• Description: Idiopathic granulomatous inflammation of the cavernous sinus causing painful ophthalmoplegia and CN III, IV, VI palsy.

• Treatment: High-dose systemic corticosteroids; MRI to rule out other causes.

• Emergency?: Yes, vision and life-threatening conditions must be ruled out.

• Differential Diagnoses: Cavernous sinus thrombosis, orbital pseudotumor, neoplasm, aneurysm.

• Helpful Testing: MRI

Notes:

Bilateral involvement is more common in children. Patients often respond dramatically to corticosteroids within 24-48 hours.

• Description: Chronic inflammatory skin condition with ocular involvement; presents as blepharitis, recurrent chalazia, meibomian gland dysfunction, and keratitis.

• Treatment: Oral doxycycline, lid hygiene, artificial tears, topical metronidazole or azelaic acid for skin.

• Emergency?: No, but can lead to vision-threatening corneal disease.

• Helpful Testing: Dry eye workup (meibography, Schirmer's, staining, meibomian gland expression, etc.) 

• Differential Diagnoses: MGD, seborrheic dermatitis, contact dermatitis, phlyctenular keratoconjunctivitis.

• Description: Lax upper eyelids that are easily everted; associated with obesity and obstructive sleep apnea; causes chronic papillary conjunctivitis.

• Treatment: Lubrication, eyelid taping at night, sleep apnea management, surgical eyelid tightening.

• Emergency?: No, but untreated sleep apnea has systemic risks.

• Helpful Testing: Corneal staining. 

• Differential Diagnoses: Allergic conjunctivitis, mechanical ectropion, dermatochalasis, MGD.