2-Eyelids and anterior segment Flashcards
What are the best treatments for allergic conjunctivitis
cold compress, antihistamine drops, oral antihistamines
What is blepharitis
chronic, intermittent inflammation of eyelids
What are possible causes of blepharitis
anterior: infectious (S. Aureus) or seborrheic
posterior: meibomian gland dysfunction
How does blepharitis present clinically
red eyes gritty FB sensation burning sensation tearing crusty lashes photophobia \+/- blurry vision
What will you see on blepharitis PE
diffuse conjunctival injection inflamed red eyelid margins Crusting or matting of lashes plugged glands collarettes
How do you treat blepharitis
warm compress, lid massage/hygiene
topical Abx (erythromycin)
oral Abx
What are the types of blepharitis
chalazion
hordeolum
stye
What is periorbital cellulitis
infection of soft tissue around eye (more common)
does NOT extend into orbit or globe
What causes periorbital cellulitis
external sources (blepharitis, insect bites, FB) sometimes sinusitis
How does periorbital cellulitis present
eye pain, swelling, and erythema
NO fever, vision change, pain with eye movement
What is absent on PE for periorbital cellulitis
No proptosis
No ophthalmoplegia
How should you work periorbital cellulitis up if you are unsure what it is
Treat like orbital cellulitis!
CBC, cultures, discharge culture, CT orbit/sinus
How do you treat periorbital cellulitis
outpatient; empiric Abx (cover S. aureus, S. pneumo, MRSA
Suspected MRSA: oral Bactrim PLUS Amoxicillin and/or cefdinir, and/or cefpodoxime
What is orbital cellulitis
infection of fat and muscle surrounding globe
does NOT involve globe
What usually causes orbital cellulitis
extension of infection from paranasal sinuses (ethmoid)
How does orbital cellulitis present
eye pain eyelid swelling/erythema *vision changes *fever *pain with eye movement
What will you see on orbital cellulitis PE
proptosis
ophthalmoplegia
conjunctivitis
+/- discharge
How do you work up orbital cellulitis
CBC
cultures
discharge cultures
CT orbit/sinuses
How do you treat orbital cellulitis
hospitalize! consult ophtho
Immediate IV broad spectrum abx (vanco+ceftriaxone) until cultures come back
surgical drainage if abscess forms
Why do you start IC abx in orbital cellulitis
to prevent optic nerve damage
prevent infection spread to cavernous sinus, meninges, and brain
Where is the macula located in respect to the optic disc
macula is temporal to the optic disc
What is conjunctivitis
inflammation of conjunctiva (white) most commonly due to viral infection
(can also be caused by bacteria, allergies, chemical)
How do you transmit conjunctivitis
direct contact
What is the most common cause of viral conjunctivitis
Adenovirus
What are signs and symptoms of viral conjunctivitis
pharyngitis, fever, malaise, watery Dx, periauricular adenopathy
How do you treat viral conjunctivitis
cold compress for discomfort
What organisms commonly cause bacterial conjunctivitis
S. pneumo
H. influenza
Pseudomonas
What are the signs and symptoms of bacterial conjunctivitis
copious discharge
eyes matted shut in morning
How do you treat bacterial conjunctivitis
erythromycin ointment fluoroquinolone drops (-floxacin)
How does allergic conjunctivitis present
bilaterally (seasonal)
itchy, conjunctival erythema and chemises (swelling)
How do you treat allergic conjunctivitis
cold compress
oral antihistamine
drops
What is Dacryocystitis
infection of lacrimal sac secondary to nasolacrimal duct obstruction
more common in children
How do you treat Dacryocystitis
aggressive abx (clindamycin, IV vanco) surgery (NLD probing)
What is Entropion
inward turning of eyelids (especially lower lid) occurring with lid tissue degeneration that comes with AGE
(can also be childhood facial structure)
Why must you treat entropion with lubrication
to prevent lashes from rubbing surface of the eye
What is Ectropion
outward turning of eyelids (lower) due to lid degeneration that comes with AGE
How do you treat ectropion
surgery, if excess tearing or exposure keratitis occur
What is a pingueculum
yellow, elevated nodule (usually on nasal side) common in 35+ y/o
Rarely grow or require treatment
What is a pterygium
fleshy, triangular growth of conjunctiva that can spread and compromise cornea and visual axis
What causes pterygium
wind, sun, dust exposure
How do you treat pterygium
artificial tears
anti-inflammatory
excision (if severe)
