Disease of the Skin of the Lid Flashcards
Angioedema w/ Urticaria
- secondary to histamine release, which triggers massive dilation
- severe swelling, hives, red-raised lesions
- associated with severe itching
- treat using oral histamines, cool compress, systemic steroids
Anthrax
cutaneous, respiratory, intestinal
- ocular anthrax is the cutaneous form; “wool sorters disease”
- found in ppl handling wool - wool products
- farmers in 3rd world countries at risk
- can also be carried by insects
- onset can occur from days to weeks
- can present as Preceptal Cellulitis
Wool Sorters Disease
cutaneous anthrax
-no pain, no tenderness, no demarcated line
-presents as red, macular rash
-papules formed (looks like spider bites); progresses to vesicular/bullous
-bullous can ulcerate, release exotoxin
-ESCHAR: black necrotic ulceration, with a pearly wreath around it (edema)
-eschar will slough off, lead to granulation and scarring
-GANGRENE can result, leading to scarring and ectropion
-can lead to death if untreated (septicemia, renal fail, shock)
Dx: gram stain, culture; look for classic black eschar
Px: vaccine (3 sub-Q injections); local redness/swelling can develop; rarely systemic rxn can occur; barriers
Tx: penicillin, skin graft, amoxicillin
Syphilis
- primary and secondary lid lesions can result
- eye signs: conjunctival chancre, madarosis, scleritis, interstital keratitis
- Tx: penicillin
Elephantiasis
- rare parsitic infection
- hypertrophy of the lids and sub-cutaneous tissues
- severe edema: lymph fluid goes into sub-cutaneous tissue, body has allergic rxn to the parasite
Vaccinia (cow pox)
- occurs secondary to the small pox vaccine; can contaminate the lid through direct contact
- vaccinia is self-limiting; will heal up and scar
- mutant small pox virus used in bio warfare; severe response occurs, leading to widespread dermatitis, skin may slough off, necrosis can occur and cause severe scarring
Vitiligo
-leukoderma
-poliosis
-Vogt Koyanagi
multisystem disorder where autoimmune response causes skin whitening with sun exposure
Ocular sign: poliosis, uveitis, inflammatory RD
Pt may also have headache, encephalopathy, seizure, vitiligo, deafness
Xeroderma Pigmentosum
- hereditary autosomal recessive
- progressive pigment changes (macules/scarring) with sun exposure
- there patients have higher risk to some cancers (Basal and Squamous cell carcinoma, melanoma, conj. malignances)
Erysipelas
- swelling, with an EXPANDING RED LINE
- occurs due to B-hemolytic streptococcus invasion through skin trauma
- can lead to ectropion or entropion
- treat with systemic antibiotics
Erythema Multifome
Stevens Johnson Syndrome
- severe delayed type hypersensitivity (meds, like sulfa drugs & barbs)
- flu symptoms, followed by severe rash, bulls eye appearance, perivascular inflammation
- ocular signs: mucous discharge, pseudomembrane formation, papillary response, bullae formation, swollen crusted lids)
- fibrosis/scarring, dry eye, corneal perforation, iritis, ectropion, death
- Tx: topical steroids, electrolytes, bandage CL, surgery for scarring
Ocular Cicatricial Pemphigold
- Late onset autoimmune mucous membrane disorder
- oral lesions
- bullous formation, fibrosis of conj. and shrinking, symblepharon, scar/keratinized cornea
- vision loss in .25 to .33 of patients
- TX: artificial tears, bandage lens, epilation, tarsorraphy, plugs; immunosuppression (steroids, cyclophosphamide)
Impetigo
- common staph infection (streptococcus)
- impetigo usually occurs in children
- presents as macular rash of lids and face with bullae and crusting
- Tx: topical antibiotic or oral if disease widespread
HZV
Herpes Zoster
-Shingles, varicella zoster; if occurs in Pt under 50, immunosuppression
-runs along dermatome; frontal nerve most common leading to rash of upper lid, forehead, superior conj
-Hutchinson sign: involves tip of nose, indicates nasociliary branch involved
-Herpes Zoster Ophthalmicus: ophthalmic branch of CN V involved
-Sx: headache, malaise, deep persistant pain, vesicles, edema, scarring, depression
-Scarring can lead to retraction, ptosis, ectropion, madarosis, entropion
Tx: no sure, treat symptoms with analgesics, antidepressants, antivirals, topical lotions or steroids
HSV
Herpes simplex
-20% of HSV only involves lids
-by age 9, 90% of population is HSV+; but small population actually develop fever/blisters, and even less with ocular HSV
-disease of children where primary lesion acquired on lids after adult directly kisses lid
-vesicles can develop, rupture, crust, then heal
-lid lesion, lid edema, and follicular response can occur
-Tx: treat primary lesion with prophylaxis, avoid corneal damage
cream, gel, antibiotics to avoid bacterial infection, use of drying agents
Erysipelas
- swelling, with an EXPANDING RED LINE
- occurs due to B-hemolytic streptococcus invasion through skin trauma
- can lead to ectropion or entropion
- treat with systemic antibiotics
