Review

Authors: Erin C O'Neil, Matthew Henderson, Mina Massaro-Giordano...

PURPOSE OF REVIEW

The prevalence and burden of dry eye disease continues to grow at a rapid pace, creating an increased need for new therapies. In a sector once limited to only a handful of treatments, clinicians now have multiple options available for patients who fail traditional therapies. This review summarizes the various treatment options available to clinicians treating complex dry eye disease patients.

RECENT FINDINGS

As we better understand the multifactorial mechanisms leading to dry eye disease, treatments increasingly focus on the amelioration of the underlying deficiencies and inflammation, rather than on transient symptomatic relief alone. Most topical medications seek to replace deficient growth factors and/or decrease inflammation on the ocular surface. The majority of new devices and procedures seek to treat meibomian gland dysfunction, with one new device stimulating tear production through utilizing the nasolacrimal reflex pathway.

SUMMARY

Clinicians have more options at their disposal in the treatment of dry eye disease than ever before, including topical medications and devices.

Topics: Dry Eye Syndromes; Eyelid Diseases; Humans; Meibomian Glands; Tears

PubMed: 30883442
DOI: 10.1097/ICU.0000000000000569

Review

Authors: Kasturi Bhattacharjee, Diva Kant Misra, Nilutparna Deori...

The human face is composed of small functional and cosmetic units, of which the eyes and periocular region constitute the main point of focus in routine face-to-face interactions. This dynamic region plays a pivotal role in the expression of mood, emotion, and character, thus making it the most relevant component of the facial esthetic and functional unit. Any change in the periocular unit leads to facial imbalance and functional disharmony, leading both the young and the elderly to seek consultation, thus making blepharoplasty the surgical procedure of choice for both cosmetic and functional amelioration. The applied anatomy, indications of upper eyelid blepharoplasty, preoperative workup, surgical procedure, postoperative care, and complications would be discussed in detail in this review article.

Topics: Blepharoplasty; Eyelid Diseases; Eyelids; Humans

PubMed: 28724810
DOI: 10.4103/ijo.IJO_540_17

Review

Authors: Priyanka Chhadva, Raquel Goldhardt, Anat Galor...

TOPIC

To discuss the pathology, causes, and ocular surface impact of meibomian gland disease (MGD), as well as its relationship to dry eye.

CLINICAL RELEVANCE

MGD is a common disorder with various contributing mechanisms and clinical manifestations. Understanding MGD pathophysiology and its relationship to dry eye is important in order to optimize diagnosis and treatment algorithms.

METHODS

A review of current literature was performed to discern MGD in terms of pathophysiology, risk factors, and ocular surface impact, and the relationship to dry eye.

RESULTS

Meibomian gland obstruction and meibocyte depletion are important components of MGD. Many pathologies can disrupt function of meibomian glands, ranging from congenital to acquired causes. Once gland disruption occurs, the quality and quantity of meibum is altered, with a negative impact on the ocular surface. Increased tear evaporation, tear hyperosmolarity, increased ocular surface staining, increased inflammation, symptomatic irritation of the eyelid and globes, as well as decreased visual acuity have all been observed.

CONCLUSION

MGD leads to changes in meibum quality and quantity that can cause evaporative dry eye and ocular surface disruption, leading to dry eye symptoms in some individuals.

Topics: Animals; Dry Eye Syndromes; Eyelid Diseases; Humans; Meibomian Glands

PubMed: 29055358
DOI: 10.1016/j.ophtha.2017.05.031

Review

Authors: Robert Thomas Carlisle, John Digiovanni

The swollen red eyelid is a common presentation in primary care. An understanding of the anatomy of the orbital region can guide care. Factors that guide diagnosis and urgency of care include acute vs. subacute onset of symptoms, presence or absence of pain, identifiable mass within the eyelid vs. diffuse lid swelling, and identification of vision change or ophthalmoplegia. Superficial skin processes presenting with swollen red eyelid include vesicles of herpes zoster ophthalmicus; erythematous irritation of contact dermatitis; raised, dry plaques of atopic dermatitis; and skin changes of malignancies, such as basal or squamous cell carcinoma. A well-defined mass at the lid margin is often a hordeolum or stye. A mass within the midportion of the lid is commonly a chalazion. Preseptal and orbital cellulitis are important to identify, treat, and differentiate from each other. Orbital cellulitis is more often marked by changes in ability of extraocular movements and vision as opposed to preseptal cellulitis where these characteristics are classically normal. Less commonly, autoimmune processes of the orbit or ocular tumors with mass effect can create an initial impression of a swollen eyelid.

Topics: Diagnosis, Differential; Edema; Eyelid Diseases; Eyelids; Humans

PubMed: 26176369
DOI: No ID Found

Authors: Álvaro Machado, Susana Machado, Manuela Selores...

Topics: Adult; Atrophy; Eyelid Diseases; Eyelids; Humans; Male; Photography; Pigmentation Disorders

PubMed: 31292031
DOI: 10.20344/amp.11246

Authors: D J Bergin, C D McCord, T Berger...

Blepharochalasis is an uncommon disorder distinguished by recurrent episodes of eyelid oedema in young patients. A hypertrophic form, manifested as fat herniation, and an atrophic form, manifested as fat atrophy, have been described. Ptosis with excellent levator function, laxity of the lateral canthal structures with rounding of the lateral canthal angle, nasal fat pad atrophy, and redundant eyelid skin develop after many episodes of eyelid swelling. Fine wrinkling, atrophy, and telangiectasias characterise the excess eyelid skin. We describe four cases of this syndrome in which external levator aponeurosis tuck, blepharoplasty, lateral canthoplasty, and dermis fat grafts were used to correct atrophic blepharochalasis after the syndrome had run its course.

Topics: Adolescent; Adult; Atrophy; Edema; Eyelid Diseases; Eyelids; Female; Humans

PubMed: 3207663
DOI: 10.1136/bjo.72.11.863

Authors: Zahra N Jaffer, Cherie Nicholson

Periocular necrotising fasciitis is a rare but sight-threatening condition, which relies on clinical judgement to detect in a timely manner. A 51-year-old woman presented to a rural hospital with rapid onset bilateral eye swelling, erythema and pain and was started on broad spectrum intravenous antibiotics. Upon admission, she became septic and required fluid resuscitation and transfer to a higher level of care. She received debridement and continued intravenous antibiotics, with step down to oral when clinically stable. Rapid recognition and treatment of her condition resulted in a positive outcome.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Diagnosis, Differential; Eyelid Diseases; Eyelids; Fasciitis, Necrotizing; Female; Humans; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Streptococcal Infections; Streptococcus pyogenes; Vancomycin

PubMed: 29472418
DOI: 10.1136/bcr-2017-220962

Review

Authors: Ling Zhang, Jingru Wang, Yingying Gao...

Nowadays, people give more importance and pay closer attention to the condition of their eyelids and lid margins. This increased recognition of eyelid hygiene is due to the growing awareness that improper eyelid cleaning might lead to various ocular surface diseases such as blepharitis and meibomian gland dysfunction. These ocular surface diseases can greatly affect people's quality of life. This article reviews the latest procedures for proper eyelid cleaning, including indications, methods, tools, detergents, and clinical applications, to maintain a healthy ocular surface and assist in the treatment of dry eye and blepharitis.

Topics: Humans; Quality of Life; Eyelids; Blepharitis; Meibomian Gland Dysfunction; Hygiene; Dry Eye Syndromes; Meibomian Glands; Eyelid Diseases; Tears

PubMed: 37991291
DOI: 10.4103/IJO.IJO_1457_23

Authors: B K Jun, J C Shin, J J Woog...

Myiasis is most prevalent in Mexico, central and south America, tropical Africa, and the southwestern United States. Although dermal myiasis is rare in most of the United States, it is a disorder that may be seen in international travelers. In the United States, external myiasis is usually caused by the cattle botfly. We report here a case of ophthalmomyiasis involving the left upper eyelid of a child. We examined a six-year-old boy who presented to the Massachusetts Eye and Ear Infirmary (MEEI) in September 1998. He complained of persistent swelling of his left upper eyelid for the previous ten days. The edema and erythema were unresponsive to warm compresses and oral antibiotics. Ocular examination revealed a mild preseptal cellulitis of the left upper eyelid with a small draining fistula. On slit-lamp examination, we found one larva protruding intermittently from the fistula site. The larva was extracted with forceps, wrapped in a moist towel and sent in a jar to the parasitology laboratory. The specimen was identified as a Cuterebra larva by a parasitologist at the Harvard School of Public Health. One week later, the patient's eyelid edema and erythema had completely resolved.

Topics: Animals; Child; Diagnosis, Differential; Diptera; Eye Infections, Parasitic; Eyelid Diseases; Eyelids; Humans; Larva; Male; Myiasis

PubMed: 10761413
DOI: 10.3341/kjo.1999.13.2.138

Review

Authors: Renato Wendell Damasceno, Georgia Avgitidou, Rubens Belfort...

Life expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

Topics: Elastic Tissue; Elastin; Eyelid Diseases; Eyelids; Female; Humans; Male; Skin Aging

PubMed: 26466237
DOI: 10.5935/0004-2749.20150087