John Rawstron Christchurch 2015
John Rawstron Christchurch 2015
Nasal and temporal pterygiae (medial and lateral) pingueculum
Body Neck Head Cap/hood Iles de Fuchs Stocker s line
Pathogenesis UV light Elastotic degeneration of conjunctival stroma Symptoms Redness Burning, grittines Visual blur
Observation Medical management Surgical management
Sunglasses Ocular lubricants Ocular decongestants (naphcon, naphcon A) Topical steroids if used sparingly (pred mild or flucon)
Indications Cosmetic Constant/recurrent inflammation Refractive change (astigmatism) Significant extension towards pupil centre 0-2mm from limbus 2-4mm from limbus >4mm from limbus Atypia -?squamous neopasia
Bare Sclera Conjunctival closure direct, flap, free graft Fibrin glue vs sutures Use of amniotic membrane Use of cytotoxic agents MMC 5FU Interferon α2b β irradiation
John Rawstron Christchurch 2015
Non-adherence of corneal epithelium to basement membrane Persistent intermittent foreign body sensation for weeks to years Typically occurs on waking Unilateral or bilateral Risk factors Trauma Diabetes Corneal basement membrane dystrophy Unilateral or bilateral
Case 28 yo mother, baby fingernail vs eye
Corneal abrasion Rx chlorsig 1/52 Getting better 2 weeks later still having symptoms
Rx chlorsig ointment 2/52 Pain on waking most mornings Improves after half an hour Light sensitive No fluorescein staining Eye slightly red
Referred to eye dept Rx copious lubricants Systane ultra hourly daytime Refresh nighttime nocte No resolution Epithelial debridement Bandage contact lens
No resolution Referred for Laser phototherapeutic keratectomy (PTK)
Examination Visual acuity Exclude infection Subepthelial deposits Loose epithelium
Corneal abrasion Corneal foreign body Contact lens-related problem Dry eye syndrome Acanthamoeba keratitis Floppy eyelid syndrome Herpes simplex keratitis
Stepwise treatment Lubricants Debridement Bandage contact lens Stromal puncture Laser PTK Laser PTK
John Rawstron 2015
Inflammation of the eyelids (margins) Red, itchy, burny Scales at base of eyelashes Blocked meibomian orifices malfunction of oil glands of eyelids Dry eye (lack of oil, low viscosity and high evaporation) Strongly associated with chalazia
Anterior (or staphylococcal) Flakes/encrusting at base of eyelashes Posterior (or meibomianitis)+/- Rosacea Red posterior lid margin Blocked meibomian orifices (plugged with dry meibum) Eyelid notches Misdirected lashes/trichiasis Mixed
Lid hygiene regimen Heat and cleanse: Old school flannel, baby shampoo, cotton bud New school wheat bag, sterilid Massage if cysts Ointments/antibacterials (anterior blepharitis) Fucithalmic, chlorsig, tetracycline Lubricant eye drops
Diet Omega 3 dark fish eg salmon, walnuts, flaxseed lacritec Steroid eyedrops Dexamethasone tds for 3/52 Doxycycline 50mg PO daily for 3/12 Antiinflammatory dose Excellent for rosacea-associated blepharitis
John Rawstron Christchurch 2015
Eyelid anatomy Management Non-surgical surgical
Hot compresses tds Massage towards eyelid margin/up and down Consider antibiotics (doxycycline, fluclox) Additional Blepharitis cares: Eyelid cleansing Consider steroid topical steroid Review in 4 weeks
Incision and curettage vs intralesional steroid I+C Safe Effective Less cosmetic risk!
1. Local anaesthetic eye drops Oxybuprocaine Alcaine Tetracaine 2. Mark lesion dot 3. Clean skin alcohol swab 4. Local anaesthetic Lignocaine with adrenaline wait
5. Half-strength povidone-iodine Do NOT use full-strength iodine as alcohol-based Alcohol will remove the corneal epithelium 6. Chalazion clamp 7. Evert eyelid 8. Incise with no 11 blade
9. Curette contents and remove with cotton bud 10. Chlorsig ointment 11. Double pad 3 hours 12. Chlorsig tds for 3 days optional
Chalazion clamp and curette No 11 blade Antiseptic Anaesthetic Topical local Eyepads Jelonet Chlorsig
Mimics Non-resolving chalazion Mimics BCC, chronic blepharitis 25% metastasize, 10% mortality (lesions >12mm)