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Ocular Disease - Lids > Disease Of Skin Of The Lid > Flashcards

Disease Of Skin Of The Lid Flashcards

1
Q

Describe angioedema with urticaria (hives)

Characteristics, associations and Treatments

A
  • secondary to histamine release and vasodilation
  • severe swelling, may see hives, red raised lesions
  • associated with severe itching
  • Tx: oral antihistamine, cool compresses, if systemic associations steroids
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2
Q

You have a patient that has severe swelling on their lids with hives and raised red lesions. The lesion is also very itchy. Tests also show significant amounts of histamines and vasodilation around the swelling. What is the diagnosis?

A. Angioedema with urticaria
B. Anthrax
C. Erysipelas
D. Shingles
E. Syphilis
A

Angioedema with urticaria

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3
Q

What are the differences between Anthrax and preseptal cellulitis?

A
  • no demarcation line
  • no tenderness
  • usually no pain
  • itching
  • no suppuration (pus)
  • slight injection and redness
  • possible anterior chamber response
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4
Q

You have a patient that has a macular rash that looks like a spider bite. One week later a Bullous formed giving a black eschar (ulcer) with a “pearly wreath” appearance. A week later, the eschar falls off leaving a scar. What is the diagnosis?

A. HZV (Shingles) 
B. Anthrax
C. Erysipelas
D. Erthyema multifome/ Stevens Johnson syndrome 
E. Ocular Cicatricial Pemphigoid
A

Anthrax

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5
Q

Describe cutaneous anthrax (ocular signs and symptoms)

A
  • short onset ~ 2 weeks
  • milder form of preseptal cellulitis
  • no demarcation line, no tenderness, usually no pain, no suppuration (pus), slight injection and redness
  • painless red macular rashes (spider bite appearance) can become bullous
  • bullae can form eschar (black necrotic ulceration)
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6
Q

Describe the diagnostic tests, prevention and treatment for anthrax

A
  • Px: vaccine, 3 sub-Q injections
  • Dx: gram stain and culture, black eschar
  • Tx: penicillin G (IV), oral doxycycline, coprofloxacin and amoxicillin, surgical repair and possible graft after eschar heals
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7
Q

Describe symphillis (eye signs and treatment)

A
  • first and second degree lid lesion
  • eye signs: conjunctival chancre (ulcerated lesion), madarosis (loss of lashes), scleritis, interstitial keratitis
  • Tx: penicillin
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8
Q

You have a patient that has lid lesions. Upon A SLE you see an ulceration with a raised edge (Conjunctival chancre), loss of lashes (madarosis), scleritis and interstitial keratitis. What is the diagnosis?

A. Vitiligo
B. Ocular Cicatrical Pemphigoid
C. Impetigo
D. Herpes Zoster Varicella (shingles)
E. Syphilis
A

Syphilis

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9
Q

Describe elephantiasis

A
  • severe edema caused by lymphatic fluid responding to parasitic infection
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10
Q

You have a patient that has severe edema on their lids comprised of lympathic fluid. What is the diagnosis?

A. Impetigo
B. Erysipelas
C. Vaccinia
D. Elephantiasis 
E. Herpes Simplex Virus
A

Elephantiasis

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11
Q

Describe Vaccinia

A
  • secondary to small pox vaccine
  • contacted via direct contact/contamination of lid from vaccination site
  • usually will heal up and scar
  • widespread dermatitis, may become exofoliative and necrotic leading to severe scarring
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12
Q

You have a patient that has widespread dermatitis that has become necrotic leaving severe scarring. They’ve recently had a small pox vaccination. What is the diagnosis?

A. Impetigo
B. Erysipelas
C. Vaccinia
D. Elephantiasis 
E. Herpes Simplex Virus
A

Vaccinia

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13
Q

What is the most common way to treat vaccinia?

A

Let it heal up and leave a scar

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14
Q

Describe Vitiligo (Vogt Koyanagi)

Lid and ocular signs
Hint: sun exposure

A
  • leukoderma (white skin), poliosis (white lashes)
  • Vogt Koyanagi: disorder causing whitening with sun exposure
  • Ocular signs: poliosis, uveitis, post inflammatory retinal detachment
  • headaches, encephalopathy, seizure limiting, vertigo, deafness
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15
Q

You have a patient that presents with leukoderma (white skin), poliosis (white lashes) and post inflammatory retinal detachment. They also experience encephalopathy, vertigo and deafness. The also mention that they become pale with sub exposure. What is the diagnosis?

A. Xeroderma Pigmentosa
B. Impetigo
C. Ocular Cicatricial Pemphigoid 
D. Vitiligo (Vogt Koyanagi)
E. Erythema multifome - Steven Johnson Syndrome
A

Vitiligo - Vogt Koyanagi

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16
Q

Describe Xeroderma Pigmentosa (what it is and what can develop)

A
  • progressive pigmentation changes (macules and scarring)

- increased incidence or basal cell carcinoma, squamous cell carcinoma, melanoma and conjunctival malignances

17
Q

You have a patient that presents significant macules and scarring from pigmentation changes. You see the formation of carcinomas, melanomas and conjunctival malignances. What is the diagnosis?

A. Xeroderma Pigmentosum
B. Impetigo
C. Ocular Cicatricial Pemphigoid 
D. Vitiligo (Vogt Koyanagi)
E. Erythema multifome - Steven Johnson Syndrome
A

Xeroderma Pigmentosum

18
Q

Describe erysipelas

A
  • B-hemolytic strep. Pyogenea secondary to skin trauma (bacterial infection)
  • RAPID swelling associated with well defined expanding red line along lid
  • scarring with entropian or ectropian
  • Tx: oral antibiotics and hospitalization
19
Q

You have a patient that had an accident that caused skin trauma. You do an SLE and see a rapid swelling and a well defined red line along their lid and the beginning of a scar with ectropian. What is the diagnosis?

A. Impetigo
B. Anthrax
C. Erysipelas
D. Elephantiasis
E. HZV (Shingles)
A

Erysipelas

20
Q

What is the treatment for Erysipelas?

A. Oral antihistamines and steriods
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. Oral antibiotic
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

Oral antibiotics

21
Q

Describe erythema multifome/Stevens Johnson syndrome (how it happens, what age group, ocular signs, treatment)

A
  • happens to younger males
  • severe delay type hypersensitivity to meds
  • flu symptoms, severe rash with perivascular inflammation and a “bulls eye” appearance
  • Ocular signs/ mucous discharge, papillary response, bullae (several blisters) formation, swollen crusted lids
  • Complications: Fibrosis, iritis, corneal perforation, dry eye, distichiasis (lid sticks to conjunctiva), epiphoria, Cicatricial
    Ectropian (scarring twists lid)
  • Tx: electrolytes, systemic topical steroids, bandage CL and surgery to reduce scarring
22
Q

You have a 8 year old male patient that has mucous discharge and swollen crusted lids. The patient tells you that they have recently has flu symptoms but broke out in a severe rash. You see perivascular inflammation and “bulls eye” appearance. What is the diagnosis?

A. Xeroderma Pigmentosum
B. Impetigo
C. Ocular Cicatricial Pemphigoid 
D. Vitiligo (Vogt Koyanagi)
E. Erythema multifome - Steven Johnson Syndrome
A

Erythema multifome/Stevens Johnson syndrome

23
Q

What is the treatment for Erythema
Multiforme/Stevens Johnson syndrome?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. Oral antibiotics
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery

24
Q

Describe Ocular Cicatricial Pemphigoid (age onset, signs, ocular signs, treatment)

A
  • onset 6th decade, mucous membrane disorder & oral lesions
  • bullous formation (blisters), fibrosis with conjunctival shrinking, symblepharon (adhesion of palpebral conjunctiva to bulbar conjunctiva), scarring and keratinzation of cornea
  • Vision Loss (25-33% of patients)
    Tx: supportive: tears, bandage lens, epilation (hair removal), (partially sewn eyelid), punctal occlusion, tarsorraphy
    -Immunosuppresion: steriods, cyclophosphamide
25
Q

You have a 60 year old female patient that complains of vision loss. The patient palpebral conjunctiva is sticking to their bulbar conjunctiva and SLE reveals significant fibrosis and conjunctival shrinking, bullous formation and keratinization of cornea. You ask the patient to open their mouth and see oral lesions. What is the diagnosis?

A. Xeroderma Pigmentosum
B. Impetigo
C. Ocular Cicatricial Pemphigoid 
D. Vitiligo (Vogt Koyanagi)
E. Erythema multifome - Steven Johnson Syndrome
A

Ocular Cicatricial Pemphigoid

26
Q

What is the treatment for Ocular Cicatricial Pemphigoid ?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. tears, bandage lens, epilation, tarsorraphy, steriods and cyclophosphamide
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

C. tears, bandage lens, epilation, tarsorraphy, steriods and cyclophosphamide

27
Q

Describe Impetigo

A
  • common staph infection (occasionally strep)
  • common in children
  • macular rash on lids and face with bullae that crusts over
    Tx: topical antibiotics (oral if widespread)
28
Q

You have a 12 year old patient that presents with a macular rash on their lid and face with signficant bullae seen. The patient indicates that they recently contracted a staph infection. What is the diagnosis?

A. Elephantiasis
B. Impetigo
C. Erysipelas 
D. Vitiligo (Vogt Koyanagi)
E. Herpes Simplex Virus
A

B. Impetigo

29
Q

What is the treatment for Impetigo?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. tears, bandage lens, epilation, tarsorraphy, steriods and cyclophosphamide
D. Topical antibiotics (oral if widespread)
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

D. Topical antibiotics (oral if widespread)

30
Q

Describe HZV- Shingles (Herpes Zoster Opthalimus)

Signs, symptoms and treatment

A
  • nerve rash found frontal along upper lid, forehead, superior conjuntiva
  • Hutchison Sign - rash on tip of the nose (involves nasociliary branch)
  • Fever, malaise, chills, severe debilitating pain (highly sensitive), edema, vesicles scarring
    -Scarring leads to: lid retraction, ptosis, ectropian, madarosis (loss of lashes), entropian
    Tx: oral antivirals (Acyclovir 200 mg 5x day for 7-10 days), topical steriods and antihistamines, prednisone (reduce swelling)
31
Q

List 5 possible ocular symptoms for HZV - Shingles.

A

retraction, ptosis, ectropian, madarosis (loss of eyelashes), entropian

32
Q

What is the treatment for HZV Shingles ?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. tears, bandage lens, epilation, tarsorraphy, steriods and cyclophosphamide
D. Topical antibiotics
E. oral antivirals (Acyclovir 200 mg 5x day for 7-10 days), topical steriods and antihistamines, prednisone (reduce swelling)

A

E. oral antivirals (Acyclovir 200 mg 5x day for 7-10 days), topical steriods and antihistamines, prednisone (reduce swelling)

33
Q

You have a patient that presents with severe paid from edema and lesions, scarring along the upper lid, forehead and superior conjunctiva. You also see a lesions at the tip of their nose and significant lid retraction, ptosis, loss of eyelashes and outward lid turn. What is the diagnosis?

A. Elephantiasis
B. Impetigo
C. Erysipelas 
D. HZV - Shingles
E. HSV
A

D. HZV - Shingles

34
Q

Describe HSV (what age group often occurs, how it occurs, ocular signs and treatments)

A
  • 20% ocular HSV involves lid only
  • often disease of children, primarily acquired when lids are kissed by affected adults
  • vesicles ruptures and then crust
  • Ocular Signs: lid edema, follicular response (duration 10-14 days)
    Tx: phrophylaxis to prevent corneal involvement, ACV creme, GCV gel (Zirgan), antibiotics to prevent secondary bacterial infection and drying agents
35
Q

You have a 6 year old patient that presents with lid edema, ruptured vesicles that have crusted over and follicular response. What is the diagnosis?

A. Elephantiasis
B. Impetigo
C. Erysipelas 
D. HZV - Shingles
E. Herpes Simplex
A

E. Herpes Simplex

36
Q

What is the treatment for HSV?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. Prophylaxis, Acyclovir creme, Gancyclovir gel, antibiotics and drying agents

D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

C. Prophylaxis, Acyclovir creme, Gancyclovir gel, antibiotics and drying agents

37
Q

What is the treatment for cutaneous anthrax?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. oral doxycycline, cyproflaxin and amoxicillin
C. tears, bandage lens, epilation, tarsorraphy, steriods and cyclophosphamide
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

B. oral doxycycline, cyproflaxin and amoxicillin

38
Q

What is the treatment for syphilis?

A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. oral doxycycline, cyproflaxin and amoxicillin
C. penecillin
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines

A

C. penecillin

Ocular Disease - Lids (9 decks)

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