Eyelid | Eyelashes

Demodex SYMPTOMS Often asymptomatic, possible irritation SIGNS Cylindrical sleeve/collarettes around lash follicle WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Tea tree oil | Cliradex | Zocular FOLLOW-UP Every 2-3 weeks during treatment. PRN if insignificant signs/symptoms. ADDITIONAL LAB | TESTS None ETIOLOGY Demodex are a normal part of skin and hair follicles that…

Keratoacanthoma SYMPTOMS Usually asymptomatic, possible irritation SIGNS Dome-shaped lesion, rolled edges, central plug WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Excision | Biopsy | Radiation therapy FOLLOW-UP If definitive diagnosis is made, frequent follow-ups are not necessary ADDITIONAL LAB | TESTS Rule out squamous cell carcinoma ETIOLOGY Age | UV exposure DIFFERENTIAL DX…

Xanthelasma SYMPTOMS Usually asymptomatic, possible irritation SIGNS Yellowish lipid plaques – usually near the upper, inner lid. WORK-UP Thorough history and slit lamp examination | Younger patients should be evaluated for hypercholesterolemia. TREATMENT Observation | Surgical excision FOLLOW-UP Frequent follow-ups are usually not necessary unless significant increase ADDITIONAL LAB | TESTS Unknown, likely lipid and…

Seborrheic Keratosis SYMPTOMS Asymptomatic | Possible irritation SIGNS Waxy, scaly lesion. Usually dark with a “stuck on” appearance. WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Biopsy | Excision FOLLOW-UP Frequent follow-ups are rarely necessary. ADDITIONAL LAB | TESTS Biopsy in atypical cases ETIOLOGY Age | UV exposure | HPV DIFFERENTIAL DX Melanoma |…

Poliosis SYMPTOMS None SIGNS Whitening of hair (due to a decrease in melanin) WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Hair coloring for cosmesis FOLLOW-UP Frequent follow-ups are not necessary ADDITIONAL LAB | TESTS Consider testing for conditions associated with poliosis (see below) ETIOLOGY Inheritance | Medications (ex. chloramphenicol) DIFFERENTIAL DX Hair coloring…

Eyelid coloboma SYMPTOMS Often asymptomatic | Possible irritation SIGNS Missing eyelid tissue | Keratopathy WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Topical lubrication | Eyelid reconstruction FOLLOW-UP PRN based on symptoms ADDITIONAL LAB | TESTS None ETIOLOGY Incomplete closure of optic (embryonic) fissure DIFFERENTIAL DX Trauma | Surgery | Entropion NOTES Coloboma refers…

Ocular rosacea SYMPTOMS Dryness | Irritation | Burning SIGNS Eyelid and facial erythema | Telangiectasias WORK-UP Thorough history. Slit lamp examination TREATMENT Eyelid hygiene | Intense pulsed light | Doxycycline 50mg qd | Omega-3 supplementation FOLLOW-UP Depends on severity. Significant symptoms may warrant follow-ups every 4-6 months. ADDITIONAL LAB | TESTS None ETIOLOGY Unknown, likely…

Dermatochalasis SYMPTOMS Vision reduction | Possible irritation SIGNS Redundant, loose lid tissue WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Blepharoplasty FOLLOW-UP Frequent follow-ups not required. 1-2 weeks following blepharoplasty ADDITIONAL LAB | TESTS None ETIOLOGY Age | Trauma | Surgery DIFFERENTIAL DX Ptosis | Floppy eyelid syndrome | Blepharochalasis NOTES None Orbit Eyelid…

Madarosis SYMPTOMS Often asymptomatic. Possible irritation SIGNS Eyelash and/or eyebrow loss WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Address underlying etiology | Hair transplant FOLLOW-UP Follow-up according to underlying etiology and severity. ADDITIONAL LAB | TESTS None ETIOLOGY Squamous cell carcinoma | Basal cell carcinoma | Chronic blepharitis | Psoriasis | Thyroid dysfunction…

Trichiasis SYMPTOMS Irritation | Tearing SIGNS Misdirected eyelashes | SPK WORK-UP Thorough history. Slit lamp examination TREATMENT Observation | Topical lubrication | Epilation | Radiofrequency FOLLOW-UP PRN based on symptoms ADDITIONAL LAB | TESTS None ETIOLOGY Idiopathic | Trauma | Surgery | Blepharitis DIFFERENTIAL DX Entropion | Blepharophimosis | Distichiasis NOTES None Orbit Eyelid |…