LECTURE No. 6. Diagnosis, clinic and treatment of inflammatory diseases of the eyelids

Signs of diseases of the eyelids are very characteristic. Patients are often concerned about itching and burning in the eyelids, eye fatigue, and there may be a change in the shape and size of the palpebral fissure, the position of the ciliary edge of the eyelids, etc. The pathology of the eyelids, unlike diseases of the eyeball, is quite easy to determine already with an external examination.

A sharp swelling and hyperemia of the eyelids may indicate the presence of gonoblenorrhea (in children), diphtheria, as well as an abscess of the eyelids, acute meibomitis, barley. Edema, especially in the outer part of the upper eyelid, is noted in cases of inflammation of the lacrimal gland. Pronounced "cold" edema can be with allergic conditions.

When examining the edge of the eyelids, attention is paid to the features of eyelash growth, the presence of skin changes at their base, the condition of the excretory ducts of the meibomian glands. To clarify the diagnosis, carefully examine the eyelids and their position under side lighting and palpation. During the examination, attention is paid to the presence of skin lesions, which can be the entrance gate for infection.

1. Abscess of the century (abscessus palpebrae)

On examination, hyperemia of the skin of the eyelids is determined, palpation reveals induration (edema, infiltration) and tissue tension, their soreness.

In addition, the anterior lymph nodes may be enlarged and painful. If, along with all these signs, there is local softening and fluctuation, then it is advisable to open the abscess (incision).

In the absence of fluctuations, the administration of antibiotics in the form of injections around the abscess and oral administration of antibiotics or sulfonamides and UHF therapy are indicated.

2. Meybomite (meibomitis, hordeolum internum)

If, when examining a patient, there is limited infiltration in the eyelid area, the eyelid is painful on palpation, and when everted through the conjunctiva, a translucent yellowish focus in the cartilage is visible, then the diagnosis of meibomitis is undoubted acute purulent inflammation of the meibomian gland. Severely leaking meibomitis can lead to the formation of an extensive abscess of the eyelid.

Treatment. Warming procedures, UHF therapy, disinfectants.

3. Chalazion

This is a tumor-like, limited, somewhat protruding formation, dense to the touch, painful, soldered to the cartilage. It usually occurs after acute inflammation of the eyelid (meibomitis) and in some cases gradually increases.

Treatment of chalazion (hailstones) consists in absorbable drug therapy. However, most often it is ineffective, and then surgical removal of the hailstone in the capsule through an incision in the conjunctiva of the eyelid and cartilage is indicated, followed by treatment of the chalazion bed with an iodine solution.

4. Barley (hordeolum)

Barley is a purulent inflammation of the hair follicle or sebaceous gland of the edge of the eyelid, located at the root of the eyelash. The causative agent is most often a representative of the pyogenic flora, mainly staphylococcus aureus. Infection is facilitated by blockage of the excretory duct of the gland with a secret, as well as a decrease in the overall resistance of the body and diabetes mellitus.

Clinical picture and diagnosis. It is characterized by the appearance of a circumscribed and sharply painful swelling near the edge of the eyelid, which is accompanied by swelling and redness of its skin and (often) the conjunctiva. The inflammatory formation grows quite quickly, and after two to four days it undergoes purulent melting, which can be determined by the appearance of a yellow head at the top of the stye. On the third or fourth day, its contents (pus, dead tissue) break out, after which the pain immediately decreases and the inflammation subsides. Swelling and redness of the skin disappear around the end of the week.

In some cases, the inflammatory formation consists of several closely spaced or merged heads. In such cases, barley can occur against the background of intoxication, high temperature, and regional lymphadenitis.

A similar clinical picture is observed in acute purulent inflammation of the meibomian gland, meibomitis, however, the breakthrough of pus usually occurs from the side of the conjunctiva and cartilage, after which granulations (connective tissue) often grow. In persons with reduced body resistance, barley is prone to recurrence and is often combined with furunculosis.

Complications of stye can occur due to orbital phlegmon, thrombophlebitis of the orbital veins, purulent meningitis, which is most often associated with attempts to squeeze pus out of it.

When examining the eyelids, their hyperemia, swelling, density and pain are revealed, i.e. the picture resembles a limited abscess or acute meibomitis. However, upon closer examination, the inflammatory focus is determined in a limited area of ​​the ciliary edge of the eyelid in the form of swelling and hyperemia at the root of the eyelash. Usually after three to four days the inflammatory focus suppurates and opens.

Treatment. Dry heat and UHF are applied locally. A 23% solution of albucid, a 20% solution of erythromycin, and a 1% solution of dexamethasone are instilled into the conjunctival sac 0,1 times a day. The area of ​​infiltration (inflammation) on the skin of the eyelid is lubricated with a 1% alcohol solution of brilliant green.

After opening the stye, 2% albucidal ointment (sodium sulfacyl), 20% syntomycin emulsion, 1% tetracycline ointment, 1% hydrocortisone emulsion, 1% yellow mercury ointment are applied to the eyelids 1 times a day.

If the disease is accompanied by symptoms of intoxication, sulfanilamide preparations are administered orally 1 g 4 times a day or tetracycline antibiotics (biomycin 100 IU 000 times a day, tetracycline or terramycin 46 g 0,25 times a day).

With recurrent barley, the patient is shown a thorough examination (determination of the immune status, glycemia, glucose tolerance, etc.) to identify the cause of the disease. Assign courses of antibiotic therapy, vitamin therapy, sometimes repeated transfusions of canned blood and autohemotherapy (transfusion of one's own blood).

5. Toxicoderma (toxicodermia) eyelid

In the practice of a pediatrician, there are often cases of drug intolerance. It must be remembered that this intolerance can occur after topical atropine, quinine, antibiotics and other drugs. At the same time, children go to the doctor with reddening of the skin of the eyelids, vesicles on the eyelids, erosions at the site of the former vesicles, as well as with conjunctivitis. This pathological condition is called eyelid toxicoderma.

Treatment. Cancellation of drugs that can cause the disease, and the appointment of desensitizing agents (calcium chloride, diphenhydramine).

6. Eyelid herpes

Sometimes, after an infection, a cold, edematous eyelids are observed with the presence of transparent vesicles or crusts that appear after the vesicles dry. The process is accompanied by severe itching and local pain. This is most likely a simple herpes of the eyelids, caused by a filterable virus (herpes symplex). In some cases, on the skin, more often than the upper eyelid, as with herpes simplex, vesicles of large sizes and in greater numbers are found. The transparent contents of the vesicles may become cloudy, become purulent, crusts, ulcers may form. The process is accompanied by severe local and headaches. This is herpes zoster. The basis of the disease is the defeat of the trigeminal nerve, often its first branch.

Treatment. Analgesics, B vitamins, brilliant green moxibustions.

7. Vaccine eyelid pustules

An external examination reveals cyanotic edges of the eyelids, pustules (cloudy vesicles) and sores with a greasy coating on the skin. The eyelids are painful on palpation, the anterior lymph nodes are enlarged and painful. Most often, from the anamnesis of these patients, it is revealed that they have had chicken pox or they have been vaccinated against smallpox. Treatment is symptomatic.

8. Infectious mollusk (molluscum contagiosum)

On the eyelids of children, single and multiple yellowish nodules of various sizes and with a depression in the center are found. This is a typical picture of an infectious mollusk. Its causative agent is a filterable virus.

Due to the significant contagiousness of the disease, treatment consists in removing the nodules and treating the bed with iodine (Lugol's solution).

9. Scaly blepharitis (blepharitis squamosa)

If the patient complains of itching in the eyelids, eye fatigue, and on examination it is found that the edges of the eyelids are hyperemic, thickened, small grayish scales or yellowish crusts (a frozen secret of the sebaceous glands) are visible at the base of the eyelashes, then this makes it possible to suspect scaly blepharitis.

10. Ulcerative blepharitis (blepharitis ulcerosa)

In cases where the edges of the eyelids are sharply hyperemic, thickened, covered with ulcers and yellowish crusts, after which the surface bleeds, one should speak of ulcerative blepharitis. At the same time, hair follicles and sebaceous glands are involved in the process. As a result, scars remain, eyelashes fall out (madarosis), often begin to grow incorrectly.

Uncorrected refractive errors, anemia, beriberi, helminthic invasions, diabetes, diseases of the teeth, tonsils, etc. predispose to the occurrence of blepharitis.

Treatment of blepharitis is aimed at eliminating its possible cause. In addition, general strengthening agents are prescribed. The edges of the eyelids are degreased with 70% alcohol, treated with disinfectant solutions: calendula, 1% solution of brilliant green, and then lubricated with 1% synthomycin emulsion, 10% sulfacyl ointment, etc. Before starting treatment for ulcerative blepharitis, hair removal must be performed eyelashes

11. Trichiasis

Occasionally (especially in children), when examining the intermarginal space, it is possible to detect abnormal growth of trichiasis eyelashes. Separate eyelashes face the eye, irritate the conjunctiva and cornea, causing tearing, pain, contributing to the development of corneal ulcers. Partial trichiasis in children may be due to scarring after ulcerative blepharitis, frequent styes.

Treatment. Diathermocoagulation of eyelash bulbs with a needle electrode; with gross changes, plastic surgery is indicated.

Author: Shilnikov L.V.

<< Back: Technique for examining the condition of the eye (part III) (Gonioscopy. Tonometry. Tonography. Echoophthalography. Exophthalmometry)

>> Forward: Congenital pathologies and neoplasms of the eyelids (Ankyloblepharon). Coloboma of the eyelid (coloboma palpebrae). Epicanthus (epicanthus). Entropion of the eyelids (entropium palpebrarum). Eversion of the eyelids (ectropium palpebrarum). Lagophthalmos, or "hare's eye" (lagophthalmus paralyticus). Dermoid cyst. Hemangioma of the eyelids. Neurofibromatosis (Recklinghausen's disease)

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