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Heat stroke may present with dizziness, weakness, emotional lability, nausea and vomiting, diarrhea, confusion, delirium, blurred vision, convulsions, collapse, and unconsciousness The skin is hot and initially covered with perspiration; later it dries The pulse is strong initially Tachycardia and hyperventilation (with subsequent respiratory alkalosis) occur Blood pressure may be slightly elevated at first, but hypotension develops later The core temperature is usually over 40 C Exertional heat stroke may present with sudden collapse and loss of consciousness followed by irrational behavior Anhidrosis may not be present Twenty-five percent of heat stroke victims have prodromal symptoms for minutes to hours that may include dizziness, weakness, nausea, confusion, disorientation, drowsiness, and irrational behavior Multiorgan dysfunction or injury is a common and serious complication

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Symptoms are irritation, burning, and itching In anterior blepharitis, the eyes are red-rimmed, and scales or granulations can be seen clinging to the lashes In posterior blepharitis, the lid margins are hyperemic with telangiectasias; the meibomian glands and their orifices are inflamed, with dilation of the glands, plugging of the orifices, and abnormal secretions The lid margin is frequently rolled inward to produce a mild entropion, and the tears may be frothy or abnormally greasy Blepharitis is a common cause of recurrent conjunctivitis Both anterior and, more particularly, posterior blepharitis may be complicated by hordeola or chalazions; abnormal lid or lash positions, producing trichiasis; epithelial keratitis of the lower third of the cornea; marginal corneal infiltrates; and inferior corneal vascularization and thinning

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Chalazion is a common granulomatous inflammation of a meibomian gland that may follow an internal hordeolum It is characterized by a hard, nontender swelling on the upper or lower lid with redness and swelling of the adjacent conjunctiva If the chalazion is large enough to impress the cornea, vision will be distorted Treatment is usually by incision and curettage but corticosteroid injection may also be effective

Ben Simon GJ et al Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: is it really effective Ophthalmology 2005 May;112(5):913 7 [PMID: 15878075]

Anterior blepharitis is usually controlled by cleanliness of the lid margins, eyebrows, and scalp Scales should be removed from the lids daily with a hot flannel or a damp cotton applicator and baby shampoo In acute exacerbations, an antistaphylococcal antibiotic eye ointment such as bacitracin or erythromycin is applied daily to the lid margins Antibiotic sensitivity studies may be helpful in severe cases In mild posterior blepharitis, regular meibomian gland expression may be sufficient to control symptoms Inflammation of the conjunctiva and cornea indicates a need for more active treatment, including long-term low-dose systemic antibiotic therapy, usually with tetracycline (250 mg twice daily), doxycycline (100 mg daily), minocycline (50 100 mg daily) or erythromycin (250 mg three times daily), and possibly short-term topical corticosteroids, eg, prednisolone, 0125% twice daily Topical therapy with antibiotics such as ciprofloxacin 03% ophthalmic solution twice

Small lesions of the skin of the lids can often be excised by the nonophthalmologist if he or she does not involve the lid margin; otherwise, surgery should be performed by an ophthalmologist to avoid deformity of the lid Histopathologic examination of eyelid tumors should be routine, since 2% of lesions thought to be benign clinically are found to be malignant Basal cell carcinoma, squamous cell carcinoma, meibomian gland carcinoma, and malignant melanoma are the common types The Mohs technique of

Entropion (inward turning of usually the lower lid) occurs occasionally in older people as a result of degeneration of the lid fascia, or may follow extensive scarring of the conjunctiva and tarsus Surgery is indicated if the lashes rub on the cornea Botulinum toxin injections may also be used for temporary correction of the involutional lower eyelid entropion of older people Ectropion (outward turning of the lower lid) is common with advanced age Surgery is indicated if there is excessive tearing, exposure keratitis, or a cosmetic problem

acute cases The chronic form may be kept latent with antibiotics, but relief of the obstruction is the only cure In adults, the standard procedure for obstruction of the lacrimal drainage system is dacryocystorhinostomy, which involves surgical exploration of the lacrimal sac and formation of a fistula into the nasal cavity Laser-assisted endoscopic dacryocystorhinostomy and balloon dilation or probing of the nasolacrimal system are alternatives Congenital nasolacrimal duct obstruction is common and often resolves spontaneously but, if necessary, can be treated by probing of the nasolacrimal system, for example

FIGURE 10-11

Kapadia MK et al Evaluation and management of congenital nasolacrimal duct obstruction Otolaryngol Clin North Am 2006 Oct;39(5):959 77 [PMID: 16982257] Mills DM et al Acquired nasolacrimal duct obstruction Otolaryngol Clin North Am 2006 Oct;39(5):979 99 [PMID: 16982258]

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