Exam 1 - Ocular adnexal disorders Flashcards
What are five examples of ocular adnexal disorders?
- Blepharitis
- Hordeolum (stye)
- Chalazion
- Nasolacrimal duct obstruction
- Preseptal and orbital cellulitis
What is blepharitis? What are its causes?
Inflammation of the eyelid
- S. aureus, seborrheic dermatitis, rosacea
Blepharitis symptoms
- Burning
- Foreign body sensation
- Tearing
- Eyelid swelling
- Itching
- Discharge
How would the provider advise the patient to manage blepharitis? What medications could be prescribed?
- Warm compresses
- Lid hygiene
Topical antibiotic applied afterwards if due to s. aureus
What can the provider prescribe if the patient has persistent or severe blepharitis?
Doxycycline 50 mg twice daily
What is a hordeolum (aka stye)? What causes it?
Acute infection and inflammation of eyelid gland
- Caused by obstructed gland; leads to growth of bacteria (s. aureus)
Hordeolum symptoms/physical exam findings
- Painful nodule on eyelid margin
- Eyelid edema
- May be erythematous
Hordeolum (stye) treatment
- Lid hygiene
- Warm, moist compresses for 10 minutes, four times a day
When do hordeolums (styes) resolve?
After 1-2 weeks
If the hordeolum is large and/or persistent, what should the provider do?
Refer to ophthalmology
What is an uncommon complication of hordeolums?
Preseptal cellulitis
What is a chalazion?
Chronic, non painful, non infectious nodule resulting from meibomian gland obstruction/inflammation
- Can result from hordeolum
Chalazion physical exam findings
- Located AWAY from eyelid margin
- Non tender
- Slightly soft or firm
Chalazion mangement
- What happens if unresponsive to treatment?
- Warm compresses
- Gentle massage for 10 minutes
If non-responsive, can refer for incision and curettage or steroid injection
How long does it take for chalazions to resolve?
Can take weeks to resolve
Are nasolacrimal duct obstructions common in neonates? When do symptoms develop and resolve?
Affects 1-30% of neonates - symptoms develop around 2-6 weeks of age; most resolve at 6 months
When do duct obstructions occur?
Acquired duct obstructions can occur at any age
Nasolacrimal duct obstruction symptoms
- Tearing
- Mucoid discharge
- Dried mucus
- Eyelid inflammation
How would the provider manage nasolacrimal duct obstructions in infants? What typically is the definitive treatment for acquired duct obstruction?
Daily massage of lacrimal duct
Definitive treatment is usually surgery
- If does not resolve by 12 months, refer for probing procedure
What is dacrocystitis? What is its treatment?
Inflammation of lacrimal duct d/t infection
Treatment: systemic antibiotics
What is the difference between preseptal cellulitis and orbital cellulitis?
Preseptal (periorbital) - anterior infection
- Common in children <5 years
- Causative organisms: strep pneumo, s. aureus, anaerobic bacteria
Orbital - posterior infection
What is preseptal cellulitis?
Superficial infection
Preseptal cellulitis symptoms
Spares the eye (no pain with eye movement)
- Swelling
- Erythema
- Warmth of eyelid
Outpatient treatment for preseptal cellulitis for children >2 years old and no signs of systemic illness
- MSSA/strep: dicloxacillin or cephalexin
- MRSA/strep: clindamycin (for resistance)
What is orbital cellulitis?
A medical emergency - go to ER for CT scan
Severe infection of soft tissue posterior to orbital septum
Orbital cellulitis symptoms
- Pain with eye movement
- Restricted eye movement
- Chemosis
- Proptosis (late) - protrusion of eyeball
- Decreased visual acuity
