Hordeolum is an acute infectious process on the eye. It develops because of penetration into gland of Zeiss or ciliary hair bulb of infectious originators.

Current of Hordeolum is acute. It is not a cosmetic problem but a serious infectious disease. Crushing purulent damages of eyes and transition of illness to a chronic form can become complications.

There is hordeolum internum and hordeolum externum. The externum is more often met. Internal arises on the surface of conjunctiva turned to the eyeball and affects cartilaginous plate of blepharon.

Hordeolum on eye can be single; but sometimes there is multiple precipitation or two eyes are affected at the same time.

In elderly people or when weakening immunity there is a transition of hordeolum from one hair follicle to another, and illness doesn’t recede for a long time.

Clinical signs of hordeolum are: itch of eyelid edge, reddening and edema, pain disturbs the patient at rest and amplifies at pressing. Sometimes edema on the blepharon is so expressed that patient cannot open a sore eye.

Body temperature increases, complains of chill, pain, headache. Submandibular and parotid lymph nodes are enlarged. Later on the end of tumescence the pustule is formed and the pain syndrome abates. At spontaneous opening of hordeolum its cavity is emptied from purulent contents, and all signs gradually disappear.

Internal hordeolum is localized in the thickness of cartilage. It is determined by turning inside out the blepharon. The disease looks as reddening and edema of conjunctiva. In three days pus of yellow-green color is seen through mucosa.

Never squeeze out purulent contents of hordeolum. The infection can penetrate into deep veins of face and eye, result in blood poisoning.


At trichiasis eyelashes grow inside, touching eyeball that causes irritation that leads to damage of cornea. In the patient the spastic stricture of blepharons and photophobia are expressed. He often blinks and closes eyes tightly that provokes more serious cornea lesion.

The trichiasis needs to be distinguished from entropion. Case history is considered, find out the existence of injuries in the past, burns, chronic inflammations. edges of eyelids are examined under a microscope and the direction of eyelashes growth is defined. Pigments are used at researches for more exact diagnostics.

The set of methods is developed for treatment of trichiasis. By means of surgery wrong eyelashes growth is eliminated. There are various approaches:

1. Epilation is the most widespread but ineffective method of trichiasis treatment. Long epilation which is carried out monthly thins eyelashes. They lose pigment and hardly succumb to other methods of treatment.

2. Diathermy-coagulation is shown only at excision of separate eyelashes. It is carried out by a needle electrode along eyelash to its bulb. It is inexpedient to delete many eyelashes by means of diathermy coagulation. If some area of blepharon edge was removed, some months later a diathermy coagulation of the remained eyelashes is carried out.

3. Argon-laser coagulation is carried out on the separate eyelashes growing incorrectly. It is carried out from a hair outlet to skin or mucous in the direction of its growth. Then antiseptic ointments or drops are prescribed.

4. The most effective method at extensive trichiasis is a through resection of part of blepharon part with rapprochement of edges and a layer-by-layer closure. Restoration of rear edge of eyelid by means of transplantation of mucous flap from patient’s lip is sometimes prescribed.


Trachoma is an infectious disease. It is caused by chlamydia, special microorganisms and intracellular parasites. 400 million people have trachoma. It is met usually in overpopulated areas with lack of sanitary conditions. Trachoma is transmitted through the polluted arms and common subjects. An important role is played by flies.

At trachoma follicles and tumescence are formed on conjunctiva inevitable for typical trachoma is development of cicatrices in conjunctiva. After transformation of follicles into cicatrices the disease comes to the end. Trachoma affects only eyes mucosa and is not met on other mucosa or in animals.

Trachoma begins with hardly noticeable mucous or purulent discharges. It can be followed by itch, lacrimation, photophobia, edema of blepharons. Process is bilateral, most of all is shown on conjunctiva of upper eyelid, sometimes exists for years without cicatrization. Then there are juicy blisters reminding raspberry, certain cicatrices on conjunctiva. In this stage patients are most infectious; the over ripe blisters easily break and contents flow outside. Gradually the inflammation decreases and the cicatrization grows. Sometimes there are exacerbations.

Inflammatory process at trachoma affects cornea. Growing of vessels into it leads to serious consequences: the patient loses vision. Because of cicatrization there is entropion of blepharons and incorrect eyelashes growth. Plaintive glands can be lost and humidification of eyes is broken.

Trachoma is treated with antibiotics and Sulfanilamide. Continuous and intermittent methods of treatment are applied. Locally ointments with antibiotics are prescribed. They are rubbed in within month and a half.

Dry keratoconjunctivitis

Вry keratoconjunctivitis is shown by decrease of tear discharge and stability disturbance of plaintive membranula on the cornea. Pathological state is caused with insufficient tear formation or its accelerated evaporation.

Dry keratoconjunctivitis with insufficient tear production can arise because of scarring of tear ducts (pemphigoid, trachoma), damage resulted from immune reaction”transplant against the owner “as a consequence of radiation therapy.

Abnormally fast tear evaporation happens at pathological structure of fats (malfunction of sebaceous glands) or decrease of a normal fatty layer of tear membranula (at seborrhea blepharitis).

Symptoms of dry keratoconjunctivitis are: itch, burning sensation, irritation, feeling of foreign matter, heaviness in the eye, photophobia. There can be misting of vision. After irritation there is a strong lacrimation. Symptoms change their intensity, interrupt, intensifying at long strain of vision, at dryness of air or existence of smoke in it. Symptoms decrease in foggy, rainy and cold days.

At all forms of illness the conjunctiva is reddened. Because of the irritation patient often and strenuously blinks. At tears deficiency the conjunctiva looks dry, dim, folded. There is a Shirmer’s test for definition whether production of tears is normal.

At any form of a dry keratoconjunctivitis use of tear substitutes is effective. Viscid substitutes cover the surface of eye longer and are useful at evaporation keratoconjunctivitis (with excessive evaporation). The ointments containing an artificial tear are applied. They are imposed for the night. It is important not to smoke, avoid passive smoking.


Concrescence of lower and upper eyelids (ankyloblepharon, cryptophthalmus) is congenital pathology at which there are no eyelids and conjunctiva cavity. The ankyloblepharon may be complete or partial; in case of complete the forehead skin immediately passes into cheek skin.

The concrescence of blepharons is referred to congenital defects. The reasons are finally not found out; pathology may arise at radiation or chemicals affected fetus.

Eyeball under the spliced blepharons is motile. At partial concrescence there is opacification and cornea dystrophy that can lead to its ulceration. At complete ankyloblepharon eye appendages are absent: conjunctiva, palpebral cartilages eyelashes, and glands.

Partial ankyloblepharon sometimes is treated conservatively. Artificial tears and gels, ointments with thiamine and antibiotics are applied. If a surgery is required, ankyloblepharon section is carried out without imposing additional sutures, transplantation of mucous and skin grafts.

The full ankyloblepharon is corrected only surgically. the external prosthesis is made consisting of eye prosthesis and artificial appendages. Ekzoprosthesis is fastened to a spectacle frame of the patient or with special glue to his skin. Full plasty of conjunctive cavity is carried out using mucous grafts from the patient’s lips. The eye prosthesis is inserted into the created cavity, and it should be replaced regularly.

Gunn Syndrome

Gunn’s syndrome was first was described by the British ophthalmologist Markus Gunn. The disease includes blepharoptosis in combination with its consensual lifting at the movements of lower jaw. The consensual movements appear during mouth opening, movements of jaw to side opposite to the eye on which the blepharon (occasionally in the same side) is lowered, at jaw pulling forward, lips movements, clenching teeth. Degree of expression of Gunn syndrome varies over wide range. In 50-60% of cases it is combined with strabismus.

Hun syndrome is usually one-side, is found at infancy when during suction of breast or food from a small bottle mother notes the strange rhythmical movements of baby’s upper eyelid.

Most often Hun syndrome is congenital. Acquired sometimes develops against the progressing vascular failure of brain or after a psychic trauma.

Physicians explain the associated movements of jaw and blepharon with pathological connection of cranial nerves when there are abnormal links between brain cells the processes of which form nerves. It is considered that the cornerstone of a Hun syndrome is the restoration of ancient branchial-oral connection because blepharon muscles develop in embryo from germs which in fishes move the operculum. In fishes when opening mouth branchial covers raise, the alimentary and respiratory movements are combined.

Forecast is favorable. Adult patients often say that combined movements decrease in some time. But objectively it is not confirmed. Probably, adults pay less attention to twitching of blepharon or manage to mask them. At the expressed ptosis of a blepharon or combination with strabismus surgical treatment is prescribed.

Retinal Separation

The retina covers an eyeball from inside. It perceives light impulses, transforms them in nervous, transferred via optic nerve to brain of the person.

Amotio of eye retina is the most dangerous pathology which requires immediate surgical treatment. Eye injuries, strong myopia, eye surgery, diabetes mellitus and vascular diseases, viral infections and stressful situations can become its cause.

The patient complains of emergence of “veil” or shadow in the section of field of vision. At the movements of head the veil can fluctuate. There can be multiple black points in the field of vision; it testifies hemorrhage into eye vitreous from damaged vessels at retina rupture. The patient sometimes has bright flashes behind his eyes; they appear suddenly, usually in areas close to temple.

Always visual acuity worsens and shapes of visible subjects sometimes are distorted. At fresh retina amotio in the mornings vision improves. The patient thinks that problems are connected to fatigue and does not apply to the doctor. In reality when the patient is sleeping the part of liquid, which has accumulated under retina, resolves. Without treatment retina amotio leads to full loss of vision.

Laser treatment is possible only at treatment of recent retina amotio. In this case procedure is called peripheral preventive laser coagulation. If a lot of time has already passed the real surgery is necessary. It may be carried outside of eyeball or from inside. If the term of retina amotio is not more than one year and the eye sees light well chances of convalescence are great.


Ptosis (ptosis) of upper eyelid is widespread pathology. There are one sided and two sided ptosis. More often congenital two sided ptosis happens, one sided is usually acquired.

The acquired ptosis is meets much more often than congenital. Ptosis is sub-divided into various types depending on cause:

1. Neurogenic ptosis. It is met at oculomotor paralysis. It can arise because of tumors, diabetic neuropathy. Sometimes this ptosis is caused in the medical purposes artificially, for example, at corneal ulcers which are not closed up long because of blepharoptosis.

2. Myogenetic ptosis. It arises at muscular weakness, usually in both sides. Loads cause blepharoptosis and doubling in eyes.

3. Aponeurotic ptosis. It develops in elderly people when the tendon of the muscle lifting an upper eyelid departs from osteal plate to which it is attached.

4. Mechanical ptosis. It appears because of horizontal shorting of blepharon at cicatrization or tumor growth.

Blepharoptosis can be partial, incomplete (blepharon reaches middle of pupil), full (blepharon closes pupil).

At ptosis eyes are irritated, it is difficult to close them; they quickly get tired because of large efforts. Often strabismus develops.

Therapeutic treatment is applied at neurogenic ptosis. Physiotherapeutic procedures are carried out: UHF, galvanotherapeutics. Temporary fixing of blepharon with emplastrum is also referred to conservative methods.

More often ptosis is treated surgery. You shouldn’t postpone the operation, especially for children whose growing organism is more subjected to complications. If the blepharon is sedentary, it is sutured to front muscle. Partial excision of muscle lifting the upper eyelid is possible. Shortening of muscle will not allow blepharon to fall.

Hordeolum treatment

Usually hordeolum externum is treated conservatively, hordeolum internum requires surgery.

Antibiotics are used at hordeolum. The preference is given to antibacterial drops. Sulfanilamide which is also an excellent prophylactic at different inflammations in the eyes (a blepharitis, conjunctivitis) is related to them.

One more anti-infective medicine is a solution of erythromycin or penicillin. At intolerance of antibiotics of penicillin group they are replaced with gentamycin. 1% solution of these medicines is instilled in both eyes. At initial stage of development of disease the instillations are carried out each three hours. For treatment of hordeolum the drops with levomycetin possessing a broad spectrum of activity are considered effective drops. Perfect reputation acquired the antibiotics of the last generation of containing the active ingredient tobramycin including into group of aminoglycosides.

At hordeolum it is necessary to instill drops in conjunctive bag, not on eyeball. Also ointments are recommended to use. It isn’t so convenient to use them but ointment does not spread and quickly interacts with microbial flora at the expense of a dense consistence. At hordeolum tetracycline, erythromycin and hydrocortisone ointments are usually prescribed.

Antibacterial gels are applied easier than ointments.

Gel is also imposed directly on a lower eyelid, not taking into account hordeolum localization.

Treatment at a hospital is recommended at the multiple centers of hordeolum or internal hordeolum. At severe course surgery is required. Hordeolum is opened; the cavity is drained with antiseptics. Local anesthesia is used. Course of antibiotics is prescribed to the patient after surgery.


The lagophthalmos (a hare eye) is incomplete closing of one or both eyes. The patient is not capable to close eyelids completely.

The most frequent cause of lagophthalmos is a flaccid paralysis of facial nerve (the seventh pair of craniocerebral nerves) which is responsible for the movements of circular eye muscle. At eyeball growth (a strong myopia) or its out pouching (exophthalmos) closing of eyelids can be incomplete. In some time the lower eyelid of the patient droops, there can be cornea erosion and subsequent ulceration.

Infections, tumors, orbit phlegmons, endocrine exophthalmos, cicatrization after damage of blepharons and skins become the cause of paralysis. The lagophthalmos also is caused with increment of blepharon to conjunctiva, usually traumatic or burn aetiology.

At incomplete closing of eye the cornea dries up (xerophthalmia). The patient complains of dryness in the eye, burning sensation and feeling of foreign matter.

In order the eye does not dry up artificial tears and ointments feeding the cornea are used before going to bed, and put on soft contact lenses. At ulceration and keratitis antibiotics are prescribed. In severe cases lagophthalmos is treated quickly, with temporary blepharons joining together.

If the lagophthalmos reason was not eliminated successfully, it is necessary to resort to the restoring operations. It can be plasty of palpebral fissure, suspension of lower eyelid, installation of an implant in upper eyelid, elimination of cicatricle changes, muscle operations, carrying out a silicone thread through eyelids.