Lid and Orbit Problem

BLEPHAROSPASM BLEPAROSPASM is a sudden, involuntary intermittent twitching of the muscles that surround the eye.This annoying twitching typically results from stress, anxiety, fatigue, lack of sleep and occasionally excessive use of alcohol or smoking. In some cases, it may result from increased caffeine consumption or from superficial irritation of the eye. Infrequently uncorrected refractive errors, eye-related factors cause of BLEPAROSPASM. Occasionally, oral decongestants containing antihistamines may reduce the annoying symptoms of this condition by relaxing the eyelid muscles. Better yet drink Quinine Water (tonic water), it may reduce or relieve the spasm. The muscle spasms are called BLEPAROSPASM.

BELL’S PALSYY The loss of the eyelid blink and exposure of the eye by the drooping lid are potentially dangerous to the eye. The eye requires moisture provided by the tear film. The eyelids are spread the tears and provide nutrients to the cornea and eye surface. Without a normal eyelid function and the tear film, the surface of the eye begins to dry out and die.

Bell’s palsy is most usually “self-limited,” resolving without treatment over a period of weeks or months. Until condition resolves, it is important to lubricate the eye. Artificial tears and ointments are important to eliminate the possibility of drying the eye.

Sometimes, taping the eyelids closed may be required to protect the eye’s vulnerable surface. Sometimes, suturing of the eyelids together (tarsorrhaphy) is necessary to protect the eye. Usually, this is only temporary. The surgery may be reversed and the lids to be fully opened.

BLEPHAROCHALASIS (Blef’-ah-row-ka-lay-sis) Blepharochalasis, Greek for “eyelid relaxation,” is droopy or excess eyelid skin. It is characterized by recurrent episodes of painless swelling of the upper eyelids. The cause may be due to previous abnormal swelling, or heredity. In the case of aging, this may be called dermatochalasis.

If the upper eyelid skin droops so that it blocks part of the vision, it is natural for the patient to unconsciously use the forehead muscles to lift the lids. Testing may be performed to determine the field of vision being blocked. This excess skin is often associated with dropping of the eyelid itself known as ptosis.

Wrinkled skin folds above and below the eyes can produce an aging, sagging or tired look. If the drooping is not affecting your appearance or your vision, there is no need for treatment. Correction involves surgery called blepharoplasty under local anesthesia.

BLEPHAROCLONUS Blepharoclonus is a increase in reflex blinking or the duration of the blink is longer than usual. This condition may be initiated by irritation or inflammation of the cornea or the conjunctiva.

Children may develop episodes of rapid involuntary blinking. Examination generally will not find a cause. In this case, if attention is removed from the child, the blinking typically decreases. When this condition develops adults, it may also involve muscles of the face. This condition is usually not organic thus treatment is unnecessary.

BLEPHAROPTOSIS / PTOSIS (Blef’ah-row Tow’-sis) Blepharoptosis, Greek for “falling eyelid,” or simply ptosis, is a condition where the eyelids droop. When the upper eyelids droop the patient unconsciously uses the forehead muscles to lift the lids. Testing can determine the extent of vision being blocked since is used determine insurance coverage. Ptosis may be congenital (present at birth), or due to trauma, neurological disease, or aging. If the drooping of the eyelids is not affecting vision, there is no need for treatment. Surgery for drooping eyelids is performed under local anesthesia.

CELLULITIS Cellulitisis an inflammation or an infection of the tissues, around the face and eyes. If the cellulitis is limited to the tissues around the eye, it is called preseptal cellulitis and is generally treated with oral antibiotics. The use of hot compresses is benificial. When the cellulitis extends to the deeper tissues, it is called orbital cellulitis which is much more serious. Orbital cellulitis requires rapid treatment.

CHALAZION Chalazia are chronic, sterile inflammations of the oil glands of the eyelid. The inflammation is a result of a blockage of the oil gland. Chalazia may become large enough to be associated with some localized pain, redness and tenderness. Treatment includes hot compresses and lid massage. Surgical intervention, to remove the lesion, may become necessary.

DACRYOADENITISDacryoadenitis is an uncommon inflammation of the lacrimal gland. The major symptom of this inflammation pain above the outer one-third of the upper eyelid.

DACRYOCYSTITISDacryocystitis is an inflammation of the lacrimal sac. The lacrimal sac is located at the side of the nose, below the inner corner of the eye. The lacrimal sac drains from the eye. This condition typically occurs in older patients. Symptoms include pain, redness and swelling of the side of the nose. Other symptoms may include tearing, with a mucus-like discharge. Hot compresses, massage, and antibiotics usually control the situation. If there is a chronic blockage of the duct leading from the nose to the eye, the condition will either re-appear in the future or will become chronic. Surgery may be indicated to create a new passage from the eyelid to the nose.

DERMATITIS Dermatitis is an inflammation of the skin. Sudden swelling, redness, with itching is associated with dermatitis. In extreme cases, there can be blisters, oozing, scaling and crusting. The most common type of dermatitis, is an allergic “contact” dermatitis. Contact dermatitis is due to direct contact with a substance to which you have an allergy or hypersensitivity. The substance or element. Common items which cause contact dermatitis include: soaps, dyes, perfume, or makeup including nail polish. The most important treatment is to eliminate the offending substance. A common misconception is that you will not be allergic to something that you have had constant contact with. The more often that you are in contact with a substance the more likely that you will develop a contact dermatitis.

Where the causative agent is unknown, eliminate all possible contact substances, and then add them back one at a time to test your skin’s reaction. Cool compresses, steroid ointments, oral antihistamines will help with both comfort and swelling.

EYELID ECCHYMOSISEcchymosis of the eyelid is a medical term for a “black eye.” The darkening of the tissue is a result of a contusion (bruise) of the eyelid and surrounding tissue. As in any bruise, the darkening is caused by blood within these tissues. Gravity will cause this darkening of tissue to grow larger. The darkening of the tissue results in a change from red to purple to yellow during the healing stages. Healing is dependent on the severity of the bruise. The tissues will clear within 7 to 14 days.

ECTROPIONEctropion is an turning outward of the upper and/or lower eyelid margin. As a result of the space between the eyelid and eyeball the tear fluid will have a tendency to spill on the cheek rather than lubricate the eye. Ectropion will generally cause excessive tearing (outside of the eye), dryness of the front surface of the eye and irritation. In mild cases artificial tears, warm compresses and/or topical antibiotic ointment are helful. Definitive treatment requires surgery to tighten the lid.

ENTROPIONEntropion is tan inward turning of the upper and/or lower eyelid margin towards eyeball. As a result the front of the eye can become irritated during the blinking. This irritation is caused by the rubbing of the lashes on the front of the eye. Artificial tears may be helpful with this condition. Topical antibiotic ointments are recommended. Definitive treatment requires surgery.

EYELID GROWTH Any changes the normal tissue surface may be called a neoplasm. It is not uncommon to find benign (not malignant) growths on the eyelids and facial structures. If there is no interference with vision, cosmesis, or comfort, then the growth may be left alone and watched carefully for growth or change.

If there is a suspicious appearance to a growth or changes such as enlargement, bleeding, or changing color of the lesion, removal should be performed with biopsy. Also, removal of such a growth is performed because of irritation or to relieve an impediment on vision. Most growths, can be removed in the office under local anesthesia. A quick injection will numb the area. You might feel a minor sensation of pressure, but no pain. The growth is excised and then bandaged, with an application of topical antibiotic for protection. Swelling may be minimized by the use of an ice pack. Tylenol is usually adequate for pain. If there is even the slightest concern, the tissue removed will be sent to further evaluation. It is important for you to pay close attention to this area to observe for future growths.

FLOPPY EYELID SYNDROME The eyelids are softer and more flexible than usual. The upper eyelid may even turn inside-out with little or no effort. This condition may make it difficult for the eyelids to close completely, especially during sleep, causing irritation and dryness to the eye. Treatment includes lubricants, antibiotics, taping of the lids at night. Rarely, eyelid-surgery is necessary. Patients with this condition may find it helpful to sleep face up.

SUBCONJUNCTIVAL HEMORRHAGEThis condition which typically occurs spontaneously is the same as a black and blue mark on the rest of the body. The sudden onset causes a high level of concern. It is not dangerous, the condition generally looks worse than it is. The cause is a rupture of the tiny blood vessel on the surface of your eye. This small hemorrhage is generally caused by a bout of coughing or sneezing. There is no treatment; however, a warm compress may facilitate cosmetic recovery. Avoid taking aspirin during the first two days. As with any bruise, it may take one to two weeks to completely resolve. During this time the blood may spread and may change color from red, to brown, to yellow. As a caution, make certain your blood pressure is normal.

HORDEOLUMThere are two types of hordeolum. External hordeolum or stye, which results from a bacterial infection of the sebaceous glands of the eyelid (these are small glands at the base of the hair follicles in the upper and lower lid). The other type is an internal hordeolum, which results from a similar bacterial infection of the meibomian glands of the eyelid (these glands secrete a the oily component that is part of the normal tear fluid). Pain or tenderness usually results when the area is touched. An eyelid scrub procedure and/or hot compresses are generally needed. Usually a topical antibiotic/steroid ointment may applied to the affected area. Surgical incision may become necessary if non-surgical efforts fail.

LAGOPHTHALMOS Lagophthalmos is a condition in which the eyelids do not completely close to completely cover the globe of the eye. This causes the front surface of the eye to be inadequately lubricated. As a result, the front surface of the eye dries and generally is uncomfortable. The more common lagophthalmos is called nocturnal lagophthalmos. It occurs when the eyelids do not completely close the eye while sleeping. This causes discomfort, especially in the early morning. Lagophthalmos commonly cause a sandy, gritty feeling accompanied by increased (tearing of the eyes. Treatment may include artificial tears, lubricating ointment and occasionally taping the eyelid or patching at bedtime. If medical therapy fails, surgically closing of the lids may be helpful.

LICEParasitic infestation of the eyelids results from the presence of lice in the lashes of the upper and lower lids. These lice typically form their nits, or egg sacs, on the base of the lashes. Treatment includes an eyelid scrub and ointment to smother the lice and a medicated (selsum-type) shampoo to kill lice infestation of the scalp.

MEIBOMIANITISThe meibomian (mi-bo’-me-an) glands, provide the oily component of the normal tear film. When these glands become blocked, or infected a “meibomitis” occurs. It may be necessary to release eyelid secretions by manually expressing them. Treatment will requires lid hygiene, including periodic hot lid-scrubs. Heat is helpful to open the glands and to soften the blocked glands. Topical application of a antibiotic/steroid ointment is sometimes helpful.

In some cases, a course of oral antibiotics is necessary. There is no permanent cure for this disease and this condition many recur. It is important to bear in mind that this is a chronic eyelid abnormality which often requires long term care by the patient.

TRICHIASIS (Tri-ki’-ah-sys) OR DISTICHIASISNormal eyelashes point away from the eye. In trichiasis one or more lashes are misdirected toward the eye and rub against the eyeball with each blink. With distichiasis there are an abnormal row of lashes, which are behind the normal eyelashes. With each blink irritation and injury to the outer surface of the eye may occur.

Frequently, it is necessary to remove offending eyelashes using forceps. Persistent problems may require cryotherapy (focal freezing treatments) or electrolysis. Rarely, surgery may be required to permanently remove the misdirected lashes.

XANTHELASMA They are characterized by yellowish, slightly raised, growths on the nasal side of the eyelids. They are harmless lipid deposits on the eyelid. No treatment is required unless they are removed for cosmetic reasons. These deposits may indicate hypercholesterolemia. Please inform your medical doctor of their presence so that the cholesterol and lipid studies can be performed in your next blood test

ROSACEA (Ro-zae’-she-a) Rosacea is a chronic, long-term skin disease which tends to worsen and improve over time. It primarily affects the face and eye. The characteristic findings of rosacea include a blush-like redness of the cheeks and nose. This condition has been called “adult acne.” The eyes can become involved in some cases by affecting the eyelids and conjunctiva. The cause of rosacea is unknown. Treatment includes topical and systemic medications.

Exposure to some substances make rosacea worse, such as alcoholic beverages, hot liquids, spicy foods, stress, and exposure to sunlight. While there is no complete cure for rosacea, the treatments available usually can control the condition.