STYE OR HORDEOLUM EXTERNUM

Definition

It is an acute suppurative inflammation of the glands of Zeis.

Etiology

Bacterial - Staphylococcus.

Symptoms

Acute Pain, Lid swelling, Watering.

Signs

•           A painful swelling at the lid margin.

•           A whitish, round, raised pus point at the affected eyelash root maybe present.

Treatment

•           Hot compresses 2-3 times per day for 4-6 days.

•           Topical Antibiotic eye drops like Ciprofloxacin 0.3%, Moxifloxacin, Gatifloxacin four to six times per day.

•           Systemic antibiotics and anti-inflammatory medications for three or four days.

•           When pus points out, it should be let out by pulling the affected lash i.e. Epilation.

•           It should never be squeezed out.

Prevention of Recurrence

•           Cleaning of lid margins.

•           Application of antibiotic eye ointments at night for at least 2 months after the stye has subsided.

•           Cap. Doxycycline 100 mg/day for 10 days but not in children below 8 years of age to avoid permanent colouring of teeth.

•           Correction of refractive errors if any.

HORDEOLUM INTERNUM (INFECTED CHALAZION)

Definition

It is an acute suppurative inflammation of the Meibomian gland.

Symptoms

Pain, lid swelling and watering.

Signs

•           A painful diffuse swelling away from the lid margin.

•           Pus point is situated away from the lid margin and is on conjunctival side.

Treatment:

•           Antibiotic eye drops 4-6 times per day.

•           Systemic antibiotics and anti-inflammatory medication for three or four days.

•           The pus should be drained by incision and curettage under systemic antibiotic cover.

•           Hot fomentation.

CHALAZION

Definition

If is chronic granulomatous inflammation of the Meibomian gland.

Etiology

Obstruction of the duct of Meibomian gland due to sub-clinical infection.

Symptoms

Painless swelling of the lid, Heaviness of lid, Watering.

Signs

Painless nodular lid swelling.

Course

•           Spontaneous resolution with or without hot fomentation.

•           If secondarily infected, then it is called as internal Hordeolum.

•           It may burst through the conjunctiva.

•           Very rarely, a malignant change may occur (Meibomian carcinoma) especially in old age with a history of recurrence.

Treatment

•           Hot fomentation.

•           Incision and curettage under local anaesthesia.

•           Intra-lesion injection of Depot steroids: 5- 10mg (0.1 to 0.2 ml) of Triamcinolone acetonide (40 mg/ml vial) may be helpful. Two to three injections at weekly interval may be needed.

•           Correction of refractive errors, if any.

Patient education

If a Chalazion recurs soon after removal or is rapidly increasing in size or ulcerates, a biopsy must be done to rule out malignancy especially in adults above 40 years of age.

ERRORS OF REFRACTION OR AMETROPIA

Definition

Ametropia is a condition of the eye in which blurred image is formed upon the retina and vision remains sub-normal due to abnormal refractive status of the ocular optics.

Types of Refractive errors.

1. Myopia (Short sightedness)

Eye cannot see distant objects clearly. Image is focused in front of the retina and it happens when the eyeball is elongated.

2. Hypermetropia (Long sightedness)

Eye cannot see closer objects clearly. Image is focused behind the retina and happens when eye i is shorter in antero-posterior length.

3. Astigmatism

No single point focus is formed. Refraction is unequal in different meridians.

Sign/Symptoms

•           Indistinct distant vision.

•           Headache and pain in the eyes (Asthenopia).

•           Eye strain and fatigue.

•           Behavioural changes in children.

4. Presbyopia

It is a condition in which the reading distance recedes beyond convenient distance (30 cms) which usually manifests by the age of 40 years and it is a physio- pathological process which affects accommodation. Patient usually complains of eye strain on near work.

Diagnosis

•           Status of decreased vision is ascertained by standardised Snellen's Charts for distant vision and Jaeger's Charts for near vision.

•           The estimation of amount of refractive error for distant vision is done by Retinoscopy, Auto refractometry or by subjective verification (hit and trial method).

Treatment

a.    If asymptomatic - No treatment is required.

b.    If Symptomatic

•           Correction by spectacles (Lenses)

•           Contact lenses

•           Refractive surgery

Spectacles (Lenses)

•           Myopia - spherical concave lenses.

•           Hypermetropia - spherical convex lenses.

•           Astigmatism - cylindrical orsphero-cylindrical lenses.

•           Presbyopia - spherical convex lenses depending on age and occupation of the patient.

Contact lenses

Commonly used lenses are soft contact lens, semi soft or gas permeable, soft toric lenses for astigmatism, bi-focal contact lenses for refractive errors.

Refractive Surgery

•           LASIK: LaserAssistedIn Situ Keratomileusis.

•           LASEK: LaserAssisted in Situ Epi-Keratomileusis.

•           PRK: Photo refractive Keratotomy.

•           Phakic IOL implantation.

•           Conductive keratoplastyforpresbyopia using radio-frequency current.

Prevention

•           Assessment of refractive errors should be done in Pre School Children (1

-3 years). The teachers should be trained for screening.

•           School going children should be screened yearly.

ALLERGIC CONJUCTIVAL DISORDERS

It is inflammation of the conjunctiva due to allergic or hypersensitive reaction to local or systemic allergens, which may be immediate or delayed.

Common types

1.  Simple allergic conjunctivitis

•           Mild, nonspecific recurrent episodes occur with renewed contact with the allergen.

2.  Vernal keratoconjunctivitis (Spring Catarrh)

•           Recurrent, bilateral, self-limiting, allergic inflammation of conjunctiva.

•           Periodic seasonal incidence in young patients, usually males between to 20 years.

•           Common in summer and greater prevalence in tropics, less in temperate zones and nonexistent in cold climatic zones.

•           In chronic stage cobble-stone appearance on the sub-tarsal conjunctiva is seen.

3.  Phlyctenularkerato conjunctivitis

-     Nodular allergic reaction by conjunctival and corneal epithelium to endogenous allergens.