ECTROPION

Ectropion - the lid margin is everted so that it fails to be in contact
with the surface of the eye. The bulbar and the palpebral conjunctiva
are exposed. The exposed tarsal conjunctiva becomes red, thick,
rough and of unpleasant cosmetic appearance. Eversion of the lower
lacrimal punctum produces epiphora.

Causes may be:
Senile - laxity and lengthening of thelid margin, its ligaments and the
supporting orbicularis.

Skin shrinkage from years of exposure to sunlight.

Scarring of the lower eyelid following trauma, burns, severe inflammation
or neoplastic diseases, or excess removal of skin by surgery.

Bell's palsy - or other paralysis of CVII - loss of support by the paralysed
orbicularis.

Treatment:
Plastic surgery

TRICHIASIS

TRICHIASIS - turning inwards of the eyelashes toward the globe producing
irritation of the cornea and the conjunctiva with the risk of corneal ulceration.

Causes:
Scars - from acute or chronic infections (stye, trachoma)
Burns - especially from lime or hot metals.
Conjunctival shrinkage - pemphigus, trachoma, symblelpharons.
Senile entropion

Treatment:
Epilation of the lashes or destruction of the hair follicles by electrolysis or
cryotherapy. If many are involved, reconstruction of the lid margin may be
necessary.

PTERYGIUM

Pterygium - wing shaped plaque of vascular connective tissue
covered by epithelium which extends from the conjunctiva onto
the cornea in the region exposed between the lids (palpebral
aperture). It is usually on the nasal side of the limbus, but it is
never on the upper or lower margins of the cornea. The cause
is exposure to sunlight, aggravated by wind and dust.

Symptoms
- Disfigurement
- Recurrent irritaion or soreness
- Reduction of visual acuity due to astigmatism or corneal opacity.

Treatment
Reduce sunglare by sunglasses and hats - consistent use will
stop many pterygia from growing. If the pterygium is enlarging
and encroaching on the pupillary area, it should be removed
surgically and followed by Beta radiation therapy.

HYPHEMA

Hyphaema - blood in the anterior chamber.

The blood may fill part or the whole of the anterior chamber.
Bleeding is caused by rupture of iris or ciliary vessels. It
usually ceases quickly.

The danger is not the primary hemorrhage, but possible
secondary hemorrhage. Unless large, the primary hemorrhage
usually absorbs within 24 to 48 hours but may recur.

Treatment:
Admit to hospital
Rest in bed and sedate
Both eyes covered to provide maximum rest to the eyes.

Complications:
Secondary hemorrhage from a broken vessel may occur from the third
to fifth day following injury. Its onset is indicated by sudden pain in the
eye.

If the anterior chamber fills totally with blood (total hyphema) the outflow
channels are likely to block, causing severe secondary glaucoma. The
high intra-ocular pressure not only damages the intra-ocular structures
(iris, retina, lens, optic nerve) but blood constituents are driven into the
cornea through the damaged endothelium (blood staining of the cornea).
Most of such eyes become useless.

Management:
Reduce intra-ocular pressure - Diamox, oral Glycerol, I.V. Mannitol
sometimes surgical removal of blood clot or degradation products.

CHALAZION (Meibomian Cyst)

Chalazion (Meibomian Cyst) - is an enlarged tarsal gland which results from
accumulation of its sebaceous products because of blockage of the tarsal duct.

There is a gradual painless swelling of the gland deep in the eyelid. It may become
secondarily infected and give rise to an acute suppurative inflammation.

Treatment is by hot forments and antibiotic eyedrops until the acute stage
subsides, then excision or curettage via the conjunctival surface.

BLEPHARITIS

BLEPHARITIS - an inflammation of the lid margin that may be acute or chronic
Seborrhoea commonly predisposes to local infections.

Signs & Symptoms:
Red rimmed lids with scales, crusts and even ulcerations.
Eye lashes are matted by cellular debris and exudate.

Treatment:
Directed mainly towards correcting the seborrhoeic condition, and maintaining the
lid margins as free as possible from discharge or scales. Elimination of secondary
infection by the use of an appropriate antibiotic may be necessary, but antibiotic
treatment should not be prolonged.

HORDEOLUM (STYE)

HORDEOLUM (STYE) - is an acute suppurative inflammation of the follicle of
an eyelash or its associated glands of Zeis or Moll, usually by staphylococci.
The initial symptom is tenderness of the lid that may become marked as the
suppuration progresses. The affected lid margin becomes swollen, red and
tense, with the production of a yellow "head" at the base of the affected
eyelash. It may be associated with a blepharitis.

Treatment:
- hot compresses (hot spoon bathing) hasten resolution of the lesion.
- epilate the eyelash to allow drainage.
- local antibiotics.
- test urine for sugar if recurrences occur.
- systemic antibiotics are rarely necessary.