Huidziekten rond het oog

General practitioners wanting to refer a patient with an eyelid disorder sometimes have trouble choosing between dermatologist and ophthalmologist. Dermatologists frequently see patients with seborrheic dermatitis or rosacea and eyelid complaints. It is important for dermatologists to have sufficient basic knowledge for adequate explanation to patients and to determine whether referral to an ophthalmologist is indicated. There is no consensus on the classification of blepharitis and the evidence for effective local therapy is disappointing. Daily eyelid hygiene is probably being the best advice. A chalazion is a lipogranulomatous inflammatory reaction to lipids from an occluded and ruptured Meibomian gland and is associated with blepharitis, seborrheic dermatitis and rosacea. The role of Demodex brevis is questionable. Chalazia usually heal spontaneously, surgical excision via the inside of the eyelid is reserved for ophthalmologists or (experienced) general practitioners. A hordeolum is an acute pustular abscess-forming staphyloccal infection of glands of Zeis or Moll (external hordeolum), or Meibom (internal hordeolum). Here as well evidence for effective topical therapy is lacking. Warm moist compresses are usually applied. Following draining of the small abscess (spontaneous or by puncture) healing usually occurs within 1-2 weeks. Eyelid disorders as side effect of oncological treatment with Epidermal Growth Factor Receptor inhibitors (EGFR inhibitors) are less known to dermatologists than the notorious papulopustular ('acneïform') follicular rash.Trichomegaly, blepharitis and 'dysfunctional tear syndrome' occur much later and persist longer. Combined treatment with artificial tears, ocular corticosteroid ointment and lid hygiene is often required.