The document discusses various eyelid conditions including inflammation, tumors, and cysts. It describes blepharitis as inflammation of the eyelid margin that causes redness, grittiness, and burning. It distinguishes between anterior and posterior blepharitis. Common benign eyelid lesions include chalazia (meibomian cysts), styes (hordeola), molluscum contagiosum, xanthelasma, and sebaceous cysts. Malignant eyelid tumors discussed are basal cell carcinoma, squamous cell carcinoma, and melanoma. Treatment options involve lid hygiene, warm compresses, antibiotics, and surgical excision or cryotherapy depending on the condition.

1. EYELID INFLAMMATION &
TUMORS
July 7, 2012

2. LID INFLAMMATION
• Blepharitis

3. DEFINITION
• It is the inflammation of the lid margin

4. blepharitis
• Inflammation of the lid margin (crusting/redness of
lids)
• Causes ‘gritty’/foreign body sensation, often
concomitant with other ocular surface disease
• Associated with recurrent hordeolum (styes) or
chalazia
• Improvement with warm compresses/lid hygeine,
artificial tears, tetracycline

7. Types
1. Anterior
a. Squamous
b. Ulcerative
2. Posterior
a. Meibomian seborrhoea
b. Meibomianitis

8. ANTERIOR BLEPHARITIS
• It involves the outer parts of the eyelid
• It is commonly caused by bacteria

9. SEBORRHEIC/SQUAMOUS
• It is characterized by the deposition of scales
• Eyelashes fall
• Hyperemic lid margin
• Absence of ulcers

10. Squamous Blepharitis

11. Symptoms
• Burning, deposits / crusting along lid margins,
grittiness , redness of lid margins,
photophobia
• Symptoms are worse in the morning

13. ULCERATIVE
• It is characterized by the presence of infective
materials such as yellow crusts or scales
• There is matting of the lashes
• Presence of ulcers

14. Symptoms
• Redness of lid margins, burning, itching,
watering and photophobia
• Signs:
– Small ulcers at lid margins on removal of
discharge, this features differentiate it from
conjunctivitis

15. Ulcerative Blepharitis

16. 14- Ulcerative blepharitis

17. 15- Ulcerative blepharitis

18. POSTERIOR BLEPHARITIS
• It involves the inner parts of the eyelids
• It is due to problems in the oil glands

20. LID LUMPS

21. STYE
• It is a tender, painful red bump located at the
base of an eyelash or inside the eyelid
• It is due to infection of the oil glands of the
eyelid or from an infected hair follicle at the
base of an eyelash

23.  - It is an abscess
in eyelash follicle.
 painful
 -Most cases are
self limiting .
 -Treatment
requires the
removal of the
associated
eyelash and
application of
hot compresses.

24. Internal hordeolum
 an abscess in
meibomian
gland.
 -Painful.
 -May respond
to topical
antibiotics but
incision by be
necessary.

26. Hordeolum Internum

28. Chalazion
 -It is a granuloma
within the tarsal
plate caused by
obstructed
meibomian gland.
 -Painless.
 -Symptoms are
unsightly lid
swelling which
resolve within six
months if the lesion
persist we remove
it surgically

30. Chalazion

31.  -Is a viral infection of
the skin or the mucous
membranes, caused by
pox virus.
 -Can be presented with
umbilicated lesion
found on the lid margin.
 -Cause irritation,
redness, follicular
conjuctivitis(small
elevation of lymphoid
tissue found on tarsal
conjunctiva)
 -Treatment requires
excision of the lid lesion.

32. Molluscum contagiosum
Signs Complications
• Painless, waxy, umbilicated nodule• Chronic follicular conjunctivitis
• May be multiple in AIDS patients • Occasionally superficial keratitis

33. Histology of molluscum contagiosum
• Lobules of hyperplastic epithelium
• Intracytoplasmic (Henderson-Patterson)
• Circumscribed lesion inclusion bodies
• Surface covered by normal • Deep within lesion bodies are small and
epithelium except in centre eosinophilic
• Near surface bodies are larger and
basophilic

35.  - Lipid
containing
bilateral lesions.
 - Usually
associated with
hyperlipidemia .
 - Removed for
cosmetic
reasons.

36. Xanthelasma
• Common in elderly or those with
hypercholesterolaemia
• Yellowish, subcutaneous plaques
containing cholesterol and lipid
• Usually bilateral and located medially

38. Adenoma of Meibomian Gland

39. Eyelids inflammation
• Blepharitis
– Anterior
– Posterior
– Staphylococcal
– Seborrhoeic
– Meibomianitis
• Treatment
– Lid hygiene
– Tears
– Antibiotics
– Warm compresses

40. Eyelids inflammation
• Allergy
– Acute allergic
blepharoconjuctivitis
– Allergic
dermatoblepharitis

41. Eyelids inflammation
• Chalazion
– Focal inflammation of the eye
lids which result from
obstruction of the meibomian
glands
– Chronic lipogranulomatous
inflammatory changes
– Treatment
• Warm compresses
• Local antibiotic
• Excision

42. EYELID CYST

43. CYST OF MOLL

44. CYST OF ZEIS

45. SEBACEOUS CYST

46. HIDROCYSTOMA

47. BENIGN TUMORS

48. VIRAL WART

49. ACTINIC KERATOSIS

50. NAEVI

51. KERATOACANTHOMA

52. PYOGENIC GRANULOMA

53. HEMANGIOMA

54. Malignant eyelid tumors
• Basal cell carcinoma
• Squamous cell carcinoma
• Meibomian gland carcinoma
• Melanoma
• Kaposi sarcoma
• Merkel cell carcinoma

55. Basal cell carcinoma
• Most common malignancy(90%)
of the eyelid
• Usually located on the lower lid
and medial canthus
• Pearly nodules which ulcerate
and have telangiectasias
• Treatment
– Surgical excision
– Cryotherapy
– Radiation therapy

56. Squamous cell carcinoma
• Less common than BCC
• May arise de-novo or
from pre-existing actinic
keratosis
• May metastasize

57. BENIGN EYELID LESIONS
1. Nodules
• Chalazion
• Acute hordeola
• Molluscum contagiosum
• Xanthelasm
a
2. Cysts
• Cyst of Moll
• Cyst of Zeiss
• Sebaceous cyst
• Hidrocystoma
3. Tumours
• Viral
•
wart
•
Keratoacanthoma
• Capillary haemangioma
Naevi
• Port-wine stain
• Pyogenic granuloma
• Cutaneous horn

58. Signs of chalazion (meibomian cyst)
Painless, roundish, firm lesion May rupture through conjunctiva
within tarsal plate and cause granuloma

59. Histology of chalazion
Multiple, round spaces previously Epithelioid Multinuc
containing fat with surrounding cells giant cel
granulomatous inflammation

60. Treatment of chalazion
Injection of local anaesthetic Insertion of clamp Incision and curettage

61. Acute hordeola
Internal hordeolum External hordeolum (stye)
( acute chalazion )
• Staph. abscess of meibomian • Staph. abscess of lash follicle and
glands associated gland of Zeis or Moll
• Tender swelling at lid margin
• Tender swelling within tarsal plate
• May discharge through skin • May discharge through skin
or conjunctiva

62. Viral wart (squamous cell papilloma)
• Most common benign lid tumour
• Raspberry-like surface
Pedunculate Sessil
d e

63. Histology of viral wart
Finger-like projections of Epidermis shows acanthosis (increased
fibrovascular connective tissue thickness) and hyperkeratosis
Rete ridges are elongated and bent inw

64. Keratoses
Seborrhoeic Actinic
• Common in elderly • Affects elderly, fair-skinned individuals
• Discrete, greasy, brown lesion • Most common pre-malignant skin lesion
• Friable verrucous surface • Rare on eyelids
• Flat ‘stuck-on’ appearance • Flat, scaly, hyperkeratotic lesion

65. Keratoacanthoma
• Uncommon, fast growing nodule • Lesion above surface epithelium
• Acquires rolled edges and keratin-filled
crater • Central keratin-filled crater
• Involutes spontaneously within 1 year• Chronic inflammatory cellular infiltrat
of dermis

66. Naevi
• Appearance and classification determined by location within ski
• Tend to become more pigmented at puberty
Intradermal Junctional Compound
• Elevated • Flat, well-circumscribed • Has both intradermal
and junctional
• May be non-pigmented • Pigmented components
• No malignant potential • Low malignant potential

67. Capillary haemangioma
• Rare tumour which presents soon after birth be associated with intraorbita
• May
extension
• Starts as small, red lesion, most frequently
on upper lid • Grows quickly during first year
• Begins to involute spontaneously
• Blanches with pressure and swells on crying
during second year

68. Periocular haemangioma
Treatment options
• Steroid injection in
most cases
• Surgical resection in
selected cases
Occasional systemic
associations
• High-out heart failure
• Kasabach-Merritt syndrom
thrombocytopenia, anaemi
and reduced coagulant fact
• Maffuci syndrome - skin
haemangiomas,
endrochondromas and
bowing of long bones

69. Histology of capillary haemangioma
Lobules of capillaries Fine fibrous septae Lobules under high magnification

70. Port-wine stain (naevus flammeus)
• Rare, congenital subcutaneous lesi
• Segmental and usually unilateral
• Does not blanch with pressure
Associations
• Ipsilateral glaucoma in 30%
• Sturge-Weber or
Klippel-Trenaunay-Weber
syndrome in 5%

71. Pyogenic granuloma Cutaneous horn
• Usually antedated by surgery or trauma• Uncommon, horn-like lesion protrudi
• Fast-growing pinkish, pedunculated or through skin
sessile mass • May be associated with underlying ac
• Bleeds easily keratosis or squamous cell carcinoma

72. PATHOLOGY OF THE LACRIMAL
APPARATUS

73. CANALICULITIS

74. DACRYOCYSTITIS

75. DACRYOCYSTITIS

76. DACRYOADENITIS

77. NASOLACRIMAL DUCT OBSTRUCTION

81. Eyelid cysts
Eccrine sweat gland
Cyst of Moll hidrocystoma
• Translucent • Similar to cyst of Moll
• On anterior lid • Not confined to lid
margin margin
Cyst of Zeis Sebaceous cyst
• Opaque • Cheesy contents
• On anterior lid • Frequently at
margin inner canthus