Eye conditions part 1
By Dr Nigel Stollery
By Dr Nigel Stollery
Basal cell carcinoma
Basal cell carcinomas (BCCs) are the most common primary malignant tumours of the eyelids. The incidence increases with age.
The lesions are asymptomatic and often grow very slowly, and so may go unnoticed by the patient for many months.
They most commonly occur on the inner part of the lower eyelid. In the early stages the only noticeable feature may be a break in the lash line, but as they increase in size telangiectasia and ulceration may become visible and the lid margin may become distorted.
BCCs can be excised or treated with radiotherapy, which can be challenging if the tumour is large, such as the one shown in the picture. Any early sign of lid disruption or loss of lashes therefore requires prompt referral for biopsy and early treatment.
An arcus is a pale ring that circumscribes the periphery of the cornea. Although it is often termed arcus senilis as it is more common in older patients, the condition can affect any age group from childhood onwards.
The condition is usually bilateral and tends to start at the 6 o'clock and 12 o'clock positions, gradually extending around the eye. There is usually a clear band between the arcus and the edge of the cornea.
Arcus is an asymptomatic condition that does not require treatment. However, there is an increased incidence in patients with hyperlipidaemia and all patients who present with the condition should have a lipid profile.
In cases of entropion the eyelid turns inwards, causing the eyelashes to come into direct contact with the cornea. This causes trauma to the surface of the eye and may lead to scarring and, in severe cases, blindness. It is less common than ectropion, in which laxity of the eyelid allows it to sag or droop, causing the eye to water more and tears to overflow.
Patients with entropion can be referred to an optician for regular plucking of the lashes, but in many cases surgery is required.
Meibomian cysts or chalazions are small, common swellings that occur just behind the lid margin. They resolve spontaneously in 30% of cases, the remainder can be excised under local anaesthetic.
However, in some cases the meibomian glands will become acutely infected and a meibomian abscess will develop. The swelling becomes red and painful, and may point and discharge through the conjunctiva or outwards through the skin.
Incision from the conjunctival side may allow drainage, after which a topical antibiotic can be used to treat the infection. In recurrent or chronic cases, long-term treatment with an antibiotic such as oxytetracycline can be tried for up to four months.
Inflammation of the iris, termed acute iritis or anterior uveitis, can be associated with a number of conditions, including toxoplasmosis, syphilis, herpes simplex infections and corneal ulcers. It can also be associated with autoimmune disorders such as systemic lupus erythematosus and rheumatoid arthritis.
Isolated idiopathic iritis, as shown in the picture, is quite common and can occur in otherwise healthy individuals. If there are no systemic symptoms at the time of presentation, investigations seldom reveal an underlying cause.
Iritis may be associated with pain extending to the forehead, photophobia and watering but not discharge. There is typically redness around the corneal edge, which may extend to involve the whole eye.
Patients with iritis should be referred to secondary care for a slit lamp examination, which will reveal a small, often irregular pupil. Treatment options include topical steroids and mydriatic eye drops.
Molluscum contagiosum is a viral infection of the skin. It is very common in young children and typically forms firm, smooth, umbilicated papules 2-6mm in diameter.
The virus is spread by direct contact and can occasionally be transferred to the eyelids. Lesions are often poorly defined and difficult to see, and may go unnoticed. However, if they increase in size they can cause irritation and soreness and may be mistaken for basal cell carcinomas. When the papules are present on the lid margin, the shedding of viral particles can also cause chronic viral conjunctivitis.
In the majority of cases molluscum contagiosum lesions will resolve spontaneously, but if they are troublesome they can be excised with gentle cautery.Further reading
Frith P, Gray R, MacLennan S. The Eye in Clinical Practice. London: Blackwell Publishing 2001Author
Dr Nigel Stollery
MB BS DPD
GP, Kibworth, Leicestershire and clinical assistant in dermatology, Leicester Royal Infirmary