Oculoplastics and Lacrimal
Disorders
Epiphora
Blepharitis
Nasolacrimal duct occlusion
Eyelid malposition
Ectropion
Entropion
Eyelid tumours
Basal cell carcinoma
Squamous cell carcinoma
Epiphora: Anatomy and Physiology
Blepharitis
• Blepharitis involving
predominantly the skin and
lashes tends to be staphylococcal
and (or) seborrheic in nature,
whereas involvement of the
meibomian glands may be either
seborrheic, obstructive, or a
combination (mixed).
• The pathophysiology of
blepharitis is a complex
interaction of various factors,
including abnormal lid-margin
secretions, microbial organisms,
and abnormalities of the tear
film.
Management
• The mainstay of treatment is an
eyelid hygiene regimen, which
needs to be continued long term
– Warmth
– Massage
– Cleansing
•
Topical antibiotics are used to
reduce the bacterial load.
• Topical corticosteroids and oral
antibiotic preparations may be
helpful in patients with marked
inflammation with specialist
monitoring
OMG- I’ve been
diagnosed with
blepharitis
Nasolacrimal duct obstruction
• Occurs in approximately 5-6% of
infants.
• A sticky, watery eye with positive
regurgitation on pressure over
the lacrimal sac confirms the
diagnosis.
• As there is a high spontaneous
rate of remission (60-90%) in the
first year of life, probing should
be delayed until 10-12 months of
age.
• Parents can be instructed to
undertake lacrimal sac massage
during the intervening period.
Earlier probing is only justified if
their is severe recurrent infection.
Recanalisation: Probing to DCR
• Probing of the naso-lacrimal
duct is the first line of
treatments
• With persistent epiphora
and recurrent infection, it
may be necessary to
perform a
dacryocystorhinostomy
(DCR).
• Bicanalicular silicone
incubation with Crawford,
Juneman or Ritleng tubes
can be carried out
Eyelid malposition
Tumours: Benign
Steps to differentiating benign
from malignant
Basal Cell Skin Cancer
 Small raised bump
 Smooth, pearly
appearance.
 Central necrotic area
 Telangectasia
 Sometimes like a scar that is
flat and firm to the touch.
Squamous Cell Carcinoma
 Sun exposed areas of skin
such as the ears, lower lip,
and the back of the hands
 Skin that have been burned
or exposed to chemicals or
radiation
 Often appears as a firm red
bump, may feel scaly or
bleed or develop a crust
Sebaceous carcinoma
Chronic blepharitis
Recurrent chalazion
Melanoma
Change
Contour
Colour
Size