Materiały źródłowe

• #1 The relationship between involutional ectropion and inflammatory disorders of the eyelids and ocular surface: insights from a large-scale national study | Scientific Reports

  https://www.nature.com/articles/s41598-025-88138-6

  This study investigated potential associations between ectropion and various chronic and systemic inflammatory diseases affecting the eyelids and ocular surface. […] Significant associations were found between involutional ectropion and several local inflammatory eyelid diseases: blepharitis (OR 4.66), chalazion (OR 2.94), hordeolum (OR 2.26), and dermatitis of the eyelid (OR 2.46). […] This study found that localized chronic inflammatory conditions affecting the periocular tissues and ocular surface are significantly associated with the development of involutional ectropion. […] The observed association between conditions of periocular inflammation, such as blepharitis, chalazion, hordeolum, dermatitis of the eyelid and involutional ectropion could be explained by various inflammatory processes affecting the nearby tissue that weaken the eyelid structure.

• #2 Blepharitis – EyeWiki

  https://eyewiki.org/Blepharitis

  Seborrheic blepharitis is characterized by less inflammation than staphylococcal blepharitis but with more oily or greasy scaling. Some patients with seborrheic blepharitis also exhibit characteristics of MGD. […] Meibomian gland dysfunction is characterized by functional abnormalities of the meibomian glands and altered secretion of meibum, which plays an important role in slowing the evaporation of tear film and smoothing the tear film to provide an even optical surface. Both quantitative deficiencies in meibum or qualitative differences in its composition can contribute to symptoms experienced in MGD blepharitis.

• #3 Current Concepts in the Diagnosis and Management of Meibomian Gland Dysfunction-Related Evaporative Dry Eye Syndrome

  https://webeye.ophth.uiowa.edu/eyeforum/tutorials/Meibomian-gland-dysfunction-related-evap-dry-eye-syndrome/index.htm

  Meibomian glands are sebaceous glands within the tarsal plates of the eyelids. There are approximately 30 and 25 glands in the upper and lower eyelids, respectively. These glands are composed of clusters of acini, and they measure 5.5 and 2 mm in length in the upper and lower eyelids, respectively. Contraction of the orbicularis oculi muscle facilitates glandular secretions that make up the outer lipid layer of the pre-corneal tear layer and are composed of lipids, proteins, and electrolytes. […] Most commonly, MGD is caused by obstruction-related hyposecretion. The underlying mechanism involves epithelial hyper-keratinization that causes duct obstruction, stasis, cystic dilation, and, ultimately, glandular atrophy. Numerous factors, including aging, rosacea, nutritional status, alterations in sex hormones, blink abnormalities, and inflammation, contribute to qualitative deficiencies in the secretion of meibomian gland oils. Rosacea is a dermatologic disease associated with overexpression of cathelicidins that contribute to neutrophil recruitment and cytokine release causing glandular dysfunction of the face and eyelids. Nutritional disorders such as malnutrition, protein deficiency, vitamin A deficiency, and a diet low in omega-3 fatty acids have all been associated with poor tear film health. Androgens deficiency has been associated with MGD while the effect of estrogen and progesterone on dry eye remains controversial.

• #4 Current Concepts in the Diagnosis and Management of Meibomian Gland Dysfunction-Related Evaporative Dry Eye Syndrome

  http://www.eyerounds.org/tutorials/Meibomian-gland-dysfunction-related-evap-dry-eye-syndrome/index.htm

  Meibomian glands are sebaceous glands within the tarsal plates of the eyelids. There are approximately 30 and 25 glands in the upper and lower eyelids, respectively. These glands are composed of clusters of acini, and they measure 5.5 and 2 mm in length in the upper and lower eyelids, respectively. Contraction of the orbicularis oculi muscle facilitates glandular secretions that make up the outer lipid layer of the pre-corneal tear layer and are composed of lipids, proteins, and electrolytes. […] Most commonly, MGD is caused by obstruction-related hyposecretion. The underlying mechanism involves epithelial hyper-keratinization that causes duct obstruction, stasis, cystic dilation, and, ultimately, glandular atrophy. Numerous factors, including aging, rosacea, nutritional status, alterations in sex hormones, blink abnormalities, and inflammation, contribute to qualitative deficiencies in the secretion of meibomian gland oils.

• #5 Current Concepts in the Diagnosis and Management of Meibomian Gland Dysfunction-Related Evaporative Dry Eye Syndrome

  http://www.eyerounds.org/tutorials/Meibomian-gland-dysfunction-related-evap-dry-eye-syndrome/index.htm

  Quantitative and qualitative deficiencies of meibomian gland secretions are the main causes of evaporative dry eye disorder. They contribute to instability of the outer lipid layer of the tear film, increased tear evaporation, and tear hyperosmolarity. In addition, qualitative deficiencies of the glands contribute to ocular surface inflammation and bacterial overgrowth on the eyelid margins.

• #6 Ptosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546705/

  Levator palpebrae superioris (LPS) and Muller’s muscle are two muscles of upper eyelid responsible for its elevation. LPS is the main elevator which is supplied by the oculomotor nerve. The levator palpebrae superioris muscle origin is the lesser wing of the sphenoid bone, it travels anteriorly above the superior rectus muscle, and attaches in multiple insertions: anteriorly into the upper eyelid skin, inferiorly on the anterior surface of the upper tarsal plate and to the superior conjunctival fornix. Muller’s muscle is a smooth muscle also attached to the superior tarsal plate with sympathetic innervation, which is defective in ptosis of Horner syndrome. Loss of innervation of LPS and Muller’s muscle causes neurogenic ptosis. […] Levator muscle dystrophy causes simple congenital ptosis. On the other hand, involutional changes in the eyelid are the most common pathogenesis in adult ptosis. Deceasing tone and thinning of the levator muscle, due to aging, results in abnormal position of the eyelid. Disinsertion of the levator aponeurosis, or its dehiscence, after any trauma or surgery, can also lead to ptosis.

• #7 The relationship between involutional ectropion and inflammatory disorders of the eyelids and ocular surface: insights from a large-scale national study | Scientific Reports

  https://www.nature.com/articles/s41598-025-88138-6

  The present study identified statistically significant associations between involutional ectropion and both hypertension and dyslipidemia, suggesting that these cardiovascular risk factors may contribute to the development of paralytic ectropion. […] This study provides compelling evidence that various inflammatory conditions affecting the eyelids and the ocular surface, as well as systemic inflammatory diseases, significantly increase the risk of developing ectropion.

• #8 Blepharitis – EyeWiki

  https://eyewiki.org/Blepharitis

  Blepharitis, an inflammatory condition of the eyelid margin, is a common cause of ocular discomfort and irritation in all age and ethnic groups. While generally not sight-threatening, it can lead to permanent alterations in the eyelid margin or vision loss from superficial keratopathy, corneal neovascularization, and ulceration. […] While the etiology of blepharitis is complex and not fully understood, bacteria and inflammation are believed to contribute to the pathology. Long-term management of symptoms may include daily eyelid cleansing routines and the use of therapeutic agents that reduce infection and inflammation. […] The exact pathogenesis of blepharitis is unknown, but suspected to be multifactorial. […] Staphylococcal blepharitis is believed to be associated with staphylococcal bacteria on the ocular surface. In one study of ocular flora, 46% to 51% of those diagnosed with staphylococcal blepharitis had cultures positive for Staphylococcus aureus as compared to 8% of normal patients. The mechanism by which the bacteria cause symptoms of blepharitis is not fully understood, and may include direct irritation from bacterial toxins and/or enhanced cell-mediated immunity to S. aureus.

• #9 Pulsenotes | Blepharitis

  https://app.pulsenotes.com/specialities/ophthalmology/notes/blepharitis

  Blepharitis refers to inflammation of the eyelid margins. […] The causes of blepharitis can be divided into anterior and posterior. […] The two predominant causes of anterior blepharitis are Staphylococci infection and Seborrhoeic type. […] Staphylococcus blepharitis: pathophysiology remains unclear, but the mechanism is thought to involve damaging effects of bacterial exotoxin production and cell-mediated immunity. […] Posterior blepharitis is also known as meibomian gland dysfunction (MGD). […] The underlying pathophysiology of MGD / posterior blepharitis is thought to be epithelial hyperkeratinisation, which results in gland obstruction, stasis of meibum, dilation of glands, and gland dropout.

• #10 Current Concepts in the Diagnosis and Management of Meibomian Gland Dysfunction-Related Evaporative Dry Eye Syndrome

  https://webeye.ophth.uiowa.edu/eyeforum/tutorials/Meibomian-gland-dysfunction-related-evap-dry-eye-syndrome/index.htm

  The signs that correspond to the symptoms suggestive of tear film instability include reduced visual acuity, evidence of meibomian gland inspissation, rapid TFBUT, and punctate epithelial erosions. Highly variable subjective responses are often noted during refraction. As with the evaluation of the cataract patient, the range of visual acuities should be documented. Although the best-corrected acuity is often normal in mild cases, it may be decreased in moderate-to-severe cases owing to tear film-related irregular astigmatism and/or punctate epitheliopathy in the visual axis. […] Clinical evidence of the chronicity of the condition can be drawn by identifying keratinization and vascularization of the eyelid margin, loss of lashes, and evidence of a previous hordeolum or chalazion. Confirmatory evidence of both chronicity and permanent functional changes to the meibomian glands can be obtained with LipiView meibography. Normal meibomian anatomy is characterized by long vertical glands that extend from the eyelid margin to the end of the tarsal plate. The glands become dilated and tortuous near, especially near the upper tarsal margin in early and mild disease. In intermediate duration and moderate disease, the gland dropout progresses with loss of identifiable gland architecture and some complete loss of gland structures. In prolonged and severe disease, all glands are severely shortened and most may be missing. In each category, there is usually a gradient that extends across the eyelid from the punctum (most severe) to the lateral canthus (least severe).

• #11 Chalazion: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1212709-overview

  Focal swelling of the eyelid is a common complaint in both primary care and urgent care settings. Chalazia (plural of chalazion), the most common inflammatory lesions of the eyelid, are slowly enlarging eyelid nodules, formed by inflammation and obstruction of sebaceous glands of the eyelids. Chalazia form when lipid breakdown products, possibly from bacterial enzymes or retained sebaceous secretions, leak into surrounding tissue and incite a granulomatous inflammatory response. Chalazia differ from hordeola in that they form as a result of gland obstruction and sterile inflammation rather than infection. […] Chalazia can recur, and those that do should be evaluated for malignancy; following excision of a recurrence, the content should be sent for pathologic examination. […] In general, chalazia tend to be larger, less painful, and have a less acute presentation than hordeola. However, one condition can result in the other. The acute inflammation of a hordeolum eventually may lead to a chronic painless chalazion, whereas a chalazion also can become acutely infected.

• #12 Chalazion: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1212709-overview

  Chalazia occur after gland blockage, which can be associated with the following: Poor lid hygiene (the precise causal role has not been established), Seborrheic dermatitis, Rosacea, Chronic blepharitis, High blood lipid concentrations (possible risk from increased blockage of sebaceous glands), Face mask wear due to the COVID-19 pandemic, Leishmaniasis, Tuberculosis, Immunodeficiency, Viral infection, Carcinoma, Stress (causality has not been proven, and the mechanism by which it might act is unknown), Trachoma, Eyelid trauma, Eyelid surgery, Bortezomib, a first-generation proteasome inhibitor used to treat hematological malignancies, Use of atropine eyedrops in myopic children. […] As noted (see Pathophysiology), a chalazion may arise spontaneously subsequently to the development of an internal or external hordeolum.

• #13 Diseases of eyelid.pptx

  https://www.slideshare.net/MeghnaVerma24/diseases-of-eyelidpptx

  Posterior blepharitis occurs mostly due to staphylococcal infection. In chronic posterior blepharitis, it is also called a meibomian gland dysfunction due to seborrhoeic bacteria. […] Chalazion is a chronic inflammation of the meibomian gland. […] Internal hordeolum is a suppurative inflammation of the meibomian gland associated with blockage of the duct. […] Trichiasis refers to inward misdirection of cilia (lashes). […] Entropion is inward turning of the lid margin. […] Ectropion is outward turning of the lid margin. […] Symblepharon results from healing of the kissing raw surfaces upon the palpebral and bulbar conjunctiva. […] Blepharospasm refers to the involuntary and forceful closure of the eyelids. […] Ptosis is abnormal drooping of the upper eyelid. […] Congenital ptosis is associated with congenital weakness (mal-development) of the LPS muscle. […] Acquired ptosis may be neurogenic, myogenic, aponeurotic, or mechanical.

• #14 Expert’s deep dive into meibomian gland dysfunction – EyeWorld

  https://www.eyeworld.org/2023/experts-deep-dive-into-meibomian-gland-dysfunction/

  Meibomian gland dysfunction (MGD) is a broad term that covers various types of meibomian gland alterations. […] Meibomian glands provide the main source of lipids for the human tear film, Dr. de Luise said. […] In healthy eyelids, the meibomian gland orifices are open, and any expressed meibum is clear at room temperature. […] Whether hypersecretory or hyposecretory, in MGD there is abnormal meibum production, with more rapid evaporation of the tear film during the interblink interval. […] Meibomian glands in MGD differ from normal in that there is an altered lipid composition of the meibomian gland secretions, which in turn destabilizes the tear film. These abnormal secretions can have a direct toxic effect on the ocular surface, he said. […] MGD is the most common type of obstructive hyposecretory dysfunction.

• #15 Expert’s deep dive into meibomian gland dysfunction – EyeWorld

  https://www.eyeworld.org/2023/experts-deep-dive-into-meibomian-gland-dysfunction/

  In MGD the altered fatty acids and inflammation lead to saponification, a detergent action. […] Technologies include those to open meibomian glands directly, to heat the meibomian glands to liquefy the congealed meibum, or to apply pressure to the meibomian glands to express them, Dr. de Luise said. […] Opening capped, keratinized, or epithelialized meibomian gland orifices can be done with Maskin probes, Dr. De Luise added. […] MGD Stage 1: Change to an omega-3 diet, applying heat and compression to the eyelids. […] MGD Stage 2: Use Stage 1 strategies and add technological approaches of thermal pulsation, short courses of topical azithromycin gel. […] MGD Stage 3: Use Stage 1 and 2 strategies and add direct opening of capped meibomian gland orifices with Maskin probes; consider a short course of oral minocycline or doxycycline.

• #16 Efficacy and safety of the disposable eyelid warming masks in the treatment of dry eye disease due to Meibomian gland dysfunction | BMC Ophthalmology | Full Text

  https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03642-z

  Meibomian gland dysfunction (MGD) is a common ocular surface disease, which may result in alteration of the tear film and discomfort. The terminal duct and orifice obstruction and qualitative/quantitative changes in meibum were the main pathogenesis. […] Eyelid warming/warm compresses was applied to improve and/or restore the function of the meibomian glands by softening or liquefying the secretions in obstructed glands, so as to improve the subjective feeling of ocular dryness. […] Obstructive MGD is characterized by the abnormal gland structure and lipid changes in the meibomian glands. […] Several studies had shown that the melting point of meibomian gland lipids ranged from 30 to 45, which partly reflected that the lipids were a highly complex mixture. […] The application of warm compresses with or without moisture, had been extensively studied in the treatment of MGD.

• #17 Blepharitis and Stress | Centers for Dry Eyes

  https://www.centersfordryeye.com/blog/blepharitis-and-stress?p=a6B5byyWazScPArbX

  Blepharitis is a common, chronic inflammation of the eyelids, usually caused by the malfunctioning of the oil glands in the eyelids known as meibomian glands. This condition can lead to irritation, redness, swelling, and a burning sensation in the eyes. […] Stress affects almost every part of the body, and yes, it can make your blepharitis worse. Studies have shown that psychological stress can trigger inflammation and weaken the immune system, making the body more vulnerable to chronic conditions, including blepharitis. High-stress levels can exacerbate the symptoms of dry eye, and eyelid irritation, and increase the likelihood of flare-ups. […] While stress alone isn’t typically the direct cause of blepharitis, it can worsen the condition. Stress can lead to poor sleep, weakened immune systems, and increased inflammation, all of which contribute to eyelid issues. When stress disrupts the body’s natural functions, conditions like meibomian gland dysfunction can become more difficult to manage, causing recurring or worsened symptoms.

• #18 Blepharitis and Stress | Centers for Dry Eyes

  https://www.centersfordryeye.com/blog/blepharitis-and-stress?p=a6B5byyWazScPArbX

  The connection between blepharitis and stress highlights the importance of managing stress levels to maintain overall eye health. […] If left untreated, blepharitis can become a chronic condition. Symptoms may come and go, but the inflammation will likely persist, leading to discomfort and potential complications like damage to the cornea. Managing both the blepharitis and any underlying stress is essential for long-term relief.

• #19 Ocular surface and tear film changes after eyelid surgery – Fan – Annals of Eye Science

  https://aes.amegroups.org/article/view/5828/html

  Dry eye syndrome (DES) is a recognized sequela of eyelid surgery. […] The unreliability of objective tear production tests suggests that a better understanding of eyelid anatomy and physiology is needed to minimize dry eye after eyelid surgery. […] Blepharoplasty changes the close interaction between the eyelids, the tear film, and the ocular surface, thereby affecting the tear film. […] Operational changes to the anatomy of the eyelid can affect eyelid closure and blink. […] However, the orbicularis oculi muscle excision may lead to a decreased blink rate, incomplete reflex blink, and lagophthalmos. […] These could eventually result in increased tear evaporation, reduced tear film distribution and tear drainage with impaired debris removal from the ocular surface. […] The transcutaneous approach mechanisms may include bending of the lacrimal canal, particularly which originates from the palpebral lobe, postoperative inflammation, changes of tear flow, widened palpebral fissure, increased tear evaporation, and changed sensitivity of the cornea and conjunctiva.

• #20 Ocular surface and tear film changes after eyelid surgery – Fan – Annals of Eye Science

  https://aes.amegroups.org/article/view/5828/html

  Lack of meibomian glands causes insufficient lipid secretion, which leads to instability of the tear film. […] The surgery can also change the eyelids and corneas relative position, thus mechanically changing the corneoscleral and conjunctival interface, aggravating dry eye disease. […] Whether the patients underwent blepharoplasty, ptosis surgery, or eyelid reconstruction, they all have the possibility of causing or aggravating dry eye after operation.

• #21 Apraxia of Lid Opening – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560542/

  Apraxia of lid opening (ALO) is a relatively rare, nonmotor disorder characterized by a patient’s difficulty in initiating the act of lifting the upper eyelid despite normal oculomotor function. There is an inability of voluntary eye reopening without an orbicularis oculi spasm despite sustained frontalis contraction. This condition is not due to weakness, fatigue, or structural abnormalities of the eyelid or its associated muscles. Rather, it is thought to arise from a disruption in the neural networks that coordinate voluntary eyelid movement. […] The eyelid opening mechanism involves a complex interaction of muscles and nerves. The levator palpebrae superioris muscle is primarily responsible for lifting the upper eyelid, and it is innervated by the superior division of the oculomotor nerve (cranial nerve III). The Mller’s muscle, innervated by the sympathetic nervous system, also assists in eyelid elevation. Voluntary eyelid control is modulated by neural pathways that connect the basal ganglia, frontal lobes, and supplementary motor area, which are areas involved in initiating and planning voluntary movements. In ALO, the dysfunction appears to lie within these neural pathways rather than in the muscles themselves. The disorder is believed to originate from a disruption in the communication between the brain’s intention to open the eyelid and the execution of that action. While the exact pathophysiological mechanism is not fully understood, it is associated with neurodegenerative conditions such as Parkinson disease, progressive supranuclear palsy, and other diseases that affect the basal ganglia.

• #22 Blepharitis (lid margin disease) – College of Optometrists

  https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/blepharitis_lidmargindisease

  Lid hygiene, using lid cleansing measures, reduces symptoms for the majority of patients with either anterior or posterior blepharitis. […] Antibiotics in the form of eye drops or ointments (and in some cases antibiotics taken by mouth) can potentially lessen symptoms and are effective in clearing bacteria from the eyelid margins. […] However, there is no strong evidence that any of these treatments can completely cure the condition and continuous ongoing treatment may be necessary.

• #23 Efficacy and safety of the disposable eyelid warming masks in the treatment of dry eye disease due to Meibomian gland dysfunction | BMC Ophthalmology | Full Text

  https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03642-z

  Our results showed that the disposable eyelid warming masks could be effective and the overall improvement of symptoms could be due to significant improvement of the function of the meibomian glands, which was consistent with the previous studies. […] Although warm compresses are convenient for patients with diverse economic capability in daily life, the compliance with warm compress therapy is a long-existing problem for the treatment of MGD. […] It should be noted that we didn’t measure the ocular temperature before and after warm compresses in this pilot study. Nevertheless, both groups raised the ocular temperatures to the levels of treatment, demonstrating the potential to provide the symptomatic relief in patients with lower disease severity. […] Generally, the disposable eyelid warming masks were safe and effective, with mild ocular AEs and no SAEs, which was similar to the previous reports.

• #24 Droopy Eyelid Part 1 | North American Society of Academic Orbital Surgeons

  https://nasaos.org/droopy-eyelid-part-1/

  The reason that understanding the mechanism of eyelid droop for each patient is so important from a surgical standpoint is that if surgery repairs just one of these causes, but the droopy eyelids were caused by two or even three of these mechanisms, then the result will be unsatisfying. […] Therefore, it is critical to identify the eyelid/brow junction and ignore the position of the hairs. Identifying the eyelid/brow junction should focus on the subtle change from thin eyelid skin to thicker brow skin. […] Repair of the muscles has absolutely nothing to do with excess skin or with brow position. The surgery requires dissecting into the deep muscle layer of the eyelid, and tightening or repairing the malfunctioning or weakened muscle. […] Therefore, it is important to assess eyelid skin even in the context of true eyelid ptosis. This is so as to avoid a post-operative surprise that will make the patient rather unhappy; their eyes open better yet they have eyelid skin hooding that looks bad, causes excess weight, interferes with their peripheral vision, and will require a second surgery to address. […] In summary, it is important to identify the correct mechanism for each patient who presents complaining of droopy eyelids.

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