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eye > eyelid and lacrimal disorders > Flashcards

eyelid and lacrimal disorders Flashcards

1
Q

common chronic bilateral inflammatory condition of the lid margins (eyelashes)

anterior and posterior

common cause of recurrent conjunctivitis

A

blepharitis

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2
Q

involves:
lid skin, eyelashes, associated glands

may be ulcerative from staph infection OR seborrheic in association with seborrhea of the scalp, brows, and ears

A

anterior blepharitis

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3
Q

results from inflammation of meibomian glands

types:
bacterial infection–> staph
primary glandular dysfunction –> acne rosacea

A

posterior blepharitis

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4
Q

crusting, scaling, and erythema of lid margins (“red rimmed”) and eyelashes

eyelids can feel irritated, burning, itching

A

anterior blepharitis

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5
Q

lid margins are hyperemic with telangiectasias (spider vein vessels)

meibomian glands and their orifices are inflamed

lid margin frequently rolled inward to produce a mild entropian

tear film may be frothy or abnormally greasy

A

posterior blepharitis

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6
Q

treatment for anterior blepharitis

A

First line: eyelid hygiene
- gentle eyelid massage
- lid scrub with baby shampoo

warm compress

acute exacerbations
- antibiotic eye ointment (bacitracin or erythromycin)

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7
Q

treatment for posterior blepharitis

A

regular meibomian gland expression and warm compress

if conjunctiva and cornea inflamed:
- long term low dose oral antibiotic therapy (tetracycline, doxycycline, minocycline)
- short term topical corticosteroids (prednisolone)

topical antibiotic therapy (ciprofloxacin) may be used short term (5-7 days)

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8
Q

acute infection commonly due to staphylococcus aureus

characterized by a localized red, swollen, acutely tender area on the upper or lower lid

blockage/infection of zeis (sebaceous) or moll (sweat) glands

A

Hordeolum (stye)

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9
Q

meibomian gland abscess that usually points onto the conjunctival surface of the lid

A

internal hordeolum

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10
Q

aka “stye”, usually smaller and on the margin

pain, swelling, erythema

A

external hordeolum

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11
Q

hordeolum treatment

A

warm compress: first line

incision may be indicated if resolution does not begin within 48 hours

antibiotic ointment (erythromycin or bacitracin) applied to lid every 3 hours may be beneficial during acute stage

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12
Q

internal hordeolum can lead to

A

cellulitis of the lid

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13
Q

characterized by a hard, contender swelling on upper or lower lid with redness and swelling of the adjacent conjunctiva

painless, rubbery, nodular lesion

vision may be affected if large enough

A

chalazion

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13
Q

chalazion treatment

A

initial treatment: warm compress

if resolution has not occurred by 2-3 weeks –> incision and curettage

corticosteroid injection may also be effective

no antibiotics are recommended

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13
Q

granulomatous inflammation of a meibomian gland

it may follow an internal hordeolum

differentiating factor: not tender

A

chalazion

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14
Q

blocked oil gland on edge of the eyelid

A

stye

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15
Q

blocked meibomian gland

A

chalazion

15
Q

outward* turning of lower eyelid
also common in elderly

signs and symptoms:
excess tearing

dry eye due to eyelid not closing completely; can lead. to exposure keratitis

can cause cosmetic problems

A

ectropion

16
Q

entropion treatment

A

can monitor

if lashes scratch cornea, then surgery is indicated

botulinum toxin injections may be used for temporary correction of lower lid in older people

16
Q

inward* turning of lower eyelid

common in elderly

causes include:
loss of lid fascia
conjunctival scarring

A

entropian

17
Q

ectropion treatment

A

keep eyes moist (OTC preparations)

surgery if excessive tearing, exposure keratitis or cosmetic issue

18
Q

infection of lacrimal sac usually due to congenital or acquired obstruction of nasolacrimal system

most often occurs in infants and >40 years old

usually unilateral

A

dacryocystitis

19
Q

pathogens for acute dacryocystitis

A

staph aureus, streptococci

20
Q

acute dacryocystitis

A

pain, swelling, tenderness, and redness near the tear sac area

purulent material may be expressed

21
Q

pathogens for chronic dacryocystitis

A

staph epidermis
streptococci
gram-negative bacilli

22
Q

chronic dacryocystitis

A

tearing and discharge are principal signs

mucus or pus may also be expressed

23
Q

treatment for chronic dacryocystitis

A

kept latent with systemic antibiotics

relief of obstruction is the only cure
–> dacryocystorhinostomy

24
Q

treatment for acute dacryocystitis

A

systemic oral antibiotics with gram-positive coverage (amoxicillin-clavulanate, cephalexin, ciprofloxacin, clindamycin)

follow up with ophthalmology –> if not improving may need surgery to relieve obstruction

25
Q

inflammation of the lacrimal gland

A

dacryoadenitis

26
Q

caused by noninfectious inflammatory disorders

sjogre’s syndrome, sarcoidosis, thyroid disease

consider neoplastic process (lymphoma of lacrimal gland)

A

chronic dacryoadenitis

27
Q

infectious
viral (EBV, mumps, coxsackievirus)
bacterial (S. aureus*, strep, neisseria gonorrhoeae)

A

acute dacryoadenitis

28
Q

symptoms evolve over hours or days

marked pain, with swelling and redness of the outer portion of the upper lid

may have purulent drainage

may have fever and malaise

A

acute dacryoadenitis

29
Q

can be bilateral

often painless

soft tissue swelling in region of lateral upper lid

A

chronic dacryoadenitis

30
Q

acute dacryoadenitis treatment
mild infection

A

oral first generation cephalosporin (cephalexin)

31
Q

acute dacryoadenitis treatment
mild infection
MRSA suspected

A

IV sulfamethoxazole- trimethoprim
linezolid

32
Q

acute dacryoadenitis treatments
severe infection

A

IV nafcillin

33
Q

acute dacryoadenitis treatments
severe infection
MRSA suspected

A

IV vancomycin

34
Q

nasolacrimal duct obstruction or narrowing

occurs in 6% of newborns and usually resolves without conservative treatment

A

dacryostenosis

35
Q

how to make dacryostenosis diagnosis

A

fluorescein applied to the eye and left for 5 mins will accumulate (normal response = cleared by lacrimal system)

LACK of accompanying signs or symptoms (fever, irritability, conjunctivitis)

35
Q

epiphora (excessive tearing)

eyelash matting

tears that appear thicker and yellow in color (mistaken for infection)

A

dacryostenosis symptoms

35
Q

dacryostenosis treatment

A

supportive

gentle massage with downward motion 3-4 times daily

if still present > 12 months of age –> dilation of duct by ophthalmology

35
Q

Chronic dacryoadenitis treatment

A

lab workup for inflammatory etiology

biopsy gland

treatment depends on cause

eye (9 decks)

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