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𝘠𝘦𝘭𝘭𝘰𝘸 𝘭𝘪𝘥𝘴!⁣

𝗫𝗮𝗻𝘁𝗵𝗲𝗹𝗮𝘀𝗺𝗮⁣

Benign cutaneous lesions around the periocular area⁣

More common in women⁣

30-50 years of age⁣

Associated lipid disorders⁣




Risk factors⁣

Diabetes mellitus⁣

Hypothyroidism⁣

Cardiovascular disease⁣

Obesity⁣

Pancreatitis⁣

Hyperuricemia⁣

Smokers⁣

Excessive alcohol intake⁣

Pathophysiology⁣

Increased plasma peroxidation of low density lipoprotein (LDL) resulting in cholesterol accumulation within macrophages to form foam cells⁣

In xanthoma formation, the ability to remove cholesterol from the tissue is reduced due to low HDL levels⁣

The rate at which LDL leaks from the capillaries is increased in areas that have more friction and are in constant motion (so eyelid skin is most commonly affected)⁣

An increase in inflammatory cells within the eyelid tissue is also thought to have an effect on the formation of xanthelasma⁣

Features:⁣

Most common site: Medial canthus. More in upper lid⁣

Soft, yellow papules or plaques filled with cholesterol⁣

Multiple, symmetric lesions⁣

HPE:⁣

Reticular dermis infiltration of foamy macrophages with sparing of the epidermis, papillary dermis, and subcutaneous fatty layer⁣

Inflammatory infiltrate in the superficial reticular dermis will be perivascular and consist of foam cells with lipid-laden cytoplasmic vacuoles⁣

Systemic Investigations⁣

HbA1C⁣

LFT⁣

Thyroid function tests⁣

Lipid profile⁣

Rx⁣

Conservative: Low-fat diet, Statins⁣

Surgical excision⁣

Laser therapy: Coagulates vessels and damages the perivascular foam cells that⁣

make up the lesion. Fractionated Er:YAG and fractionated CO2 lasers are used⁣

Chemical peel: With Tricholoroacetic acid (70% concentration)⁣

Peel induces a chemical cauterization causing coagulation of proteins within the⁣

skin- this is then neutralized within the superficial dermal plexus⁣

Effective on small lesions⁣

Cryotherapy: causes vasoconstriction and the formation of microthrombi as a result of cell death within XP lesions Now avoided because of high risk of eyelid swelling.⁣

Radiofrequency ablation: electrocoagulation for instant hemostasis and is used in vascular lesions. For lesions that are very close to the globe or have indistinct borders.⁣


www.ophthalmobytes.com⁣

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White Centered hemorrhages⁣

𝗥𝗼𝘁𝗵 𝗦𝗽𝗼𝘁𝘀⁣




Described by Moritz Roth in 1872, Named as ‘Roth Spot’ in 1878 by Litten ⁣

𝘌𝘵𝘪𝘰𝘭𝘰𝘨𝘪𝘦𝘴:⁣

● Subacute bacterial endocarditiis⁣

● Anemia/Thrombocytopenia⁣

● Leukemia⁣

● Collagen vascular diseases⁣

● Hypertensive/Diabetic Retinopathy⁣

● HIV⁣

● Anoxia⁣

● Shaken baby syndrome⁣

● CO poisoning⁣

● Vitamin B 12 deficiency⁣

● Traumatic delivery etc⁣

𝘗𝘢𝘵𝘩𝘰𝘱𝘩𝘺𝘴𝘪𝘰𝘭𝘰𝘨𝘺:⁣

● They result from retinal capillary rupture and extrusion of whole blood.⁣

● This is followed by platelet adhesion to the damaged endothelium initiating a⁣

coagulation cascade and formation of a white lesion in the centre of the hemorrhage,⁣

which is a platelet-fibrin thrombus.⁣

● In leukemia, the white centre could correspond to an accumulation of leukemic cells.⁣

𝘚𝘺𝘮𝘱𝘵𝘰𝘮𝘴:⁣

Asymptomatic unless macula is involved⁣

𝙁𝙞𝙣𝙙𝙞𝙣𝙜 𝙤𝙛 𝙍𝙤𝙩𝙝 𝙎𝙥𝙤𝙩𝙨 𝙨𝙝𝙤𝙪𝙡𝙙 𝙙𝙞𝙧𝙚𝙘𝙩 𝙩𝙝𝙚 𝙤𝙥𝙝𝙩𝙝𝙖𝙡𝙢𝙤𝙡𝙤𝙜𝙞𝙨𝙩 𝙛𝙤𝙧 𝙤𝙩𝙝𝙚𝙧 𝙥𝙝𝙮𝙨𝙞𝙘𝙖𝙡 𝙨𝙞𝙜𝙣𝙨 𝙤𝙛 𝙨𝙮𝙨𝙩𝙚𝙢𝙞𝙘 𝙞𝙡𝙡𝙣𝙚𝙨𝙨𝙚𝙨 𝙖𝙨𝙨𝙤𝙘𝙞𝙖𝙩𝙚𝙙 𝙬𝙞𝙩𝙝 𝙍𝙤𝙩𝙝 𝙎𝙥𝙤𝙩𝙨⁣

𝙏𝙧𝙚𝙖𝙩𝙢𝙚𝙣𝙩 𝙨𝙝𝙤𝙪𝙡𝙙 𝙗𝙚 𝙙𝙞𝙧𝙚𝙘𝙩𝙚𝙙 𝙖𝙩 𝙪𝙣𝙙𝙚𝙧𝙡𝙮𝙞𝙣𝙜 𝙨𝙮𝙨𝙩𝙚𝙢𝙞𝙘 𝙞𝙡𝙡𝙣𝙚𝙨𝙨⁣

www.ophthalmobytes.com⁣

Image from Rajan Eye Care Hospital #ophthalmology #ophthal #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency #oftalmologia #surgery #surgeon #apaoyo

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