Oculoplastic, Lacrimal and Orbital Disease
Concept anchors
Eyelid problems are mechanical or structural. Aponeurotic ptosis shows a high lid crease with good levator function and is repaired by levator advancement; congenital ptosis has poor levator function and risks amblyopia. Involutional entropion results from horizontal laxity, lateral canthal tendon laxity and preseptal overriding, so repair addresses all components. Ectropion is commonly involutional and treated with lateral canthal tightening. Trichiasis is lasered or electrolysed, and distichiasis arises from an abnormal meibomian row.
Lacrimal
Epiphora is classified by site: punctal, canalicular, sac or duct. Dacryocystitis presents as a painful medial swelling; acute cases are treated with antibiotics and dacryocystorhinostomy after settling. Canaliculitis produces a pouting punctum with concretions.
Orbit
Preseptal cellulitis spares eye movements and vision; orbital cellulitis causes proptosis, ophthalmoplegia, pain on movement and needs imaging plus intravenous antibiotics. Blowout fracture shows restricted elevation, diplopia and enophthalmos. Thyroid eye disease progresses through active and quiescent phases; smoking cessation and selenium help mild disease, steroids and radiotherapy active disease, and surgery is reserved for the quiescent phase.
Traps
Orbital compartment syndrome with a tense orbit after trauma or surgery needs urgent lateral canthotomy. Never biopsy a suspected choroidal melanoma without specialist input. Sarcoidosis and lymphoma mimic each other in the lacrimal gland.
Rule of thumb
Any proptosis with reduced motility or acuity is orbital, not preseptal, and needs imaging.