Eye Conditions Flashcards
What are the roles of eyelids and lashes
- protect the globe (eyeball) from foregin bodies and maintain wet corneal surface
*skin of eyelid is among the thinnest anywhere on the body which allows for mobility of eyelids.
- underneath the skin of the eyelid = loose areolar tissue capable of significant edema and swelling
- under that is orbicularis oculi responsible for closing eyelid
- behind eyelid is tarsus, dense fibrous connective tissue supposting the lid margin
What is a stye?
Description,
signs and symptoms
onset
- Description
- Acute infection of 1 or more eyelid glands (meibomian, Zeis or Moll)
- Signs and symptoms
- Unilateral painful lesion, localized lid swelling, tenderness, erythema
- Onset
- acute (days)
What is chalazion?
Description,
signs and symptoms
onset
- Description
- Sterile, focal, chronic inflammation of the lid
- due to obstructed meibomian gland
- Signs/symptoms
- Non-tender (painless), rubbery nodule, localized lid swelling, often unilateral
- Onset
- Gradual enlargement (days to weeks)
What is Blepharitis?
Description,
signs and symptoms
onset
- Description
- Chronic inflammation of the lid margins
- associated with infection, dermatological conditions or meibomian gland dysfunction
- Signs and symptoms
- Irritated possibly reddened lid margins
- greasy, scaly and/or flaky
- usually bilateral
- Onset:
- Gradual irritation (weeks to months)
Describe the pathophsiology of a stye
- aka hordeolum -> msot common eyelid infection
- bacterial infection of eye lid glands
- most common infecting organism = staphylococcus aureus
- treatment usually just drainage of lesion -> dont nee dot culture
*styles assocaited with blepharitis and acne rosacae have tendency to reoccur
internal vs external stye
- External
- involves glands of zeis or Moll
- smaller more superficial infection
- lesion always points towards skin
- Internal
- larger area of sweeling
- involves meibomian glands
- lesion can point either to skin or to sonjunctival surface
- more porlonged course than external
what are the goals of therapy for stye
Resolve infection
Prevent recurrence
Prevent transmission to other eye or to household contacts
How do you assess patients with hordeolun or chalazion
- if NOT associated with pain, photophobia, vision disturbances, blunt trauma, chemical exposure, imbedded foreign body, heat exposure, eye protrcution are are contract lens wearer
- see if red/irritated eye or if an eye lid problem, if eye lid problem
- see if lid is swollen with nodule
*then probably hordeolum or chalazion
recc self care, needs medial assess is no imporement after 48 h
*chalazion can be assesses if no pain
How do you assess patients with Blepharitis
– symptoms of blepharitis = irritation, photophobia, burning/ itching of lid margins, crust on the eyelashes, and eyelid sticking
- can be foreign bosy sensation in eyes
- sandy/gritty snesation usually worse upon awakening bc during sleep inflamed lids lie against corea, tear secretion dec and inflammatory mediators ahve several hours to act on surface of eye
*if symptoms worsen in evening, liekly dry eye disease
How to prevent a Hordeolum
* use to avoid infecting other eye or ransmitting to other persons
- Avoid touching the eyes; wash the hands after any contact with the infected eye.
- Change compresses, towels and pillowcases after each use.
- Do not share makeup with others.
- Do not wear makeup or contact lenses until the stye resolves.
- Replace eye makeup, contact lenses and contact lens case after stye resolves.
- Do not allow the tip of eye drop bottles or ophthalmic ointments to touch the eye or eyelashes. If this occurs, discard them due to contamination.
*Conscientious attention to treating symptoms of blepharitis may help to decrease the incidence of recurrent stye
non pharmacologic therapy of styes
- external usually drain spontaneously within 48h
- warm compress applied 10-15 min 3-4x/day can help speed up
*dont microwave cloth, risk of burning, just warm water
- after apply warm compres, gently massage eyelid towards lid margin
*hard boiled egg kept in shell retains heat longer -> wrap in thin cloth, can reboil the egg
- can also use bead filled eye masks
what do do once stye drains
- remove excress discharge by cleaning eye lid with warm water and face towel, or cotton swab sipped in diluted baby shampoo
*seek medical advice is external styes dont drain spontaneously in 48h -> may need incision and drainage
how long does it take acute interal styes to resolve
- 1-2 weeks
- warm compress can be used but not clinical trails to demonstrate effectivness of non surigcal innervations for acute internal styes
- seek medical advice if internal sye doesnt resolve in 1 week
What is pharmacologic therapy for a stye
- self medication with non-rx opthalmic antibacterials is not necessary and not recommended bc most drain spontaneously
- if incisiona nd drainage req, an opthalmic antibacterial like erythromycin applied to conjunctival sac several times a day is common to prevent further infection
*neomycin, polymyxin B and framicidin ineffective to provide significant benefit
what is preseptal cellulitis
- infection from stye spead locally
- presents as generalized swelling and redness of eyelid rather than localized leiosn
- requries assessemnt by ophthalmolosist with systemic antibacterials
what is Chalazion
- chalazion = idiopathic, sterile, chronic inflammation of a meibomian gland
- blockage of meibomian gland orifices = stagnation of sebaceous secretions
- lesion develops over a period of weeks and is characterized by painless, localized swelling
- most point towards conjunctival surface, causing cunjunctival redness and swelling
Who is more prone to Chalazia
- risk factors = smoking, gastritis and IBS
- more common in poeple with blepharitis, acne rosacae or seborrheic dematitis
- these pateints at greater risk of developing multiple or recurring chalazia
- if recurring, require evaluation for more serious condition like meibomian gland carcinoma
initial symptoms of chalazion
localized eyelid swelling, red lesion/nodule may resemble a stye without the acute inflammatory signs (pain, tenderness)
- can be dsitibusihed from styes by lack of pain
- large chalazion may press on eyeball and cause astigmatism or visual distortion
Goals of therapy
Resolve lesion
prevent recurrence
How to rpevent chalazion
- Encourage patients who have recurrent chalazia associated with blepharitis to maintain good lid hygiene
- if have acne rosacea or seborrheic dermatitis to adhere to treatment of those conditions, bc adhereance will decrease lieklihood of blocking meibomian glands and exacerbating chalazia
- encourage and support smoking sensation
non pharmacologic therapy for chalazion
- similar to stye, esp for small lesions
- warm compress applied several times/day -> softens sebacous secretiosn that cna be blocking meibomian grand orifice
*25-50% of lesions resolve with this treatment
- after apply warm compress, gently massage lid towards lid margin
- once drains, remove excess discharge by cleaning lid with warm water, face towel/eyelidwipe/cotton swab and diluted baby shampoo
*further assessment req if lesion does not begin to resolve in few days on initiating warm compress treatment
(immediate referaal if eye pain or impaired vision
Pharmacologic therapy for chalazion
- not result of infection, so self mediaction with non-rx opthalmic antibacterials not recommended
- larger chalazia may req surgical incision, intralesional steriod injection or both
*done by opthalmologist
- when excision req, vertical inciion on conjucntival surface is made, and curettement of gelantinour materal
- can do biposy to rule out malignancy with recurrent chalazia
- topical antibacterials or corticosteriod may be prescribed after surgery to preent infection and dec inflammation
What is Blepharitis
- chronic condition with periods of exacerbation that affects eyelids bilaterally
- often associated with chronic dermatologic condiitons (*rosacea and *seborrheic dermatitis and dry eye, contact lens associated–giant papillary conjunctivitis, ulcerative colitis, irritable bowel syndrome, anxiety, gastritis and isotretinoin therapy)
*to control blepharitis thses condiitons must be treated
role of parasites in blepharitis
- presence of Demodex mites is assocaited with anterior and posterior blepharitis, they inhibit hair follicles and sebaceous glands
- causes obstruction and inc eyelid inflammation
- incidence of Demodex infestation inc with age
- Phthirus pubis (crab lice) is less common, but can be inolved in more acute forms of blepharitis
long term complications of blepharitis
- long term complications from chronic disorder = physical damage to eyelids and cornea
- inflammation of cornea -> scarrring, loss of smoothness and vusal acuity
- if severe inflammation, corneal perforation may occur
How is blepharitis classified?
as anterior or posterior, depending on part of eyelid effected
- most patients present with combo of both, so difficult to accurately dianose and treat
describe anterior blepharitis
- classified as staphylococcal or seborrheic, most common to have mix of both
- either form of anterior blepharitis are predisposed to developing conjunctivitis
- Staphlyococcal
- caused by S. aureus or Staphylococcus epidermidis
- patients present with inflammation and erythema along anterior margin of eye lid
- lid margins are scaly with crusts and tiny ulcerations around lashes
- if chonic, loss of eyelashes can occur
- complications: recurrent chalazia, epithelial keratitis and marginal corneal infiltrates.
- Seborrheic blepharitis (non ulcerative)
- less inflammation and redness along anterior border of eyelid
- scales are more oily and greasy than in staphylococcal blepharitis
- associated with seborrheic dermatitis affecting other parts of the body.
Goals of Blepharitis therapy
Reduce inflammation and discomfort associated with blepharitis
Reduce risk of recurrence of severe symptoms
Reduce risk of complications such as conjunctivitis and keratitis
describe posterior blepharitis
- caused by Meibomian gland dysfunction -> inflammation of posterior aspect of eyelid
- bilateral chonic conditions, can coexist ith anterior blepharitis
- two types : meibomian seborrhea or meibomianitis.
Meibomian Seborrhea
- excessive glandular secretions
- symptoms: photophobia, burning feeling, excesively oily and foamy tear film and froth on lid margin
Meibomianitis
- inflammation and obstruction of meibomian glands
- signs: diffuse or localized inflammation of posterior lid margin
- in chronic - gland orifices can be obstructed and posterior lid may be thick, rounded and notces
- when pressure applied over glands, a soft cheese substance is expressed
How to assess blepharitis
general symptoms: irritation, photophobia, burning and itching of the lid margins, crust on the eyelashes, and eyelid sticking
- can be foreign body sensation in eyes
- patients may complain of sandy/gritty sensation, worse upon awakening
- if symptoms worse in evening -> more likely dry eye disease
*often can coexist
- patients benefit from axamination by eye acre professional -> slit lamp biomicroscopy to evaluate tear film, anterior lid margin, lashes, poteriod lid margin, tarsal conjunctiva, bulbar conjunctiva and cornea
How to prevent blepharitis
- chronic condition
- treatment failure usually caused by nonadhereance with lid hygiene
- encourage patients to maintain a long term lid hygiene program -> helps exacerbations and long term complications
- also treat dermatologic conditions elsewehre in body
non pharmacologic therapy for blepharitic
*eyelid margin hygiene
- warm compess applied to closed eyelids (5-10min) to melt solidified material in glands
- products are avail to maintain temp of 43C for 10 min
- Gentle cleasing of lid margin -> dont scrub
- May be instructed to perform film massage on lid margin after warm compress to enhance secretionfrom meibomian glands
- artificial tears can help alleviate symptoms esp is also have dry eye disease
*perform lid hygeiene 2-3x daily immediately after initial diagnosis and during epriods of exacerbation, can then go down to 2x/week
- if persists, cask if using product with cocamidopropyl betaine (CAPB), surfactant in many hygene products known to cause contact dermatitis
antibacterials for blepharitis treatment
Anterior
- ophthalmic antistaphylococcal antibiotics after cleansing
- pointments > drops bc inc contact time between dryg and tissues
- apply ointment externally on eyelid margins by wiping across closed eyelid near lashes w/ swab
- ex: eryhtomycin
Posterior
- due to significant meibomiam gland dysfunction and subsequent ocular surface disease
- pat may req antibacterial therapy for weeks: tetracyline, doxycycline or minocycline
- erythromycin if tetracyclines are contraindicated (allergy or pregnancy)
- Azithromycin cna be used as pulse therapy
Ophthalmic Anti-inflammatory Agents for blepharitis treatment
- some patients require ophthalmic corticosteroids or corticosteroid/antibacterial combinations during exacerbations
- prescribed on advice of ophthalmologist
- ointment perferred over drops
- dexamethasone commonly used but loteprednol can be just as effective and has lower risk of increased intraocular presure
- fluoromethalone drops may also be sonsidered due to lwoer ocular prentration
other agents used to treat blepharitis
*opthalmologist may prescribe immunomodulatory agents
Calcineuin inhibitors: cyclosporine
oral ivermectin: reduce or even eradicate demodex infestation in patients with blepharitis and/or ocular rosacea
NHP for blepharitis treatment
- Omega 3 fatty acids:
- have anti inflammatory properties, may enhance lubrication and useful in pat with tear deficiencies
- but trial of 12 months found no significant improvement in symp of dry eye disease
- Tea tree oil
- lid cleansers or shampoo has shown promise, mainly due to efficacy against demodex infestations
- has broad antibacterial, antifungal and anti-inflammatory properties that alleviate sympm even without demodex involvement
monitoring stte, chalazion and blepharitis
- Stye:
- patient: daily
- practitioner: 48 h
- Goal: spontaneous drainage in 48 h
- Chalazion
- patient: daily
- practitioner: 2-3 days
- goal: improvement in few days, complete resolution weeks-months
- Blepharitiz:
- patient: daily during exacerbation, less often when controlled
- practioner: each vitis in chronic disease - within 1 week if patient req anti infective
- goal: control inflammation and discomfort, reduce risk of severe long term complications
what types of drugs are used to treat blepharitis
ophthalmic corticosteriods, antibiotics and
