Ingrowing Eyelashes Trichiasis

The lashes could grow in an aberrant manner even though the eyelids themselves are in good position. This might be the result of chronic infection of the lid margins or follow trauma. Sometimes one or two aberrant lashes appear for no apparent reason (Figure 5.10). The lashes tend to rub on the cornea producing irritation and secondary infection. The condition is referred to as trichiasis. When one or two Figure 5.10. Trichiasis. This ingrowing eyelash on the lower eyelid has been causing a sore eye for three months. IB Figure 5.10. Trichiasis. This ingrowing eyelash on the lower eyelid has been causing a sore eye for three months. IB lashes are found to be the cause of the patient's discomfort, it is common practice simply to epilate them with epilating forceps. This produces instant relief, but often the relief is shortlived because the lashes regrow. At this stage, the best treatment is to destroy the lash roots by electrolysis before epilation. Needless to say, before removing...

External Eye and Lids

Aligned against the globe and that there are no ingrowing lashes. Early basal cell carcinomas (also known as rodent ulcers) on eyelid skin can easily be missed, especially if obscured by cosmetics. The presence of ptosis should be noted and the ocular movements assessed by asking the patient to follow a finger upwards, downwards and to each side. Palpation of the skin around the eyes can reveal an orbital tumour or swollen lacrimal sac. Palpation with the end of a glass rod is sometimes useful to find points of tenderness when the lid is diffusely swollen. Such tenderness can indicate a primary infection of a lash root or the lacrimal sac. Both surfaces of the eyelids should be examined. The inside of the lower lid can easily be inspected by pulling down the skin of the lid with the index finger. The upper lid can be everted by asking the patient to look down, grasping the lashes gently between finger and thumb, and rolling the lid margins upwards and forwards over a cotton-wool bud...

Impaired Drainage of Tears

Lus and thence into the tear sac (Figure 5.1). The tear sac is connected directly to the naso-lacrimal duct, which opens into the inferior meatus of the nose below the inferior turbinate bone. The lacrimal puncta are easily visible to the naked eye and, in the elderly, the opening of the lower punctum can appear to project upwards like a miniature volcano. Inadequate drainage of tears can result from displacement of the punctum the lower lid in the elderly sometimes becomes turned inwards (entro-pion) because the whole tarsal plate rotates on a horizontal axis (Figure 5.2). This, in turn, is caused by slackening of the fascial attachments of the lower margin of the tarsal plate. At first, the eyelid turns in whenever the patient screws up the eyes but, eventually, the lid becomes permanently turned in so that the lashes are no longer visible externally and rub on the cornea. Such patients complain of watering, sore eyes and the matter can be corrected effectively by eyelid surgery....

Excessive Secretion of Tears

A wide range of conditions affecting the eye can cause an excessive production of tears, from acute glaucoma to a corneal abscess, but these do not usually present as a watering eye because the other symptoms, such as pain or visual loss, are more evident to the patient. Occasionally the unwary doctor can be caught out by an irritative lesion on the cornea, which mimics the more commonplace lacrimal obstruction. For example, a small corneal foreign body or an ingrowing eyelash can present in this way. Not uncommonly, a loose lash may float into the lower lacrimal canaliculus where it might become lodged, causing chronic irritation at the inner canthus. Its removal after weeks of discomfort produces instant relief and gratitude.

Other Infective Agents

The conjunctiva can be affected by a wide variety of organisms,some of which are too rare to be considered here, and sometimes the infected conjunctiva is of secondary importance to more severe disease elsewhere in the rest of the body. Molluscum contagiosum is a virus infection, which causes small umbilicated nodules to appear on the skin of the lids and elsewhere on the body, especially the hands. It can be accompanied by conjunctivitis when there are lesions on the lid margin. The infection is usually easily eliminated by curetting each of the lesions. Infection from Phthirus pubis (the pubic louse) involving the lashes and lid margins can initially present as conjunctivitis but observation of nits on the lashes should give away the diagnosis.

Clinical Features

Progeria, illustrated in Figure 1, is a rare genetic disease with striking clinical features that resemble premature aging (1-3). It has a reported birth incidence of about 1 in 8 million (1). Patients with this condition generally appear normal at birth, but by about 1 year of age, severe growth retardation is usually seen. Balding occurs, and loss of eyebrows and eyelashes is common in the first few years of life. Widespread loss of subcutaneous tissue occurs. As a result, the veins over the scalp become prominent. The skin appears old, and pigmented age spots appear. The patients are very short and thin. They average about 40 inches in height, but they usually weigh no more than 25 or 30 pounds even as teenagers. The weight-to-height ratio is thus very low. The voice is thin and high-pitched. Sexual maturation usually does not occur. They have a characteristic facial appearance with prominent eyes, a beaked nose, a plucked-bird appearance, and facial disproportion resulting from a...

Medical Complications Direct Results of Cocaine

In terms of pulmonary effects, pneumomediastinum and cervical emphysema have been reported after smoking cocaine due to alveolar rupture with prolonged deep inspiration and Valsalva's maneuver (Aroesty, Stanley, & Crockett, 1986). Other respiratory complications of inhaling or smoking freebase cocaine include abnormal reductions in carbon monoxide diffusing capacity (Itkonen, Schnoll, & Glassroth, 1984), granulomatous pneumonitis (Cooper, Bai, Heyderman, & Lorrin, 1983), pulmonary edema (Allred & Ewer, 1981), thermal airway injury, pulmonary hemorrhage, hypersensitivity reactions, interstitial lung disease, obliterative bronchiolitis, asthma, and persistent gas-exchange abnormalities (Laposata & Mayo, 1993). Respiratory manifestations include shortness of breath, cough, wheezing, hemoptysis, and chest pains. Severe respiratory difficulties have been reported in neonates of abusing mothers. Inhalation of hot cocaine vapors may also result in bilateral loss of eyebrows...

Acute Intermittent Porphyria

PE White hair, including eyelashes and eyebrows eye exam shows nystagmus and poor development of macula with blue iris poor visual acuity (20 350) skin is pink-white with lack of pigmentation throughout body, numerous actinic (SOLAR) keratoses on face and scalp as well as on dorsum of hands ulcerated lesion with indurated edges on dorsum of hand with hyper-pigmentation.

The Eyelids

The eyelashes arise from hair follicles anterior to the grey line,while the ducts of the meibomian glands (modified sebaceous glands) open behind the grey line. The meibomian glands are long and slender, and run parallel to each other, perpendicular to the eyelid margin, and are located in the tarsal


The common form is the inversion of the lower eyelid seen in elderly patients. Often, the patient does not notice that the eyelid is turned in but complains of soreness and irritation. Closer inspection reveals the inverted eyelid, which can be restored to its normal position by slight downward pressure on the lower eyelid, only to turn in again when the patient forcibly closes the eyes. The inwardly turned eyelashes tend to rub on the cornea and, if neglected, the condition can lead to corneal scarring and consequent loss of vision. The condition is often associated with muscular eyelids and sometimes seems to be precipitated by repeatedly screwing up the eyes. Slackening of the fascial sling of the lower eyelid with ageing combined with the action of the orbicularis muscle allows this to happen. This common type of entropion is called spastic entropion and it can be promptly cured without leaving a visible scar by minor eyelid surgery. Entropion...


This refers to a chronic inflammation of the lid margins caused by staphylococcal infection. The eyes become red rimmed and there is usually an accumulation of scales giving the appearance of fine dandruff on the lid margins. The condition is often associated with seborrhoea of the scalp. Sometimes it becomes complicated by recurrent styes or chronic infection of the meibomian glands. The eye itself is not usually involved, although there could be a mild superficial punctate keratitis, as evidenced by fine staining of the lower part of the cornea with fluorescein. In more sensitive patients, the unsightly appearance can cause difficulties, but in more severe cases, the discomfort and irritation can interfere with work. Severe recurrent infection can lead to irregular growth of the lashes and trichiasis.

Lid Injuries

One of the commonest injuries to the eyelids is caused by the presence of a foreign body under the eyelid - a subtarsal foreign body. A small particle of grit lodges near the lower margin of the lid, but to see it the lid must be everted. Every medical student should be familiar with the simple technique of lid eversion. This is performed by gently grasping the lashes of the upper lid between finger and thumb and at the same time placing a glass rod horizontally across the lid. The eyelid is then gently everted by drawing the lid margin upwards and forwards. The manoeuvre is only achieved if the patient is asked to look down beforehand, and the everted lid is replaced by asking the patient to look upwards. If a small foreign body is seen, it is usually a simple matter to remove it using a cotton-wool bud (Figure 5.15).


Visual acuity is usually normal in conjunctivitis. The conjunctiva appears hyperaemic and there can be evidence of purulent discharge on the lid margins, causing matting together of the eyelashes. The redness of the conjunctiva extends to the conjunctival fornices and is usually less marked at the limbus. When a rim of dilated vessels is seen around the cornea, the examiner must suspect a more serious inflammatory reaction within the eye. Apart from being red to a greater or lesser degree,the eyes also tend to water, but a dry eye might lead one to suspect conjunctivitis results from inadequate tear secretion. Drooping of one or both upper lids is a feature of some types of viral conjunctivitis and this can be accompanied by enlargement of the preauricular lymph nodes. The ophthalmologist should train himself or herself to feel for the preauricular node as a routine part of the examination of such a case. Closer inspection of the conjunctiva might reveal numerous small papillae,...

Acute Conjunctivitis

This is usually infective and caused by a bacterium it is more common in young people. It can spread rapidly through families or schools without serious consequence other than a few days incapacity. When adults develop acute conjunctivitis, it is worth searching for a possible underlying cause, especially a blocked tear duct if the condition is unilateral. Sometimes an ingrowing lash might be the cause or occasionally a free-floating eyelash lodges in the lacrimal punctum. The important symptoms of acute conjunctivitis are redness, irritation and sticking together of the eyelids in the mornings. Management entails finding the cause and using antibiotic drops if the symptoms are severe enough to warrant this. However, it must be remembered that the inadequate and intermittent use of antibiotic eye drops could simply encourage growth of resistant organisms.


Presenting complaint is contact of the eyelashes with the posterior surface of the spectacle lens. Extraconal masses usually displace the globe toward the orbital wall that lies opposite to the position of the tumor. The differential diagnosis can be refined based on the direction of displacement of the eye.


The lack of pigmentation might be limited to the eye, ocular albinism, or it might be generalised. The typical albino has pale pink skin and white hair, eyebrows and eyelashes. There is often congenital nystagmus. The optic fundus appears pale and the choroidal vasculature is easily seen. The iris has a grey-blue colour but the red reflex can be seen through it, giving the iris a red glow. Albinism is inherited in a recessive manner and can be partial or complete. Albinos need strong glasses to correct their refractive error, which is usually myopic astigmatism. Dark glasses are also usually required because of photophobia. Tinted contact lenses can sometimes be helpful.

Cilia and Flagella

Cilia and flagella appeared very early in the evolution of eukaryotic cells and have remained essentially unchanged to the present day. The terms cilium (meaning an eyelash) and flagellum (meaning a whip) are often used arbitrarily. Generally, cilia are shorter than flagella (< 10 m compared to > 40 m) and are present on the surface of the cell in much greater numbers (ciliated cells often have hundreds of cilia but flagellated cells usually have a single flagellum). The real difference, however, lies in the nature of their movement (Fig. 18.7). Cilia row like oars. The movement is biphasic, consisting of an effective stroke in which the cilium is held rigid and bends only at its base and a recovery stroke in which the bend formed at the base passes out to the tip. Flagella wriggle like eels. They generate waves that pass along their length, usually from base to tip at constant amplitude. Thus the movement of water by a flagellum is parallel to its axis while a cilium moves water...