Chap 3 Eye MDT Flashcards
Common chronic bilateral inflammatory condition of lid margins
Blepharitis
Involves the lid skin, eyelashes, and associated glands
Seborrhea of the scalp, brows, and ears (dermatitis)
Scales or granules can be seen clinging to eyelashes
Anterior blepharitis
Results from inflammation of Meibomian glands
Strong association with acne rosacea
Meibomian glands and their orifices are inflamed
Posterior blepharitis
Symptoms and physical exam findings:
Itching, burning, mild pain, foreign body sensation, tearing, erythema of the lids, and crusting around the eyes upon awakening
Frothy/greasy tears
May have conjunctival injection
Blepharitis
Treatment for blepharitis
Eyelid margins cleaned twice daily with commercial eyelid scrub (Ocusoft) or baby shampoo
Warm compresses for 10-15 minutes, 1-2 times a day
- Lid massage
- Artificial tears
- Omega 3 supplements
- Bacitracin ointment
Long-term, low dose antibiotic therapy for blepharitis
Tetracycline 250mg BID
Doxycycline 100mg BID
Erythromycin 1g/day
Azithromycin 500mg day one, 250mg x4 days
Clarithromycin 250mg BID x 7 days
Blepharitis follow up
2-4 weeks
Sebaceous glands connected to the eyelashes, secretions from these glands lubricate the eyelid surface
Gland of Zeis
Oil glands along the edge of the eyelids where eyelashes are found
Meibomian glands
Acute infection that usually involves Staphylococcus species
External (Gland of Zeis)
Internal (Meibomian gland)
Hordeolum
Chronic focal granulomatous inflammation within the eyelid, secondary to the obstruction of a meibomian gland or gland of Zeis (hordeolums)
Chalazion
Symptoms and physical examination findings:
- Localized eyelid tenderness, swelling and erythema
- May have foreign body sensation depending on location
- Visible, or palpable, well-defined subcutaneous nodule in the eyelid
- May also note “pointing” of mucopurulent material
- Associated blepharitis or acne rosacea
Hordeolum
Symptoms and physical exam findings:
- Hard and nontender nodule on the eyelid, usually farther back than a hordeolum
- Edema on the upper or lower lid
- Erythema and edema of the adjacent conjunctiva
Chalazion
Risk factors of hordeolums and chalazions
1) Touch eyes with unwashed hands
2) Insert contact lenses without thoroughly disinfecting them
3) Leave makeup overnight
4) Used or expired cosmetics
5) Have blepharitis
Hordeolum or chalazion treatment
Warm compresses 15 minutes four times a day
Massage infected eyelid after warm compress to aid in drainage
Discontinue eye make up
When would you consider antibiotic ointment for a hordeolum or chalazion?
- Concern the patient will develop periorbital cellulitis
- 48 hours of warm compresses does not clear it up
Most common cause of viral conjunctivitis
Adenovirus
Nongonococcal bacterial conjunctivitis is caused by:
- Staphylococcus aureus
- Staphylococcus epidermis
- Haemophilus influenzae (associated with otitis media)
- Streptococcus pneumoniae
- Moraxella catarrhalis
Ophthalmologic emergency because corneal involvement may rapidly lead to perforation
Gonococcal conjunctivitis
Sx: Itchy, burning, tearing, gritty or foreign body sensation; History of URI
Signs: Water discharge, red and edematous eyelids, pinpoint subconjunctival hemorrhages, punctate keratopathy (epithelial erosion in severe cases), membrane/pseudo membrane (severe cases)
Viral conjunctivitis
Sx: Itching, watery discharge, and a history of allergies are typical. Usually bilateral.
Signs: Chemosis (swollen conjunctiva), red and edematous eyelids, conjunctival papillae, periocular hyperpigmentation, no preauricular node
Allergic conjunctivitis
Sx: Redness, foreign body sensation, discharge, itching is much less prominent. Often complains of having to wipe purulent exudate in morning.
Signs: Purulent discharge of mild to moderate degree.
Preauricular node typically absent
Bacterial Conjunctivitis (nongonococcal)
Signs: Severe purulent discharge, hyperacute onset (12-24 hrs)
Preauricular adenopathy, eyelid swelling
Gonococcal conjunctivitis
Treatment for viral conjunctivitis
Mild: Artificial tears
Moderate: Epinastine (Ophthalmic antihistamine)
Treatment for a patient with viral conjunctivitis that has photophobia
Consult Ophthalmology:
Opthalmic Corticosteroids
Treatment for allergic conjunctivitis
Mild: Artificial tears
Moderate: Antihistamine (Topical are more effective than oral)
Treatment for:
Bacterial conjunctivitis for non-contact lens wearers (non-gonococcal)
Erythromycin Opthalmic ointment
-0.5 inch ointment inside lower lid QID for 5-7 days
Trimethropim/polymyxin B
Treatment for:
Bacterial conjunctivitis for contact lens wearers (non-gonococcal)
Fluroquinolones:
-Ciprofloxacin
Added to the antibiotic treatment if associated dacryocystitis (tear duct infection) is present
Amoxicillin/Clavulanate
Cephalexin
Treatment for:
Gonococcal conjunctivitis
Ceftriaxone 1g IM & Azithromycin 1g PO
Treatment for:
Gonococcal conjunctivitis for patients with penicillin/cephalosporin allergy
Gentamicin 240mg IM x1 dose & Azithromycin 2g PO x 1 dose
Causes of a conjunctival hemorrhage
1) Valsava
2) Traumatic
3) HTN and Diabetes
4) Bleeding disorder
5) Antiplatelet/anticoagulant medications
6) Topical steroid therapy
7) Hemorrhage due to orbital mass
8) Idiopathic
Sx: Red eye, foreign body sensation, usually asymptomatic unless there is associated chemosis
Signs: Blood underneath the conjunctiva, often in one sector of the eye, entire view of the sclera can be obstructed by blood
Conjunctival hemorrhage
Treatment for:
Conjunctival hemorrhage
None required (clears up usually in 2-3 weeks)
Artificial tear drops QID for irritation
Degeneration of fibrovascular, deep conjunctival layers resulting in vascular tissue proliferation, which extended onto the cornea
Usually related to sunlight exposure, chronic inflammation and oxidative stress
Pterygium
Sx: Irritation, redness, decreased vision; may be asymptomatic
Signs: Wing-shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea. Usually nasal in location.
Pterygia
Pterygium treatment
Protect eyes from sun, dust, wind
Artificial tears
Treatment for:
Moderate to severe pterygium
Opthalmic corticosteroids
NSAID drops
Pterygium surgical removal is indicated when:
Interfering with vision and excessive irritation
Pterygium asymptomatic patients should be checked every:
1 to 2 years
Initially pterygiums should be measured:
Initially, then every 3-12 months
Follow-up:
Corneal foreign body noncontact lens wearer
F/U in 24 hours (or sooner if symptoms worsen)
-Revisit every 3-5 days until healed
Follow up:
Corneal foreign body contact lens wearer
Close follow-up until epithelial defect resolves
May resume contact lens wear after the eye feels normal for 1 week
Corneal epithelium regenerates quickly, healing time for abrasions is usually within:
24-48 hours
Symptoms and physical exam:
- Severe pain, tearing and photophobia
- History of trauma to the eye, commonly a foreign object
Corneal abrasion
Studies:
Corneal abrasion
Slit lamp to identify dimensions of abrasion
Treatment:
Non-contact lens wearer corneal abrasion
Antibiotic ointment (erythromycin, bacitracin)
Antibiotic drops (polymyxin B/Trimethoprim or a fluoroquinolone)