03 diffuse eyelid diseases
TRANSCRIPT
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DIFFUSE EYELID DISEASE1. Allergic
• Acute oedema• Contact dermatitis• Atopic dermatitis• Blepharochalasis
2. Infections• Preseptal cellulitis• Herpes simplex• Herpes zoster ophthalmicus• Impetigo• Erysipelas• Necrotizing fasciitis
3. Miscellaneous• Fat herniation• Systemic causes
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Acute allergic oedema
• Causes - insect bites, urticaria and angioedema• Unilateral or bilateral• Painless, red, pitting oedema• Chemosis may be present• Self-limiting
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Contact dermatitis
• Sensitivity to topical medication• Unilateral or bilateral• Painless oedema and erythema• Vesiculation and crusting• Thickening if chronic
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Atopic dermatitis• Associated with asthma and hay fever• Chronic itching and scratching
Facial - in young children Flexural - knees, elbows, wrists and ankles
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Ocular associations of atopic dermatitis
Angular blepharitis Vernal disease in children
Thickening, crusting and fissuring
Staph. blepharitis
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Ocular associations of atopic dermatitis
Keratoconus Keratoconjunctivitis
Shield - like cataract Retinal detachment
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Blepharochalasis
• Uncommon, usually bilateral
• Starts at about puberty
• Recurrent, non-pitting oedema
• Usually upper eyelids
• Resolves after few days
• Complications - wrinkled, thin skin and aponeurotic ptosis
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Preseptal cellulitis
Causes• Skin trauma or insect bites of lids or eyebrows• Spread from local infection• Upper respiratory or ear infectionSigns• Usually unilateral• Tender and red • Periorbital oedemaTreatment - systemic antibiotics
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Herpes simplex
Signs• Crops of small vesicles• Rupture and crust• Heal without scarring after 7 days
Complications • Follicular conjunctivitis • Keratitis
Treatment - topical antivirals
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Herpes zoster ophthalmicus
• Crusting ulcerationTreatment - oral antivirals
• Painful vesicles and pustules• Periorbital oedema - may be bilateral
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Impetigo
• Infection with Staph. or Strep.
• Initially small vesicles and bullae
• Later golden-yellow crusting Treatment - topical and systemic antibiotics
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Erysipelas
• Staph. infection through site of minor trauma
• Acute spreading cellulitis
• Well-defined, red, tender subcutaneous plaque
Treatment - antibiotics
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Necrotizing fasciitis
• Skin gangrene caused by Staph. or Strep.
• Affects elderly or debilitated
• May cause bilateral lid necrosis
Treatment - surgicaldebridement and systemic antibiotics
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Fat herniation
• Age-related, usually bilateral
• Pockets of fat herniating into upper lids, especially medially
Treatment - blepharoplasty
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Systemic causes of lid oedema
• Myxoedema
• Renal disease
• Congestive heart failure
• Obstruction of superior vena cava
• Fabry disease