Opthal

BLEPHAROKERATOCONJUNCTIVITIS
PHAROKERATOCONJUNCTIVITIS
- is a type of inflammation of the surface of the eye and eyelids that involves changes of the
eyelids, dysfunction of the meibomian glands, and inflammation of the conjunctiva and cornea.
- Chronic inflammation of the cornea can lead to scarring, vascularisation and opacity.
diagnosis is clinical and based on changes of the

- lid margin = telangiectasia, thickening, scarring
- meibomian gland dysfunction (MGD) = cause Dryness of eyes
- redness of the eye (conjunctival hyperaemia),
- conjunctival chemosis(swelling) and inflammation of the cornea (punctate epithelial keratitis,
corneal opacities, ulceration, thinning, vascularisation and scarring) .
- Inflammation of the ocular surface causes symptoms such as watering, itching, foreign body
sensation, burning sensation, eye rubbing and sensitivity to light (photophobia)
Treatment
- obstruction of meibomian gland openings by melting, expression and removal of meibomian
gland secretions and debris by daily warm lid compresses and lid margin cleaning .
- the altered bacterial flora of lid margin and conjunctiva by topical and systemic antibiotics
(Erythromycin , Azithromycin, Chloramphenicol) .
- ocular surface inflammation by topical immunosuppressants and topical/systemic antibiotics
inhibiting bacterial lipase. (Glucocorticoid)
- topical lubricants diluting inflammatory mediators in the tear film and compensating for tear film
deficiency.
SUPERFICIAL
PUNCTATE KERATITIS
(SPK)
PUNCTATE KERATITIS (SPK)
- surface of the Cornea is dry from Inflammation (-itis...thus keratitis: -kera means Cornea).
- Cornea’s surface epithelial cells have died and left a bare area of underlying Bowman's membrane (the layer under the epithelium).
- When we put a Fluorescent drop , it stains Bowman membrane cells and not healthy epithelial cells.
cause of superficial punctate keratitis:

- A viral infection
- A bacterial infection
- Dry eyes
- Strong chemicals splashed in the eye
- Exposure to ultraviolet light (sunlight, sunlamps, or welding arcs)
- Prolonged use of contact lenses
Symptoms
- eyes are usually painful,
- watery,
- sensitive to bright light,
- vision blurred.
- burning, gritty feeling or a feeling as if a foreign object is trapped in the eye.
- When ultraviolet light causes the disorder, symptoms usually do not occur until several hours after exposure,
and they last for 1 to 2 days.
- When a virus causes the disorder, a lymph node in front of the ear on the affected side may be swollen and
tender.
Treatment
- Treatment depends on the cause
- cause by virus (other than a herpes simplex eye infection or herpes zoster of the eye ), no treatment
is needed, and recovery usually occurs within 3 weeks.
- cause by bacterial infection or prolonged use of contact lenses, antibiotics are used, and the wearing
of contact lenses is temporarily discontinued.
- cause by dry eyes, ointments and artificial tears are effective.
Dendritic corneal ulcer (blue pic)= herpes simplex keratitis
Contact lens related keratitis (green pic)
LOWER LID
MASS
CHALAZION
- develop when a meibomian gland at the edge of an eyelid becomes blocked or inflamed.
Symptoms
- early stages = small, red , inflamed area of the eyelid.
- few days, this inflammation can develop into a painless and slow-growing lump.
- A chalazion can appear on the upper or lower eyelid, but they are more common on the upper lid.
- generally painless .
- can cause the eye to become watery and mildly irritated.
- large chalazion may press on the eyeball, which can lead to blurry vision.
Management
􏰀 - May spontaneously disappear in weeks to months
􏰀 - Warm compress
􏰀 - Small = Intralesional triamcinolone injection􏰀
- Large = Incision and curettage
HORDEOLUM
- A hordeolum is a common disorder of the eyelid.
- an acute focal infection (usually staphylococcal) involving either the glands of Zeis
(external hordeola, or styes) or, less frequently, the meibomian glands (internal
hordeola).
􏰀 - Usually caused by S. aureus
- 􏰀 Painful, tender, red nodular masses near the eyelid margin
- 􏰀 May occasionally evolve into a chalazion

􏰀
Management
􏰀 - Warm compress
􏰀 - Topical antibiotic ointment 􏰀
- Systemic antibiotic 􏰀
- Incision and drainage
EPIDERMAL INCLUSION CYST
- is a dermal implantation cyst of epidermis.
- It can be congenital or acquired.
- The acquired form is usually in a site of prior trauma, which causes occlusion of
the orifice of the hair follicle.
- slow-growing, elevated, round, smooth, white lesion.
Treatment options
• Excision
• Marsupialization
ANTERIOR
SEGMENT
DYSGENESIS
ANTERIOR SEGMENT DYSGENESIS
- Disorders that affect the development of the front of the eye .
- which includes the cornea, iris, ciliary body, and lens.
- Glaucoma develops in approximately 60% of people with ASD, during
infancy or much later.
- can be autosomal dominant or autosomal recessive.
Treatment of signs and symptoms depends on the specific features in

ASD
- medications
- eye surgery
- corrective lenses for poor vision
Specific eye signs and symptoms of ASD
• Underdevelopment of the iris (iris hypoplasia).
• Growth of new blood vessels (vascularization) and opacity in the cornea.
• Corectopia (displacement of the pupil).
• Polycoria (more than one pupillary opening).
• Ectopia lentis (displacement of the lens).
• Aphakia (absent lens).
• Cataracts.
• Anterior synechiae (when the iris adheres to the cornea).
• Posterior keratoconus (thinning of the cornea).
Anterior synechiae
Individual disorders within the ASD spectrum include Axenfeld-Rieger
syndrome and Peters anomaly.
Axenfeld-Rieger syndrome
Peters anomaly.

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BLEPHAROKERATOCONJUNCTIVITIS

diagnosis is clinical and based on changes of the

cause of superficial punctate keratitis:

- 􏰀 May occasionally evolve into a chalazion

Treatment of signs and symptoms depends on the specific features in

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