Exam 1 - Ocular adnexal disorders

Question 1

What are five examples of ocular adnexal disorders?

Answer 1

• Blepharitis
• Hordeolum (stye)
• Chalazion
• Nasolacrimal duct obstruction
• Preseptal and orbital cellulitis

Question 2

What is blepharitis? What are its causes?

Answer 2

Inflammation of the eyelid

• S. aureus, seborrheic dermatitis, rosacea

Question 3

Blepharitis symptoms

Answer 3

• Burning
• Foreign body sensation
• Tearing
• Eyelid swelling
• Itching
• Discharge

Question 4

How would the provider advise the patient to manage blepharitis? What medications could be prescribed?

Answer 4

• Warm compresses
• Lid hygiene

Topical antibiotic applied afterwards if due to s. aureus

Question 5

What can the provider prescribe if the patient has persistent or severe blepharitis?

Answer 5

Doxycycline 50 mg twice daily

Question 6

What is a hordeolum (aka stye)? What causes it?

Answer 6

Acute infection and inflammation of eyelid gland

• Caused by obstructed gland; leads to growth of bacteria (s. aureus)

Question 7

Hordeolum symptoms/physical exam findings

Answer 7

• Painful nodule on eyelid margin
• Eyelid edema
• May be erythematous

Question 8

Hordeolum (stye) treatment

Answer 8

• Lid hygiene
• Warm, moist compresses for 10 minutes, four times a day

Question 9

When do hordeolums (styes) resolve?

Answer 9

After 1-2 weeks

Question 10

If the hordeolum is large and/or persistent, what should the provider do?

Answer 10

Refer to ophthalmology

Question 11

What is an uncommon complication of hordeolums?

Answer 11

Preseptal cellulitis

Question 12

What is a chalazion?

Answer 12

Chronic, non painful, non infectious nodule resulting from meibomian gland obstruction/inflammation

• Can result from hordeolum

Question 13

Chalazion physical exam findings

Answer 13

• Located AWAY from eyelid margin
• Non tender
• Slightly soft or firm

Question 14

Chalazion mangement

• What happens if unresponsive to treatment?

Answer 14

• Warm compresses
• Gentle massage for 10 minutes

If non-responsive, can refer for incision and curettage or steroid injection

Question 15

How long does it take for chalazions to resolve?

Answer 15

Can take weeks to resolve

Question 16

Are nasolacrimal duct obstructions common in neonates? When do symptoms develop and resolve?

Answer 16

Affects 1-30% of neonates - symptoms develop around 2-6 weeks of age; most resolve at 6 months

Question 17

When do duct obstructions occur?

Answer 17

Acquired duct obstructions can occur at any age

Question 18

Nasolacrimal duct obstruction symptoms

Answer 18

• Tearing
• Mucoid discharge
• Dried mucus
• Eyelid inflammation

Question 19

How would the provider manage nasolacrimal duct obstructions in infants? What typically is the definitive treatment for acquired duct obstruction?

Answer 19

Daily massage of lacrimal duct

Definitive treatment is usually surgery

• If does not resolve by 12 months, refer for probing procedure

Question 20

What is dacrocystitis? What is its treatment?

Answer 20

Inflammation of lacrimal duct d/t infection

Treatment: systemic antibiotics

Question 21

What is the difference between preseptal cellulitis and orbital cellulitis?

Answer 21

Preseptal (periorbital) - anterior infection

• Common in children <5 years
• Causative organisms: strep pneumo, s. aureus, anaerobic bacteria

Orbital - posterior infection

Question 22

What is preseptal cellulitis?

Answer 22

Superficial infection

Question 23

Preseptal cellulitis symptoms

Answer 23

Spares the eye (no pain with eye movement)

• Swelling
• Erythema
• Warmth of eyelid

Question 24

Outpatient treatment for preseptal cellulitis for children >2 years old and no signs of systemic illness

Answer 24

• MSSA/strep: dicloxacillin or cephalexin
• MRSA/strep: clindamycin (for resistance)

Question 25

What is orbital cellulitis?

Answer 25

A medical emergency - go to ER for CT scan

Severe infection of soft tissue posterior to orbital septum

Question 26

Orbital cellulitis symptoms

Answer 26

• Pain with eye movement
• Restricted eye movement
• Chemosis
• Proptosis (late) - protrusion of eyeball
• Decreased visual acuity