Eye and Eyelid Disorders Flashcards
Describe the anatomy of the eyelid?
Multilayer tissue covered externally by the skin and internally by a thin mucocutaneous epithelial layer
There is a middle layer, glands of Moll, the gland of Zeiss and Meibomian glands
What is the middle layer of the eyelid?
Glandular tissue and muscles for eyelid movement
What are the glands of Moll do?
They are modified sweat glands on the edge of the eyelid (waterline)
What is the gland of Zeiss?
Modified sebaceous glands at the bottom of the eyelashes
What are the Meibomian glands?
Modified sebaceous glands that produce the lipid layer of the tear film that goes along the eyelid
What are the functions of the eyelid?
Primarily protect the anterior surface of the eye
Aids in the regulation of light reaching the eye
Aids in tear flow through pumping action on the conjunctival and lacrimal sacs
Helps with the distribution and elimination of tears
What is the conjunctiva?
Thin, transparent, mucous membrane
It covers the inner surface of eyelids (palpebral portion) and anterior surface of the eye (bulbar portion)
The anterior surface only covers the white of the eye
Main function is to prevent the eye from drying by secreting a moisturizing mucous
What are some eye conditions?
Eyelid conditions
Conjunctivitis
Dry eye
What are the different types of eyelid conditions?
Hordeolum (stye; either external or internal)
Chalazion
Blepharitis
What are the different types of conjunctivitis?
Acute bacterial Hyperacute bacterial Chronic Viral Seasonal allergic
What are general red flags for eye disorders?
Blunt trauma
Foreign particles trapped/embedded in the eye
Ocular abrasion
Eye exposure to chemical or chemical fumes
Thermal injury - Welder’s eye or snow blindness
Blurred vision (not due to ocular ointments)
Pain
Photophobia (light causes dramatic pain in the eye)
Redness around the cornea
Abnormal pupil
Condition lasting for more than 48 hours (note: are exceptions to this)
Contact lens wearers with conjunctivitis
What are the treatment goals for an infection in the eye?
Cure
Prevent transmission
Prevent reoccurence
What are the treatment goals for dry eye?
Manage symptoms
Prevent complications
Identify any exacerbating factor(s)
What is a hordeolum?
Aka a stye
It is an acute localized infection involving either the glands of the Zeis or Moll (external hordeola) or the meibomian glands (internal hordeola) of the eyelid
Results in the formation of a small cyst or abscess
Unilateral, localized lid swelling, tenderness and erythema
Often associated with blepharitis
What causes a hordeolum?
The most common infecting organism is S. aureus
Describe an external hordeolum
Smaller and more superficial cyst or abscess
Lesion always points towards the skin
How do we treat external hordeolum?
Can treat with warm compresses applied 10-15 minutes 3-4 times a day. Can follow warm compresses with eyelid massage and it should drain on its down within 48 hours
OTC antibiotic ophthalmic ointment may be applied to the affected area 3-4 times daily but it is not required and not generally recommended
Refer to a physician if it doesn’t drain (48 hours) - may then require prescription antibiotics (i.e., topical eythromycin or possibly oral treatment)
Describe an internal hordeolum?
Involves the meibomian glands (usually deep inside/underneath eyelid)
Usually larger and more discomfort than external styes
Lesion can point either to the skin or to the conjunctiva
Often resolves within 1-2 weeks
How do we treat internal hordeolum?
Warm compresses for 5-10 minutes several times daily. Refer if not resolved in 1 week.
If not resolved then it may not drain on its own and may require an incision and prescription ophthalmic ointment (bacitracin or erythromycin)
If infection is severe, oral antibacterials may be needed (erythromycin, cloxacillin or tetracycline)
How is transmission of styes prevented?
Wash hands before and after any contact with infected eye
Avoid touching eyes
Change towels and compresses after each use (do not share towels, facecloths, pillows, etc.)
Proper use of eye drops (avoid touching the eye/eyelashes) - clean the tip after use
Avoid use of eye cosmetics during infection
Address treating symptoms of blepharitis (if present) to help decrease recurring hordeola
What is a chalazion?
Inflammation of the meibomian glands (deep chalazion) or Zeis sebaceous glands (superficial of the area)
Generally chronic in nature
Nodule develops over a period of weeks (not acute)
Lesion usually points towards to the conjunctival and swelling
What are symptoms of a chalazion?
Characterized by painless, localized redness and swelling
How is more likely to develop a chalazion?
More common in people with blepharitis, acne rosacea or seborrheic dermatitis
How are chalazions treated?
Initial symptoms may resemble hordeolum without the acute inflammation
Initial treatment is similar to that for external hordeolum (warm compresses 10-15 minutes 3-4 times daily, eyelid massage, often resolves spontaneously within a few says, refer is no improvement within 48 hours of initiating treatment)
Immediate referral if chiazzino is painful or visual distortion/impairment
For patients with blepharitis, encourage lid hygiene to prevent recurrence
What is blepharitis?
Chronic inflammation of the eyelids
Usually bilateral
Often associated with chronic dermatological conditions (acne rosacea, seborrheic dermatitis)
It’s not contagious
Long term complications may include physical damage the eyelids and cornea, scarring, vision impairment, corneal perforation
What are the symptoms of blepharitis?
Red, swollen, itchy lid margins, eye red and watery
Landmark sign: eyelid is scaly
Foreign body sensation or burning
Sandy or gritty sensation in the eye - worse upon awakening (similar symptoms to dry eye but this is an eyelid disorder)
Loss of eyelashes lashes grow abnormally
Symptoms may be unilateral or bilateral
Appearance can often be confused with conjunctivitis and/or other eyelid conditions
How is blepharitis diagnosed?
Initial diagnosis or exacerbations require referral
Usually a chronic problem
Treatment of concomitant dermatologic disorders important for long-term control
What are the prescription treatment options for blepharitis?
Antibacterial ointments (bacitracin or erythromycin) preferred to drops because of increased contact time Short-term treatment with weak corticosteroids or corticosteroid/antibacterial combinations during exacerbations Oral antibiotic treatment may be required (tetracycline, minocyline, doxacyline or erythromycin)
What are non-pharmacological treatment options for blepharitis?
Regular and long-term eyelid margin hygiene is essential
Warm compresses applied for 5-10 minutes
Gental scrubbing of the lid margin (commercial eyelid scrubs, at cotton swab dipped into a solution of a few drops of baby shampoo in a small amount of warm water)
Recommend once or twice daily immediately after initial diagnosis or during exacerbations
May be reduced to twice a week once under control
Refer if new onset suspected and exacerbations
What is conjunctivitis?
General term referring to any inflammatory condition of the conjunctiva (mucous membrane lining the back of the eyelid and the front of the eye, except the cornea)
Inflammation can be hyper acute, acute or chronic
What can cause conjunctivitis?
Caused by viral/bacterial infections, allergies, other irritants and dryness
Describe acute bacterial conjunctivitis
Usually self-limiting and resolves after 2 weeks (treatment often shortens the course) Highly contagious (proper personal hygiene is important to avoid transmission, i.e., hand washing, separate towels, etc.) Children should be automatically referred to health care provider Contact lens wearers should be referred due to high risk (patients should wear glasses during the course of treatment)
