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Dermatology

  • Acne rosacea – abnormal flushing of face, problems to lid margin; reduced tear film and secondary severe dry eye disease

    • Often associated with pustule

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  • Topical allergy

    • Can affect conjunctiva

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  • Psoriasis

    • uveitis

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  • Mucous membrane pemphigoid

    • Ocular surface disease

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  • Lid tumours

    • BCC, SCC

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Blepharitis

  • Acne rosacea eye disease tends to occur in the form of blepharitis

  • Ubiquitous seborrheic disorder of the Meibomian glands

    • Located at lid margin at base of eye lashes, normally secrete oily layer onto tear film to prevent evaporation of aqueous

  • Causes mild ‘gritty’ sensation if glands blocked

    • Bacteria which normally live within lid margins can proliferate so can get secondary hypersensitivity reaction on surface of eye

  • Treated with lid hygiene ± oral tetracyclines

    • Hot compresses across eye for 5-10 minutes twice a day, wipe around eyelid with cotton wool bud and cool bowl of water to try and remove some of debris from the glands

    • E.g. doxycycline 50-100mg daily for up to 6 months

      • Reduce bacterial load in lid margins

 

Stevens Johnson syndrome

  • Acute reaction to drugs and infection

  • Fas-FasL mediated keratinocyte apoptosis

  • Prodrome: fever, malaise, sore throat, arthralgia

  • Eye: pseudomembranous conjunctivitis, cicatrisation of the conjunctiva and lids

    • Cicatrisation = abnormal adhesions between conjunctiva and eyelid  loss of usual fornices, disturbance of ocular surface (can see evidence in bottom right)

  • Skin: erythematous maculopapules, vesicubullous lesions, skin denudation

  • Mouth: bullae, erosions, haemorrhagic crusts

 

Herpes Zoster Ophthalmicus

  • Shingles affecting CNV1

    • Important to check the nose on affected side

      • If vesicles along side of nose, suggests ciliary branch involvement  greater risk of ocular involvement

  • Multiple possible ocular complications

    • Keratitis

    • Uveitis

    • Glaucoma

  • Require ophthalmic examination

 

Mucous membrane pemphigoid

  • Rare, idiopathic, chronic progressive immune-mediated disease

  •  Females>males

  • Inflammation followed by scarring

  • Skin: affected in 25%

    • Type 1: recurrent vesicobullous, non-scarring

    • Type 2: localised erythematous plaques, with recurrent vesicles and bullae, healing to small atrophic scars

  • initially acute phase, with inflamed ocular surface. Later – peripheral scarring following resolution of inflammation

  • Mouth: 80%

    • Submucosal blisters leading to erosions, scars and strictures

  • Eye: 50-70%

    • Dry eye, symblepharon, ankyloblepharon, keratopathy

      • Symblepharon: adhesions between lid and globe

      • opaque cornea due to severe infiltrate and inflammation. Injected conjunctiva surrounding opacified area

    • Treatment with topical and systemic steroids, immunosuppressants, contact lenses, lid surgery

 

Sturge Weber Syndrome

  • Rare congenital disorder

  • Port-Wine stain

  • Seizures

  • Mental retardation

    • Intracranial AVMs

  • 50% have glaucoma

 

Malignancy

  • Basal cell carcinoma

    • Lid distortion of lid margin

    • Central ulceration

    • Telangiectasia

    • Good prognosis if removed early

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