Clinical images: Conditions affecting the eye

Dr Nigel Stollery explains the differences in characteristic features of diseases of the eye.

Entropion

Presentation

  • Inversion of the upper or lower eyelids
  • Main problem is due to the eyelashes rubbing against the eye, causing irritation and pain
  • In severe untreated cases, corneal damage can occur, affecting vision
  • Incidence increases with age
  • Very rarely can be congenital

Management

  • Taping the eyelid to the cheek may help
  • Plucking the eyelashes can lessen the irritation
  • Lubricating eyedrops may help to alleviate irritation
  • Botulinum toxin injections have been used successfully
  • In many cases, surgery is required

Blepharitis

Presentation

  • Blepharitis is a condition of inflammation of the eyelids
  • The eyelid margins are most commonly affected
  • Usually a chronic condition affecting both eyes
  • Three main types are seborrhoeic blepharitis, staphylococcal blepharitis and meibomian blepharitis
  • All three produce symptoms of soreness and irritation
  • Eyelids may look greasy and stick together in the mornings
  • Fine scale is often present

Management

  • No cure, but regular treatment will keep it under control
  • The mainstay of treatment is eyelid hygiene

Ectropion

Presentation

  • Occurs when the eyelid loses contact with the eye and everts
  • Common condition of the elderly, caused by laxity of muscles and skin
  • Lower eyelid mostly affected
  • The affected eye tends to water constantly
  • Loss of lubrication by tears may result in palpebral keratinisation and corneal damage

Management

  • Taping the eyelids closed may prevent drying overnight
  • Lubricating drops can help to protect the cornea
  • Treatment is usually by surgery to tighten the eyelid

Contact dermatitis

Presentation

  • Most commonly caused by cosmetics and therapeutic eyedrops
  • May occur secondary to nail varnish touching the eyelids
  • Pruritis suggests an allergic cause; burning and stinging, an irritant cause
  • Oedema and scale may be seen

Management

  • Ideally, remove the cause
  • Cold compresses can be applied directly to the eyelids
  • Emollients should be applied on a regular basis
  • Low-potency topical steroids in more severe cases
  • Pimecrolimus is a steroid-free alternative

Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

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