Patología de parpados Dra Andrea Hurtado

Introduction to Eyelid Pathology

Overview of Eyelid Anatomy

• Andrea Carolina Hurtado Moreno introduces the topic of eyelid pathology, emphasizing the importance of understanding anatomy and function.

• The skin consists of epidermis (four layers of keratin-producing cells) and dermis (thicker connective tissue with blood vessels, lymphatics, nerves).

• Sebaceous glands are located between the caruncle and eyebrow follicles; Meibomian glands drain lipids into the tear film.

• D6 glands are modified sebaceous glands associated with eyelash follicles; Moll's glands are apocrine sweat glands draining at the eyelash base.

• Eccrine sweat glands are distributed throughout eyelid skin, differing from Moll's in drainage location.

Clinical Terminology for Eyelid Lesions

• Key clinical terms include macula (color change), papule (solid elevation <1 cm), vesicle (fluid-filled lesion <0.5 cm), and bulla (larger fluid-filled lesion).

• Pustules contain pus (<1 cm); crust refers to solid exudate; nodules are palpable areas >1 cm.

• Additional important terms: plaques, scales, papillomas, ulcers—crucial for accurate diagnosis based on patient presentation.

Eyelid Structure and Function

Layers of the Eyelid

• The eyelid comprises two layers: anterior (skin and orbicularis muscle) and posterior (tarso-conjunctival layer), separated by a gray line.

• Upper eyelids have levator muscle attachment; skin is among the thinnest in the body allowing rapid movement.

Age-related Changes

• Aging leads to skin separation from deeper planes, resulting in redundancy; upper lids are ideal for skin grafting due to lack of subcutaneous fat.

Functions of Eyelids

• Key functions include mechanical protection, light shielding, tear distribution/maintenance, cleaning function, and aesthetic role.

Vascularization and Innervation

Blood Supply

• Arterial supply comes from internal carotid artery branches via ophthalmic artery; external carotid supplies facial branches.

Venous Drainage

• Superficial venous drainage includes frontal, angular, facial veins; deep drainage involves facial profunda vein and cavernous sinus.

Nerve Supply

Overview of Eyelid Pathologies

Sensory Innervation and Classification of Eyelid Pathologies

• The sensory innervation of the eyelids is provided by the fifth cranial nerve, specifically its first and second branches.

• Eyelid pathologies are categorized into five important groups: infectious, inflammatory, tumoral, traumatic, and malpositions.

Infectious Conditions: Blepharitis

• Blepharitis is a common chronic infectious disease affecting the eyelid margins, classified into anterior (affecting eyelashes and skin) and posterior (related to meibomian gland dysfunction).

• The etiology of blepharitis is multifactorial, involving infectious agents like bacteria and Demodex mites, as well as inflammatory and dermatological factors. Previous patient history should be thoroughly evaluated.

Diagnosis of Blepharitis

• Diagnosis relies on clinical evaluation through detailed anamnesis and physical examination of the eyelids. Key findings include erythema, scaling, crusting at the base of eyelashes (collarettes), vascular alterations in eyelid margins, and meibomian gland dysfunction signs.

• Collarettes are particularly noted in cases associated with Demodex infestation. Treatment focuses on symptomatic relief with long-term management strategies due to the chronic nature of blepharitis.

Treatment Approaches for Blepharitis

• Initial treatment includes proper eyelid hygiene using warm compresses and regular cleaning; specialized shampoos may assist in maintaining hygiene. Patients must adhere to these practices consistently for effective management.

• Topical antibiotics may be prescribed for anterior blepharitis to reduce bacterial superinfection; however, patients should be informed that treatment is often chronic rather than curative. Persistent care leads to gradual improvement over time.

Common Eyelid Infections: Styes (Orzuelos)

• A stye is an acute localized infection of sebaceous glands at the eyelid margin typically caused by Staphylococcus aureus; it presents as a painful red mass on the lid margin. Differentiation from other conditions like chalazia is crucial due to differing symptoms and treatments.

• First-line treatment involves local measures such as warm compresses several times daily to promote drainage; systemic or topical antibiotics are rarely needed unless complications arise from secondary infections or persistent inflammation.

Chalazia: Chronic Inflammatory Condition

• Chalazia are non-infectious masses surrounding meibomian glands that can develop after a stye or due to gland obstruction; they usually present without pain unlike styes which are acutely painful infections.

Chalazion and Hordeolum: Understanding Differences and Treatments

Chalazion Treatment Options

• Large or recurrent chalazia may require incision and drainage. Intralesional steroid injections can also be beneficial for conservative treatment to reduce size.

Histopathology of Chalazia

• Image B shows a non-inflamed chalazion, while image C depicts a marginal chalazion with superimposed bacterial infection. Image D illustrates a conjunctival chalazion.

Differentiating Between Hordeolum and Chalazion

• Painful nodules on the eyelid indicate hordeolum, treated with antibiotics, warm compresses, and possible drainage if unresolved. Non-painful nodules suggest a chalazion, initially managed with warm compresses.

• Persistent chalazia may require intralesional corticosteroids or surgical intervention (incision and curettage).

Comparative Analysis of Hordeolum vs. Chalazion

• A comparative table outlines definitions, etiology, pain presence, erythema, lesion characteristics, consistency (hordeolum is more fluctuating; chalazion is firmer), evolution speed (hordeolum is acute; chalazion is chronic), and initial treatment similarities.

Preseptal Cellulitis Overview

• Preseptal cellulitis presents with hyperemia and edema without orbital congestion signs. It may follow infections like infected hordeola or dacryocystitis.

• Important to gather patient history thoroughly to rule out trauma that could lead to infection. Edema can be severe but visual acuity remains normal in preseptal cellulitis cases.

Orbital Cellulitis Symptoms

• Orbital cellulitis symptoms include blurred vision, diplopia, restricted eye movement pain during motion. Presence of proptosis alongside inflamed eyelids indicates potential orbital involvement.

• Key findings such as bilateral ocular symptoms or signs of meningeal infection raise concerns for cavernous sinus thrombosis necessitating thorough evaluation.

Eyelid Malpositions: Ectropion

• Ectropion involves eyelid eversion commonly seen in elderly patients due to various causes (involutive, paralytic). Consequences include constant tearing (epiphora) and exposure keratitis.

Surgical Treatments for Eyelid Conditions

Overview of Eyelid Disorders

• The primary treatment for eyelid repositioning involves surgical intervention to ensure proper palpebral occlusion.

• Entropion is characterized by the inward turning of the eyelid margin, which can lead to corneal irritation and symptoms like desquamation.

Types of Eyelid Conditions

• Tosis refers to the drooping of the upper eyelid, with causes including congenital factors, aponeurotic issues, neurogenic conditions, and myogenic origins.

• It is crucial to assess the position of the eyelid in relation to the pupil axis and evaluate muscle function during examination.

Tumors Associated with Eyelids

Benign Tumors

• Common benign tumors include nevi (moles), papillomas, and xanthelasmas; each requires careful anatomical description regarding size and color.

• Systemic health inquiries are essential when assessing lesions; understanding patient history can reveal underlying conditions that may affect treatment.

Malignant Tumors

• Basal cell carcinomas are prevalent malignant tumors presenting as pearly nodules with telangiectasia; they typically require surgical management.

• Squamous cell carcinomas are less common but more aggressive; symptoms such as rapid growth or irregular borders should raise suspicion for malignancy.

Allergic Reactions and Systemic Associations

• Patients with severe allergies may exhibit specific eyelid pathologies; thorough history-taking about respiratory symptoms is vital for appropriate referrals.

Diagnostic Algorithms in Eyelid Pathology

• A diagnostic algorithm helps categorize patients presenting with red or inflamed eyelids, guiding urgent care decisions based on associated symptoms like diplopia or trauma.

Understanding Eyelid Pathologies

Differential Diagnosis of Eyelid Conditions

• If a diffuse swelling is observed, consider angioedema and rule out allergies in patients.

• A well-defined erythema that is flat or slightly elevated may indicate a capillary hemangioma; if the eyelid shows a dry, elevated plaque, atopic dermatitis should be considered.

• In cases of painless proptosis with insidious onset, determine if it is unilateral (potential tumor) or bilateral (consider Graves' disease and thyroid profile).

Signs of Orbital Infections

• If the eyelid appears diffusely red and swollen with pain, fever, and general malaise, check for proptosis and extraocular movement limitations to rule out orbital cellulitis.

• An intravenous contrast CT scan is crucial for confirming orbital cellulitis; immediate hospitalization and ophthalmology consultation are necessary for intravenous antibiotics.

Distinguishing Between Cellulitis Types

• If the patient is afebrile with intact extraocular movements and no visual impairment, consider preseptal cellulitis; systemic antibiotics should be administered.

• For defined masses on the eyelid: differentiate between a papule (rule out stye if on eyelid margin) or chalazion if within the lid body.

Importance of Detailed Observations

• Documenting abnormalities in eyelashes and eyelids is essential; observe their orientation, color changes, and overall appearance during examination.

• Patient history can reveal chronic conditions; photographs can help compare acute versus chronic lesions.

Key Takeaways on Common Eyelid Conditions

• Blepharitis is highlighted as the most common condition requiring accurate detection and treatment.

• Recognizing signs of malignancy in eyelid skin is critical for timely referrals.