Transcript Pterygium/Pingueculum

Cataract and Premium IOLs
Blepharoplasty
Lid Surgery
Botox and Facial Fillers
Laser Refractive Surgery
Pterygium
Dry Eyes
Diabetic
Glaucoma
Clinical Studies
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Irritation, burning, tearing
Foreign body sensation
Redness
Decreased vision
Double vision in advanced cases
May be asymptomatic
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Yellow-white flat or slightly raised
conjunctival lesion
Usually in the interpalpebral fissure, nasal to
the limbus
Not involving the cornea
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Wing-shaped fold of fibrovascular tissue
Elevated at the interpalpebral fissure of the
conjunctiva
Nasal > temporal to the limbus
Can be bilateral, usually asymmetric
Extending onto the cornea – loss of corneal
transparency and irregular astigmatism
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May be vascularized and injected
May be associated with superficial punctate
keratitis or dellen (thinning of the cornea due
to uneven tear pooling and drying)
Stocker’s line (iron line) may be seen on the
leading edge of the pterygium on the cornea
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Conjunctival intraepithelial neoplasia (CIN)
◦ Unilateral jelly-like, velvety, leukoplakic (white)
mass
◦ Often elevated, vascularized, and not wing-shaped
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Dermoid
◦ Congenital white lesion
◦ Usually inferotemporal limbus
◦ Occasionally associated with deformity of the ear,
preauricular skin tags, and/or vertebral skeletal
defects (Goldenhar’s syndrome)
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Pannus
◦ Blood vessels growing on to the cornea, often
associated with contact lens wear, trachoma,
phlyectenular keratitis, atopic disease, blepharitis,
ocular rosacea, herpes keratitis, or others
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Elastoid degeneration of collagen and the
subepithelial fibrovascular tissue
UV sun, dust, wind… repeated exposure
Chronic irritation – contact lenses, welding
Higher prevalence with proximity to the
equator
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Conservative therapy, unless
◦ Reduce vision due to induced astigmatism or
encroachment onto the visual axis
◦ Cosmetic
◦ Marked discomfort and irritation, unrelieved by
conservative treatment
◦ Restricted ocular motility
◦ Progressive growth toward visual axis
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Protect eye from sun – wear sunglasses
Mild - topical lubricants
Moderate - topical
antihistamine/vasoconstrictor
Mod. to severe - topical corticosteroid
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Recurrence rate is very high 10% - 90%
No single approach is universally successful
Recurrence rate is reduced with grafting
approach
Temporal Recurrent Pterygium – 5 years
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Excise pterygium – head and body
Clean conjunctiva to bare sclera
Avoid damage of underlying rectus muscle
Polish with diamond burr
Mitomycin C application – antifibroblast
Harvest autograft – limbus to limbus
Tisseel fibrin glue
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Topical antibiotic and steroid
Watch IOP
http://www.youtube.com/watch?v=A7m61oVD
ytc
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Abnormal eversion or turning out of the lid
margin away from the globe.
Usually involves lower lids
Usually has a horizontal lid laxity
Co-morbidity: associated with
corneal/conjunctival exposure
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Red and irritated eye with tearing.
Pain, gritty feeling, crusting of lids
Constantly wiping their eyes, exacerbating
the lid laxity.
History of chronic eye drop use, especially in
glaucoma pts.
History of facial or eye
trauma/cancer/surgery.
Facial skin pathology
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Congenital
◦ Rare
◦ May be associated with other orbital abnormalities
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Blepharophimosis
Microphthalmos
Buphthalmos
Down syndrome
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Acquired
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Involutional – most common
Paralytic
Cicatricial
Mechanical
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Most common
Horizontal lid laxity – age related
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CN VII palsy – Bell palsy, herpes zoster, tumor
of parotid gland
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Scarring of anterior lamella
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Facial burns
Trauma
Chronic dermatitis
Chronic use of eye drops - glaucoma
Excessive lower lid blepharoplasty
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Lid tumors
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Lubrication
Wipe only superiorly and nasally to avoid
conjunctival irritation
Antibiotic ointment, especially at night
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Lateral tarsal strip procedure – for horizontal
lid laxity/involutional ectropion
Medial conjunctival spindle procedure – for
mild medial ectropion with punctum
ectropion
Anterior lamella graft may be necessary in
cicatricial ectropion
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Conjunctival and corneal exposure –
keratinization and perforation
Retrobulbar hemorrhage, hematoma,
infection, wound dehiscence, poor
positioning of tarsal strip, and rounded
lateral canthus
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Inversion of eyelid margin
Usually lower lid
Lashes rubbing against ocular surface
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Red and irritated eye
Foreign body sensation
Blurred vision
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Congenital
Acute spastic
Involutional
Cicatricial
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Rare
Pediatric epiblepharon – no symptoms
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Result of ocular irritants – infection,
inflammatory, trauma
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Horizontal lower lid laxity of medial and /or
lateral canthal tendons
Snap test
Tight squeeze test
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Scarring of palpebral conjunctiva – trauma,
chemical burns, Stevens-Johnson syndrome,
ocular cicatricial pemphigoid, infections, or
topical medication
Snap test is difficult
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Epiblepharon – pretarsal orbicularis muscle
and skin override the lid margin and push the
eyelashes inward.
◦ Asymptomatic
◦ Common in Asians
◦ Spontaneously resolves as face matures
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Trichiasis
Distichiasis
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Lubrication
Lid hygiene
Antibiotic/steroid
Taping of lower lid
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Quickert sutures
◦ Temporary fix
◦ Good for spastic entropion
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Tarsal wedge resection
◦ Successful
◦ In-office procedure
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Horizontal or vertical lid shortening
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Retrobulbar hemorrhage
Wound dehiscence
Infection
Corneal injury
Recurrence
Consecutive ectropion