Lid margin

Ciprofloxacin White crystalline precipitates lid margin crusting crystals/scales foreign body sensation itching conjunctival hyperemia bad taste in mouth corneal staining keratopathy/keratitis allergic reactions lid edema tearing photophobia corneal infiltrates nausea decreased vision. 

Allergic reactions, alopecia, chest pain, conjunctivitis, diarrhea, diplopia, dizziness, dry mouth, dyspnea, dyspepsia, eye fatigue, hypertonia, keratoconjunctivitis, keratopathy, kidney pain, lid margin crustingor sticky sensation, nausea, pharyngitis, tearing, urticaria... 

Abnormal vision, cataract, conjunctivitis, dry eye, eye disorder, flare, iris discoloration, keratitis, lid margin crusting, photophobia, subconjunctival hemorrhage, and tearing... 

The tear film leaves the surface of the globe and eyelids, enters the upper and the lower punctum at the medial aspect of the lid margin, and enters the lacrimal sac before drainage to the nasolacrimal duct and the nasal cavity. However, much of the tear film is eliminated by direct evaporation or by absorption at the level of the lacrimal sac. The lacrimal outflow system is based on an active and dynamic pumping mechanism. Blinking cycle leads to changes in the drainage canaliculi that activate a pump mechanism that drains tears even with the head held in an inverted position. When the palpebral blink mechanism is impaired, tears accumulation leads to spillover to the skin of the lids and cheek [4],... 

Although solutions are the most commonly used vehicles for topical ocular medications, ointments are also frequently used for application to the eye. When applied to the inferior conjimctival sac, ophthalmic ointments melt quickly, and the excess spreads out onto the lid margins, lashes, and skin of the lids, depending on the amount instilled and on the extent of lacrimation induced by any irritation.The ointment at the lid margins acts as a reservoir and enhances drug contact time. 

Application of solutions or ointments directly to the lid margin is especially helpful in treating seborrheic or infectious blepharitis. After several drops of the antibiotic solution or detergent, such as baby shampoo, are placed on the end of a cotton-tipped appUcator, the solution is applied to the Ud margin with the eyeUds either opened or closed (Figure 3-11). Antibiotic ointments are applied in the same way. 

Figure 3-11 Technique of lid scrub. Drug application to the lid margin is accomplished with a cotton-tipped applicator applied to the opened (A) or closed (B) eyelids.

Staphylococcal infections of the eyelid are commonly treated with erythromycin ointment applied to the Ud margins (see Table 11-1). Warm moist compresses should be applied to the lid, and then the lid margins should be gently cleaned with diluted baby shampoo or a commercial lid cleanser before applying the drug. Erythromycin ointment can be applied only at bedtime or more often as required by infection severity. For the prophylaxis of ophthalmia neonatorum, a 0.5- to 1-cm ribbon of erythromycin ointment is instilled into each conjunctival sac and not flushed from the eyes after application. 

Wolff E.The muco-cutaneous junction of the lid-margin and the distribution of the tear fluid.Trans Ophthalmol Soc UK 1946 66 291-308. 

Blepharitis is a broad term that refers to a collection of lid margin inflammatory disorders that cause changes in adjacent or surrounding structures and often includes, or is associated with, dermatologic conditions such as seborrhea and rosacea. The etiology remains poorly understood despite a strikingly high prevalence in the population it has been reported that approximately 590,000 patients per year seek care due to blepharitis, and it is estimated that 20 million people suffer from this disorder worldwide. 

Mixed seborrheic-staphylococcal blepharitis Posterior lid margin Meibomian gland dysfunction Meibomian seborrhea Meibomitis Primary Secondary... 

Lid hygiene consists of hot compresses, lasting 5 to 10 minutes and performed two to four times daily, followed by lid scrubs using a mild detergent cleanser such as baby shampoo and a washcloth or prepackaged commercially available lid scrubs (Box 23-2). Dilution of the shampoo is not necessary imless the patient has an unfavorable reaction to full strength. The hot compresses serve to loosen lid debris and dilate blood vessels to allow increased blood flow to the area. The scrubs not only facilitate removal of debris but also serve to lyse bacterial membranes and to reduce the bacterial load. Antibiotic ointment should then be applied directly to the lid margin two to foiu- times daily. Antibiotic drops are used when a secondary conjunctivitis is also present. 

Figure 23-7 Greasy lashes and scurf in seborrheic blepharitis. Note the external hordeolum (stye) on the lower lid margin black arrow). (From Kanski JJ. EyeUds. In Clinical ophthalmology a systematic approach. Philadelphia Butterworth-Heinemann, 2003 10.)...

Figure 23-10 Rosacea with severe blepharitis. Note the thickened lid margins and the corneal neovascularization. This is the same patient as seen in Figure 23-9. (From Palay DA, Krachmer JH. Conjunctival abnormalities. In Primary care ophthalmology, ed. 2. Philadelphia Mosby, 2005 98.)...

The lesion usually appears as a localized area of redness, tenderness, and swelling adjacent to or surrounding an eyelash (Figure 23-11).The primary symptom is localized pain of recent onset. Within a few days the lesion develops a yellow point on the surface of the lid margin. In most cases the abscess spontaneously drains within 3 or 4 days after pointing. Rarely do external hordeola cause any other tissue damage. 

In patients with severe lid involvement, lubricating ointments should be instilled into the cul-de-sac to prevent complications arising from exposure or trichiasis. An oculoplastic surgeon should manage scarring and contraction of lid tissue that creates cicatricial ectropion, lid retraction, lid margin deformity, or severe corneal complications. 

Figure 23-19 (A-C) Cylindrical sleeves (arrows) that rest on the lid margin as seen in Demodex blepharitis. (Gao Y, Pascuale MA, Li W, et al. High prevalence of Demodex in eyelashes with cylindrical dandruff, Invest Ophthalmol Vis Sci 2005 46 3089-3094).

Severe itching and irritation characterize phthiriasis palpebrarum. Blepharoconjunctivitis, blood-stained thickened discharge from fecal matter on the lid margins, nits, and adult parasites on the eyelashes may all be visible. 

Anticholinesterase agents, such as 0.25% physostig-mine ointment, are also a viable treatment option and may be applied to the lid margins. Side effects, such as miosis and browache, may limit their use. Gamma benzene hexachloride should be avoided on treating the lid condition because of potential ocular irritation and... 

Verrucae are self-limiting but can be very serious in the immunosuppressed. Treatment is primarily cosmetic but also prevents further dissemination. Most verrucae lesions resolve spontaneously after several months to years therefore therapy should be conservative. Because the lesions are localized to the epidermis, most treatments are limited to this level and should not result in scarring. Benign treatments include topical applications of irritants salicylic acid and lactic acid, applied under an occlusive barrier, can be purchased over the counter. More advanced treatment modalities include cryotherapy, surgical removal, or electro-or chemical cautery. Neither of these cautery methods is suitable for lesions on the lid margin because of the risk to the ocular surfece. 

Sebaceous cysts are benign retention cysts of sebiun. They often appear in the geriatric population due to aging. Milia are small (0.5 mm), round, sebaceous cysts that tend to remain intracutaneous (Figure 23-24). They are common on the eyelids, are whitish in color, are found away from the lid margin, and cause little irritation.They are important only from a cosmetic standpoint. 

BCCs represent the most common form of human malignancy. Roughly 80% to 90% of all BCCs occur on the head and neck and 20% of those occur on the lid or lid margin. BCCs account for 90% of all eyelid tumors thus extreme care must be taken when evaluating any suspicious eyelid lesion.The incidence is 500/100,000 people in the United States, with 60 years the average age at diagnosis. 

Nodular BCCs are typically shiny or translucent elevated lesions, of any color, that resemble a mole.They may occur anywhere on the lid or lid margin and might be confused with a papilloma. It is important to remember that papillomas do not grow over time, do not bleed, and have a normal overlying skin appearance. The nodule may ulcerate, forming the most easily recognized BCC,... 

Any suspicious lesion that appears to alter the surroimding skin, causing loss of eyelashes or irregular lid margins, which cannot be determined as benign, must be referred for biopsy this is the only true method to diagnosis a malignancy. It is not uncommon to confuse a BCC... 

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