Diseases of the lids and nasolachrymal apparatus

Diseases of the eyelids and nasolachrymal system include tumours, deformities of the lids, and watering (epiphora). Globally, the most important disease of the lids is trachoma, which scars them, and causes them to turn inwards (entropion, 24.13). The commonest and usually the most harmless disease of the lid is a stye.

THE LIDS If a patient has a red swelling on his lid margin, with an eyelash coming out of it, he has a stye (hordeolum). This is a staphylococcal infection of the follicle of an eyelash. Pull the eyelash out of the swelling, and give him an analgesic. Antibiotics are only necessary in recurrent styes, or if there are signs that infection is spreading beyond his lid (carotid sinus thrombosis is a rare complication, 5.5). Suggest that he tries hot spoon bathing (24.1).

If he has a swelling in either lid, some distance from its margin, pointing towards its conjunctival surface, he probably has a tarsal cyst, (chalazion, Meibomian cyst). Avoid an external scar by incising his conjunctiva wherever the cyst points.

If a few lashes turn in on the eye (trichiasis), remove them with a pair of forceps (epilation). They regrow, and need removing at regular intervals.

If most of his lashes or the margin of his lid is turned in (entropion), he needs surgery (24.13).

If the margin of either lid is everted (ectropion), usually as the result of scarring, seventh nerve palsy, or leprosy, surgery may be necessary (unusual).

THE NASOLACHRYMAL APPARATUS If a mother brings you her young child saying that he has had a watering eye since birth, he has congenital atresia of his nasolachrymal duct. It will probably resolve spontaneously by the age of 18 months. Reassure her, and give her a topical antibiotic to apply if he gets conjunctivitis. If his eye is still watering at the age of 2 years, his nasolachrymal duct needs probing and syringing. Refer him.

If something interferes with the drainage of an adult's tears, his eye waters (epiphora) even if there is no local irritation. He can usually learn to live with it, but epiphora can occasionally be so severe that it needs surgery (dacryocystorhinostomy). Refer him.

If he has a tender swelling between his eye and the side of his nose, he probably has acute dacryocystitis (an abscess in his tear sac). Give him a systemic antibiotic, an analgesic, and warm soaks (5.5).