Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.

Study of histomorphological spectrum of eyelid lesions

Background: Eyelid pathologies are the most common surgical specimens encountered among all of the ophthalmic lesions and constitute a wide range of diseases by their unique histologic features. This study aims to find out the histopathological spectrum of eyelid lesions, their demographic distribution, and preferential location prevalent in our community.Materials and Methods: This is an observational study in which we retrospectively evaluated the data of 692 patients retrieved from the histopathology department of National Reference Laboratory, Kathmandu, from May 2016 to April 2019.Results: A total of 701 histologic diagnoses comprised of benign, precursor, and malignant lesions and accounted for 86.6%, 2.6%, and 10.8% respectively with preponderance in females. The common benign lesions included melanocytic nevus (17.7%), epidermal cyst (11%), hemangioma (8.9%), dermoid cyst (8.2%), chalazion (6.7%), and squamous papilloma (6.4%). Tumour of epidermal origin was the most common neoplastic lesion accounting for 31.2%. Basal cell carcinoma (50%) followed by sebaceous carcinoma (27.6%) and squamous cell carcinoma (14.5%) constituted the majority of malignant lesions prevalent above the age of 60 years with the preferential site of the upper eyelid for basal cell carcinoma and squamous cell carcinoma; and lower eyelid for sebaceous carcinoma.Conclusions: Benign eyelid lesions are more prevalent than malignant ones with overall female preponderance. Epidermal tumours are common among neoplasms. A malignant tumour, a disease of an elderly individual, is predominated by basal cell carcinoma followed by sebaceous carcinoma, an aggressive tumour with a high recurrence rate in our population.

Accuracy of periocular lesion assessment using telemedicine

ObjectivesTo assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics.MethodsIn this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant.ResultsComplete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s.ConclusionsThis study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.

Paediatric Eyelid Lesions- A Report of 20 Cases

Background: Eyelid lesions are one of the commonest lesions encountered by ophthalmologists in their clinical practice. They could be classified in various ways such as neoplastic or non-neoplastic; congenital or acquired. The common benign conditions affecting the eyelid include cysts like dermoid, epidermoid and epithelial cysts, inflammatory lesions, melanocytic nevi and papilloma. Ignorance about the benign nature of the lesion may lead to increased debility. The purpose of this study is to contribute information to the literature on various eyelid lesions and their incidence as found in a tertiary hospital. Methods: This is a retrospective observational study of surgically excised eyelid lesions in patients below 12 years of age. The study was conducted after obtaining permission from the Institutional Ethics Committee. Result: Out of 20 lesions, 15 cases belonged to the non-neoplastic category while five cases were neoplastic in nature. Cystic lesions predominated in the non-neoplastic category (11 out of 15 cases). The remaining four cases in the non-neoplastic category included three cases of infective etiology and one case of developmental etiology. There were no malignant neoplasms found in our study. The common presenting feature was that of eyelid swelling. Highest incidence of eyelid lesions was in the upper lid (14 of 20 cases, i.e. 66.66%). Conclusion: It is necessary to subject every lesion of the eyelid to histopathological examination. Sometimes, clinically benign lesions turn out to be malignancies which entails a wider surgery later. This study points out to the wide spectrum of lesions that can afflict the eyelid.