Chalazion, Ptosis, Eye Stroke and Epiphora

Dr. Andy CHENG

Honorary Consultant in Ophthalmology

Specialist in Ophthalmology  

Chalazion

A chalazion is a small, slow-growing lump or cyst that develops within the eyelid.  A chalazion can develop when a meibomian gland at the edge of an eyelid becomes blocked or inflamed. Treatment of chalazion involves antibiotics / steroid ointment and warm compression. Surgical incision and curettage may sometimes be needed if the chalazion is causing significant inflammation or persistent.

If the lump remains or inflammation persists in the same eyelid area for a long time, early medical attention must be sought since this can also be a symptom of sebaceous gland carcinoma, which is a malignant cancer of the skin.

Ptosis

Ptosis is the term for droopiness of the eyelid. Ptosis can occur in one or both eyes.  Ptosis may make one looks tired, affects social life and in severe cases, may even block vision especially the superior visual field. Early treatment of severe ptosis is essential for young children as ptosis covering the visual axis or causing significant astigmatism may result in amblyopia.

The causes of ptosis are myriad, e.g. chronic eye rubbing, long-term use of contact lens, age-related dehiscence of levator muscles, cranial nerve palsy, Horner syndrome, myasthenia gravis, eyelid tumour, etc. For the levator muscle / aponeurosis dehiscence, surgery can be performed with either anterior or posterior approach to tighten the levator muscle / aponeurosis.

For neurological causes of ptosis, e.g. Myasthenia Gravis, Horner’s Syndrome and third cranial nerve palsy, though less common, they may result in serious or life- threatening sequelae. For example, third cranial nerve palsy may be resulting from intracranial aneurysm (especially the posterior communicating artery aneurysm), which can be a life-threatening condition.

Eye Stroke

Unhealthy eating habits and lifestyles are known to be associated with high blood pressure, high blood cholesterol and high blood sugar. These conditions are common in modern urban population, which may lead to early atherosclerosis of blood vessels. Atherosclerosis may result in occlusion of blood vessels, which may result in ischaemia or infarction of the supplying organs or tissues. The term “eye stroke”is a general term that describes infarction of ocular tissue including optic nerve or retina resulting from blockade of blood vessels supplying them.

The risk of eye stroke can be reduced significantly by adopting a healthy lifestyle and diet and quitting smoking. One should seek medical attention as soon as possible when there is sudden blurring or loss of vision.

Early identification and treatment of “eye stroke” including retinal artery / vein occlusion or ischaemic optic neuropathy may have an impact on the visual outcome or further cerebral stroke risk.

Epiphora

Epiphora is tearing or overflow of tears, which is not provoked by other causes including crying.

Possible causes of epiphora include:

• Overproduction of tears due to lashes problem, eyelid inflammation, eyelid ectropion/entropion, paradoxical tearing
• Reduced tears outflow due to lid laxity, blocked lacrimal ducts.

With aging eyelid muscles may become lax, and tears may accumulate in the eyes due to slowing of tears draining through the lacrimal drainage system.

Dry eyes may sometimes cause paradoxical tearing. When the eyes are too dry, there is reflexive increase in tear production causing episodic tearing.

When the nasolacrimal duct is blocked, tears cannot run down into the nasal cavity and may result in tearing. Excessive tears may accumulate in the lacrimal sac. With stasis of tears in the lacrimal sac that may predispose infection, acute dacryocystitis may result. Nasolacrimal duct obstruction may be treated surgically by dacryocystorhinostomy. This is to create a new opening between the lacrimal sac and the nasal cavity so that tears may drain into the nasal cavity. The surgery can be done by nasal endoscopic approach, so that there will be no skin scarring after operation.