3: Eyelids- Infectious and Non-Infectious Disease Flashcards
normal size of palpebral fissure
- 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))
size of eyelid margin
~2mm thick and 30 mm long
glands of Zeis:
- gland type?
- what do they secrete?
holocrine glands;
secrete sebum into hair follicle
glands of Moll:
- gland type?
- what do they secrete?
apocrine glands;
secrete sweat into hair follicle
papule
a bump, palpable and circumscribed, elevated and less than 5 mm in diameter; may be pigmented, erythematous, or flesh-toned
macule
a spot, circumscribed, up to 1 cm; not palpable; not elevated above or depressed below the surrounding skin surface; hypopigmented, hyperpigmented, or erythematous
molluscum contagiosum
viral infection of the epidermis
molluscum contagiosum etiology
molluscum contagiosum (poxvirus); transmitted through skin to skin contact or contact with fomites
molluscum contagiosum demographics
- most commonly seen in infants and children
- if seen in adults, consider immunodeficiency
molluscum contagiosum laterality
unilateral or bilateral
molluscum contagiosum symptoms
- bumps on skin
- mild itching of bumps
molluscum contagiosum signs
- 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
molluscum contagiosum management
- 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
molluscum contagiosum clinical pearls:
-immunocompromised patients may have _____
larger (up to 5 mm) and more numerous lesions
impetigo
bacterial infection of the epidermis
impetigo etiology
most commonly Staph aureus, Strep pyogenes
impetigo demographics
most commonly occurs in infants and children
impetigo laterality
unilateral or bilateral
impetigo symptoms
- red, itchy skin rash
- may be painful
impetigo signs
- skin macules (flat lesion), erythematous
- macules evolve rapidly into thin-walled blisters; when rupturing, blisters produce honey-colored (golden-yellow) crusts
impetigo management
- 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
impetigo clinical pearls:
- highly _____
- most commonly affects the _____
- can scar
- most common _____ in children
contagious;
the arms, legs, and around the nose and mouth;
bacterial skin infection
hordeolum
- acute bacterial infection of the eyelid’s sebaceous glands with retention of oils and inflammatory debris
- external: Zeis glands
- internal: Meibomian glands
hordeolum etiology
most commonly Staph aureus
hordeolum demographics
no predilection
hordeolum laterality
unilateral > bilateral
hordeolum symptoms
- eyelid swelling (focal but may be diffuse if preseptal cellulitis is present)
- pain in the area of the hordeolum
external hordeolum signs
- 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
internal hordeolum signs
- visible or palpable nodule pointing posteriorly through the palpebral conjunctiva
- injection in the area of the hordeolum
hordeolum complications
- pre-septal cellulitis is commonly present
- orbital celluliltis
hordeolum management
- 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
hordeolum clinical pearls:
-may evolve into ____ or _____
a chalazion (post spontaneous drainage or post active infection); pre-septal cellulitis
pre-septal cellulitis
infection of the subcutaneous tissue anterior to the orbital septum
pre-septal cellulitis etiology/associations
- 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
pre-septal cellulitis demographics
no predilection
pre-septal cellulitis laterality
unilateral
pre-septal cellulitis symptoms
eyelid swelling, redness, tenderness/pain
pre-septal cellulitis signs
- eyelid edema, erythema with tenderness/pain on eyelid palpation
- low-grade fever
pre-septal cellulitis complications
orbital cellulitis
pre-septal cellulitis management
- 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
pre-septal cellulitis clinical pearls:
- may develop into ____
- _____ is an ocular emergency
orbital cellulitis;
orbital cellulitis
chalazion
- 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)
chalazion etiology/associations
- commonly due to chronic blepharitis, ocular rosacea, or MGD
- inflammation within MG, gland of Zeis
- may have evolved from a previous hordeolum
chalazion demographics
- lower socioeconomics
- urban population
- most common in women 10-29 years, men >60 years (but can affect all people of all ages!)
chalazion laterality
unilateral > bilateral
chalazion symptoms
- “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
anterotarsal/external chalazion signs
visible or palpable nodule pointing anteriorly through the skin
retrotarsal/internal chalazion signs
- visible or palpable nodule pointing posteriorly through the palpebral conjunctiva
- must evert lid to evaluate!
chalazion management
- 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
chalazion clinical pearls:
-if recurs in the same location, especially with pertinent malignant findings, consider DDx of _____
sebaceous gland carcinoma
blepharochalasis
recurrent episodes of inflammatory edema of the eyelids
blepharochalasis etiology/associations
- unknown etiology
- associated with Ascher syndrome
blepharochalasis demographics
- typically begins in teens-20s
- women > men
blepharochalasis laterality
bilateral > unilateral
Ascher syndrome
- unknown etiology
- eyelid swelling (blepharochalasis), narrow horizontal palpebral fissure, lip swelling (double lip sign), euthyroid (non-toxic) goiter
blepharochalasis symptoms
- painless eyelid swelling
- droopy eyelid(s) with fine wrinkles
blepharochalasis signs
- 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
blepharochalasis management
- 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)
