributes the lipid layer, which remains in a fairly dynamic state well after the completion of the blink. Each time the eyelid reopens, a new tear film layer is spread across the ocular surfece. The blink itself may also augment meibomian gland expression. 

The puncta are located on the posterior margins of the upper and lower eyelids, at the nasal end of the tarsus, approximately 6 mm from the nasal canthus. Each punc-tal opening measures 0.2 to 0.3 mm in diameter and is surrounded by a connective tissue ring. The four puncta point toward the globe, so that under normal conditions they are not directly visible without lid manipulation. Normally when the eyelids are closed, the upper and lower puncta are directly opposed to one another. 

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