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Anterior Segment Disease > 3: Eyelids- Infectious and Non-Infectious Disease > Flashcards

3: Eyelids- Infectious and Non-Infectious Disease Flashcards

1
Q

normal size of palpebral fissure

A
  • horizontal: ~30 mm
  • vertical: ~10 mm (add marginal reflex distance-1 (distance b/t corneal reflex and UL margin) to marginal reflex distance-2 (distance between corneal reflex and LL margin))
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2
Q

size of eyelid margin

A

~2mm thick and 30 mm long

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3
Q

glands of Zeis:

  • gland type?
  • what do they secrete?
A

holocrine glands;

secrete sebum into hair follicle

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4
Q

glands of Moll:

  • gland type?
  • what do they secrete?
A

apocrine glands;

secrete sweat into hair follicle

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5
Q

papule

A

a bump, palpable and circumscribed, elevated and less than 5 mm in diameter; may be pigmented, erythematous, or flesh-toned

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6
Q

macule

A

a spot, circumscribed, up to 1 cm; not palpable; not elevated above or depressed below the surrounding skin surface; hypopigmented, hyperpigmented, or erythematous

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7
Q

molluscum contagiosum

A

viral infection of the epidermis

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8
Q

molluscum contagiosum etiology

A

molluscum contagiosum (poxvirus); transmitted through skin to skin contact or contact with fomites

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9
Q

molluscum contagiosum demographics

A
  • most commonly seen in infants and children

- if seen in adults, consider immunodeficiency

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10
Q

molluscum contagiosum laterality

A

unilateral or bilateral

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11
Q

molluscum contagiosum symptoms

A
  • bumps on skin

- mild itching of bumps

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12
Q

molluscum contagiosum signs

A
  • skin papules (dome-shaped bump): single or multiple, flesh-colored or pearly white, 1-2 mm in size, central umbilication due to a central keratin plug (non-ulcerative)
  • if on the eyelid margin, may cause follicular conjunctivitis
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13
Q

molluscum contagiosum management

A
  • self-limiting within 6-12 months
  • if does not self-limit or accompanied by chronic conjunctivitis, curettage for eyelid lesions (manually scraped with a curette under local anesthesia)
  • cryotherapy, cautery, chemical, laser can be used for lesions elsewhere on the body
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14
Q

molluscum contagiosum clinical pearls:

-immunocompromised patients may have _____

A

larger (up to 5 mm) and more numerous lesions

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15
Q

impetigo

A

bacterial infection of the epidermis

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16
Q

impetigo etiology

A

most commonly Staph aureus, Strep pyogenes

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17
Q

impetigo demographics

A

most commonly occurs in infants and children

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18
Q

impetigo laterality

A

unilateral or bilateral

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19
Q

impetigo symptoms

A
  • red, itchy skin rash

- may be painful

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20
Q

impetigo signs

A
  • skin macules (flat lesion), erythematous
  • macules evolve rapidly into thin-walled blisters; when rupturing, blisters produce honey-colored (golden-yellow) crusts
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21
Q

impetigo management

A
  • topical antibiotic
  • oral antibiotic in addition to topical
  • discuss hand-washing, avoidance of eye rubbing and towel sharing, and restrict school to reduce risk of transmission
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22
Q

impetigo clinical pearls:

  • highly _____
  • most commonly affects the _____
  • can scar
  • most common _____ in children
A

contagious;
the arms, legs, and around the nose and mouth;
bacterial skin infection

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23
Q

hordeolum

A
  • acute bacterial infection of the eyelid’s sebaceous glands with retention of oils and inflammatory debris
  • external: Zeis glands
  • internal: Meibomian glands
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24
Q

hordeolum etiology

A

most commonly Staph aureus

25
Q

hordeolum demographics

A

no predilection

26
Q

hordeolum laterality

A

unilateral > bilateral

27
Q

hordeolum symptoms

A
  • eyelid swelling (focal but may be diffuse if preseptal cellulitis is present)
  • pain in the area of the hordeolum
28
Q

external hordeolum signs

A
  • visible or palpable nodule pointing anteriorly through the skin
  • erythema in the area of the hordeolum
  • eyelash may be at the apex of the hordeolum
29
Q

internal hordeolum signs

A
  • visible or palpable nodule pointing posteriorly through the palpebral conjunctiva
  • injection in the area of the hordeolum
30
Q

hordeolum complications

A
  • pre-septal cellulitis is commonly present

- orbital celluliltis

31
Q

hordeolum management

A
  • oral antibiotic x10-14 days
  • warm compress with massage to express the contents of the hordeolum (at least BID, 5-10 mins of heat, massage the eyelid toward the lashes as tolerated)
  • lid hygiene
32
Q

hordeolum clinical pearls:

-may evolve into ____ or _____

A 
a chalazion (post spontaneous drainage or post active infection); 
pre-septal cellulitis
33
Q

pre-septal cellulitis

A

infection of the subcutaneous tissue anterior to the orbital septum

34
Q

pre-septal cellulitis etiology/associations

A
  • skin trauma (e.g., laceration, insect bite) with subsequent bacterial infection
  • extension from an adjacent infection (e.g., hordeolum, dacryoadenitis, dacryocystitis, sinusitis)
  • most commonly Staph aureus, streptococcus, H influenzae; less commonly herpes simplex, varicella zoster
35
Q

pre-septal cellulitis demographics

A

no predilection

36
Q

pre-septal cellulitis laterality

A

unilateral

37
Q

pre-septal cellulitis symptoms

A

eyelid swelling, redness, tenderness/pain

38
Q

pre-septal cellulitis signs

A
  • eyelid edema, erythema with tenderness/pain on eyelid palpation
  • low-grade fever
39
Q

pre-septal cellulitis complications

A

orbital cellulitis

40
Q

pre-septal cellulitis management

A
  • oral antibiotic x10-14 days
  • if moderate to severe and no improvement or worsening after 24-48 hours of oral antibiotic, refer to ER- might require IV antibiotics
41
Q

pre-septal cellulitis clinical pearls:

  • may develop into ____
  • _____ is an ocular emergency
A

orbital cellulitis;

orbital cellulitis

42
Q

chalazion

A
  • obstruction and inflammation of a meibomian gland with resultant accumulation/formation of lipogranulomatous material
  • anterotarsal: aka external; anterior to the tarsal plate (skin side)
  • retrotarsal: aka internal; posterior to the tarsal plate (conjunctiva side)
43
Q

chalazion etiology/associations

A
  • commonly due to chronic blepharitis, ocular rosacea, or MGD
  • inflammation within MG, gland of Zeis
  • may have evolved from a previous hordeolum
44
Q

chalazion demographics

A
  • lower socioeconomics
  • urban population
  • most common in women 10-29 years, men >60 years (but can affect all people of all ages!)
45
Q

chalazion laterality

A

unilateral > bilateral

46
Q

chalazion symptoms

A
  • “bump” on eyelid: may be described as red, puffy, cyst, knot, or stye; cosmesis
  • painless, perhaps mild tenderness in the area of the bump
  • may have discharge or “drainage”
  • may have multiple chalazia, may have a Hx of chronic occurrences
47
Q

anterotarsal/external chalazion signs

A

visible or palpable nodule pointing anteriorly through the skin

48
Q

retrotarsal/internal chalazion signs

A
  • visible or palpable nodule pointing posteriorly through the palpebral conjunctiva
  • must evert lid to evaluate!
49
Q

chalazion management

A
  • warm compress with digital massage to express the contents (at least BID for 5-10 mins, massage lid toward lashes)
  • eyelid hygiene
  • oral doxycycline (esp in ocular rosacea or MGD) (100 mg bid x2 weeks (prominent chalazion), 50 mg bid x4 weeks, then consider 50 mg qday for another 2 months (MGD > chalazion))
  • intralesional corticosteroid injection (Kenalog)
  • incision and curettage under local anesthesia
50
Q

chalazion clinical pearls:

-if recurs in the same location, especially with pertinent malignant findings, consider DDx of _____

A

sebaceous gland carcinoma

51
Q

blepharochalasis

A

recurrent episodes of inflammatory edema of the eyelids

52
Q

blepharochalasis etiology/associations

A
  • unknown etiology

- associated with Ascher syndrome

53
Q

blepharochalasis demographics

A
  • typically begins in teens-20s

- women > men

54
Q

blepharochalasis laterality

A

bilateral > unilateral

55
Q

Ascher syndrome

A
  • unknown etiology
  • eyelid swelling (blepharochalasis), narrow horizontal palpebral fissure, lip swelling (double lip sign), euthyroid (non-toxic) goiter
56
Q

blepharochalasis symptoms

A
  • painless eyelid swelling

- droopy eyelid(s) with fine wrinkles

57
Q

blepharochalasis signs

A
  • eyelid edema
  • repeated episodes of edema may result in atrophy and laxity of the upper eyelid tissues: thin, stretched, redundant skin with fine wrinkles; ptosis; deep superior sulci; lacrimal gland prolapse
58
Q

blepharochalasis management

A
  • self-limiting within a few days but can recur; with time, episodes become less frequent
  • no standardized treatment protocol
  • if redundant skin, ptosis, or lacrimal gland prolapse, consider referral out to oculoplastics for surgery (blepharoplasty or other lid restructuring surgeries)

Anterior Segment Disease (22 decks)

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