The lid is a very complex, and important structure. It has
multiple functions that require a constant flow of fluids, and physiological
maintenance. Disruption of any part of this mechanism can, and often does result
in disease, pain and the possibility of secondary complications. The lid’s most
basic function is to protect the eye from trauma. This is accomplished by simply
closing the eye. The lashes also play a role as they catch debris, and inform us
when something is too close to our eyes. In addition, they house many glands
that secrete fluids that bathe our eyes and keep them moist.
If any of
the glands of the lid get clogged, infection results, and often called a stye.
It present as a red bump in the lid, that is tender to the touch. The lid is red
and swollen, and may even appear as a pimple on the lid if the infection is in
the front section of the lid. Another lid infection, blepharitis, is an
inflammation of the lid,
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and appears as a red lid margin with debris on the lid surface. It often leads
to dry, red eyes,
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general discomfort of the eye. Proper treatment will alleviate this
condition.
A more serious condition of
the lid area is Dacryocystitis which is an infection of the nasolacrimal sac.
This lies between the inner corner of the eye lid and the nose. It most often
results from blockage of the duct that permits tears to flow from the tear
producing gland to the nose. This condition most often causes pain,
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most area of the lid, and excessive tearing. The blocked tear duct becomes
infected with bacteria such as Staphylococcus aureus, Streptococcus pneumoriae
and Pseudomonas. Dacryocystitis may be acute or chronic and may be the result of
tear duct malformation, injury, trauma and infection.
Clinical
presentations will include the pain, redness and swelling as well as puss that
will extrude with digital pressure to the area. Most patients are very
uncomfortable and present with a puffy red inner eye lid. It looks different
then a basic lid infection in that the location, and is always nasal and the
pain is much more severe with palpation, or digital pressure.
According
to Dr. Marc Werner, an Oculoplastic surgeon from Long Island, NY, aggressive
treatment is necessary to prevent secondary complications. He recommends
irrigating the infected duct to clear any obstructions,
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away bacteria infected puss. If the irrigation is not effective in opening a
clean duct, then surgery is required to cure this condition. In addition, oral
antibiotics, and topical antibiotics and on occasion a topical steroid is
employed to reduce the inflammation. Palpitating the effected area to remove as
much of the puss as possible is necessary at the onset of treatment. Proper
follow up is also required on a daily basis to make sure that the infection is
draining and not spreading to the surrounding ocular areas. Dr. Werner always
checks vision and pupillary function on every visit for the same reason. It
should be noted that Dr. Werner is also a Neuro-Ophthalmologist and as such
always looks for any potential neurological complication that might arise.
If the Dacryocystitis does not resolve with this therapy, and the duct
remains obstructed then when the initial infection is eliminated a surgical
procedure called Dacryocystorhinostomy ( DCR) must be performed. This is done
under general anesthesia and creates a new passage for the tears to flow. As
usual, proper diagnosis and treatment is required from the start to obtain the
best possible outcome.