Ch 7: Disorders of the Eyes & Lids

Question 1

The major risk from contact lens wear is _________, ______, or ______ corneal infections.

Answer 1

bacterial, amebic, fungal

p. 164

Question 2

What is the most common eye disease?

The disease can be caused by…

Answer 2

conjunctivitis

….bacteria, viruses, allergies, or chemical irritants.

Question 3

What are most cases of conjunctivitis due to?

Answer 3

Viral or bacterial (including gonococcal and chlamydial) infection.

Question 4

What is the most common cause of viral conjunctivitis?

Answer 4

Adenovirus

Question 5

In viral conjunctivitis, there is usually _________ disease with copious watery discharge, often with marked foreign body sensation, and a follicular conjunctivitis.

Answer 5

bilateral

Question 6

What is a hordeolum?

Answer 6

Hordeolum is a common staphylococcal abscess. It causes a localized red, swollen, acutely tender area on the upper or lower lid. Pain tends to be proportional the amount of edema.

Question 7

What is chalazion?

Answer 7

Chalazion is a common granulomatous inflammation of a meibomian gland that may follow an internal hordeolum. It is characterized by a hard, NONTENDER swelling on the upper or lower lid with redness and swelling of the adjacent conjunctiva.

Chalazion can get large enough to impress the cornea, which distorts vision.

Question 8

What is the treatment for hordeolum?

Answer 8

Warm compresses are helpful, (at least 4 times daily for 20 minutes each time).
An antibiotic ointment (bacitracin or erythromycin) applied to the eyelid every 3 hours.
Incision may be indicated if resolution does not begin within 48 hours.

Question 9

What is the treatment for chalazion?

Answer 9

Treatment is usually by incision and curettage by an ophthalmologist but corticosteroid injection may also be effective.

Question 10

What is blepharitis?

Answer 10

Blepharitis is a common chronic bilateral inflammatory condition of the lid margins. It will cause eyelid irritation, burning, itching, erythema and crusting of the lid margins.

Question 11

What does anterior blepharitis involve?

Answer 11

Anterior blepharitis involves the eyelid skin, eyelashes, and associated glands. It may be ulcerative, because of infection by staphylococci, or seborrheic in association with seborrhea of the scalp, brows, and ears.

Question 12

What is the meibomian gland?

pronounced my-boe-me-an

Answer 12

one of the long sebaceous glands of the eyelids that discharge a fatty secretion (meibum) which lubricates the eyelids; may also be called a tarsal gland

[from https://www.merriam-webster.com/medical/meibomian%20gland]

Question 13

In humans, more than __ different proteins have been identified in meibomian gland secretions.

Answer 13

90

[from https://en.wikipedia.org/wiki/Meibomian_gland]

Question 14

What does posterior blepharitis result from?

Answer 14

Posterior blepharitis results from inflammation of the meibomian glands. There may be bacterial infection, particularly with staphylococci, or primary glandular dysfunction, in which there is a strong association with acne rosacea.

Question 15

What signs/symptoms are seen in anterior blepharitis?

Answer 15

In anterior blepharitis, the eyes are “red-rimmed” and scales or granulations can be seen clinging to the lashes.

Question 16

What signs/symptoms are seen in posterior blepharitis?

Answer 16

In posterior blepharitis, the lid margins are hyperemic with telangiectasias, and the meibomian glands and their orifices are inflamed. The lid margin is frequently rolled inward to produce a mild entropion, and the tears may be frothy or abnormally greasy.

Question 17

Blepharitis is a common cause of recurrent ______________.

Answer 17

conjunctivitis

Question 18

Both anterior and, more particularly, posterior blepharitis may be complicated by ________ or ________.

Answer 18

hordeola or chalazia

Question 19

What is trichiasis?

Answer 19

a turning inward of the eyelashes often causing irritation of the eyeball

Question 20

Anterior blepharitis is usually controlled by ___________ of the lid margins, eyebrows, and scalp. Scales should be removed from the lids daily with a hot wash cloth or a damp cotton applicator and baby _______. In acute exacerbations, an __________________ antibiotic eye ointment, such as bacitracin or erythromycin, is applied daily to the lid margins. Antibiotic ___________ studies may be helpful in severe cases.

Answer 20

cleanliness
shampoo
antistaphylococcal
sensitivity

Question 21

In mild posterior blepharitis, regular meibomian gland __________ may be sufficient to control symptoms. Inflammation of the conjunctiva and cornea indicates a need for more active treatment, including long-term low-dose ____ antibiotic therapy, usually with ____________ (250 mg twice daily), doxycycline (100 mg daily), minocycline (50–100 mg daily), or erythromycin (250 mg three times daily), and possibly short-term topical corticosteroids, e.g., prednisolone, 0.125% twice daily. Topical therapy with antibiotics, such as _____________ 0.3% ophthalmic solution twice daily, may be helpful but should be restricted to short courses.

Answer 21

expression
oral
tetracycline
ciprofloxacin

Question 22

Entropion is….

It occurs occasionally in older people as a result of…

Answer 22

….an inward turning of usually the lower lid.

….degeneration of the lid fascia.

Question 23

Surgery is indicated for entropion if the lashes rub on the ______. _________ _____ injections may also be used for temporary correction of the involutional lower eyelid entropion of older people.

Answer 23

cornea

Botulinum toxin

Question 24

When you examine the eye, you really only have one of your four diagnostic tools to use: __________.

For the fundoscopic exam, it is a really systematic exam. Start ________ and go to the lateral aspect of the retina, begin with the optic disc and end with the fovea
Remember to use your ____ eye and hand for your patient’s right eye. Your head with the ophthalmoscope move as a single unit…

Inspection of the Optic Disc:
Check the margins: they should be round or slightly oval with _____ borders.
Color: _______ in light skinned people and yellow-orange in darker pigmented people
Physiologic Cup: the central part of the disc penetrated by retinal vessels…. cup to disc ratio should be ___ - ___.

Retinal Vessels: arteries are smaller than veins, from 2/3 to 4/5 the size of the veins
Inspect the vessels in 4 directions: superior temporal, superior nasal, inferior temporal, and inferior nasal

Macula: is _________ area with a pinpoint reflective center (the _____).
Macula is about 2 disc diameters from the optic disc.

Answer 24

inspection
medially
right

sharp
pinkish
0.1 - 0.5

avascular
fovea

[from EENT powerpoint lecture]

Question 25

What is the hedgehog pathway?

Answer 25

The Hedgehog (Hh) pathway is a major regulator of many fundamental processes in vertebrate embryonic development including stem cell maintenance, cell differentiation, tissue polarity and cell proliferation. 
The Hh signaling pathway has also recently been recognized to be one of the most important signaling pathways and a therapeutic target in cancer.

[Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126020/]

Question 26

Eyelid tumors are usually ______. _____ cell _________ is the most common malignant tumor.

Answer 26

benign
Basal cell carcinoma

(p. 165)

Question 27

Histopathologic examination of eyelid tumors after excision should be routine, since _% of lesions thought to be benign are malignant.

Answer 27

2%

p. 165

Question 28

What is your differential diagnosis when you see something that looks like a hordeolum?

Answer 28

conjunctivitis
chalazion
blepharitis
dacrocystitis

[from EENT powerpoint lecture]

Question 29

Dacryocystitis is infection of the ________ ___ usually due to congenital or acquired obstruction of the nasolacrimal system. It may be acute or chronic and occurs most often in infants and in persons over 40 years. It is usually __________. The usual infectious organisms are Staphylococcus aureus and streptococci in acute dacryocystitis, and Staphylococcus epidermidis, streptococci, or gram-negative bacilli in chronic dacryocystitis.

Answer 29

lacrimal sac

unilateral

Question 30

Acute dacryocystitis is characterized by pain, ________, tenderness, and redness in the tear sac area; purulent material may be expressed. In chronic dacryocystitis, _______ and _________ are the principal signs, and mucus or pus may also be expressed.

Answer 30

swelling

tearing, discharge

Question 31

Acute dacryocystitis responds well to ________ __________ therapy.

Answer 31

systemic antibiotic

Question 32

Surgical relief of the underlying obstruction is usually done electively but may be performed urgently in acute cases.
The chronic form may be kept ______ with antibiotics, but relief of the obstruction is the only cure. In adults, the standard procedure for obstruction of the lacrimal drainage system is _____________________, which involves surgical exploration of the lacrimal sac and formation of a _______ into the nasal cavity.

Answer 32

latent
dacryocystorhinostomy
fistula

Question 33

What is the differential diagnosis associated with blepharitis?

Answer 33

Conjunctivitis
Hordeolum
Dacrocystitis
Chemical irritation

[from EENT powerpoint lecture]

Question 34

If you suspect gonococcal conjunctivitis, you should order….

Answer 34

….a gram stain and culture.

[from EENT powerpoint lecture]

Question 35

It is important to know that the discomfort would be mild, not _________ _______, and that there should be no ___________ if it is a simple conjunctivitis.

Answer 35

extremely painful

photophobia

Question 36

Bacterial: ________ discharge; with Gonococcal conjunctivitis, it can be _______.
Viral conjunctivitis is characterized by ______ discharge.
While allergic conjunctivitis is usually seen with bilateral tearing and a _______ discharge.

Answer 36

purulent, copious
watery
stringy

Question 37

What is the treatment for bacterial conjunctivitis?

Answer 37

Bacterial conjunctivitis in many cases is self limiting, and will resolve in 10 – 14 days if untreated. Treatment options include both pharmacologic and non pharmacologic treatments:
Pharmacologic:
Sulfacetamide 10% solution, 2 gtts tid – qid
Gentamycin 2% soln, 1 – 2 gtts tid
and others

Question 38

Gonococcal conjunctivitis, usually acquired through contact with infected genital secretions, typically causes copious purulent discharge. It is an ophthalmologic emergency because corneal involvement may rapidly lead to ____________. The diagnosis should be confirmed by stained smear and culture of the discharge. A single 1-g dose of _____________ ___________ is usually adequate. (_______________ resistance is common.)

Answer 38

perforation
intramuscular ceftriaxone
Fluoroquinolone

(p. 167)

Question 39

________ is the most common infectious cause of blindness worldwide.

Answer 39

Trachoma

Question 40

What is the medical term for dry eyes?

Answer 40

keratoconjunctivitis sicca

Question 41

What are the essentials of diagnosis for cataracts?

Answer 41

Gradually progressive blurred vision.
No pain or redness.
Lens opacities (may be grossly visible).

(p. 182)