eyelid and lacrimal disorders Flashcards
common chronic bilateral inflammatory condition of the lid margins (eyelashes)
anterior and posterior
common cause of recurrent conjunctivitis
blepharitis
involves:
lid skin, eyelashes, associated glands
may be ulcerative from staph infection OR seborrheic in association with seborrhea of the scalp, brows, and ears
anterior blepharitis
results from inflammation of meibomian glands
types:
bacterial infection–> staph
primary glandular dysfunction –> acne rosacea
posterior blepharitis
crusting, scaling, and erythema of lid margins (“red rimmed”) and eyelashes
eyelids can feel irritated, burning, itching
anterior blepharitis
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
posterior blepharitis
treatment for anterior blepharitis
First line: eyelid hygiene
- gentle eyelid massage
- lid scrub with baby shampoo
warm compress
acute exacerbations
- antibiotic eye ointment (bacitracin or erythromycin)
treatment for posterior blepharitis
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)
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
Hordeolum (stye)
meibomian gland abscess that usually points onto the conjunctival surface of the lid
internal hordeolum
aka “stye”, usually smaller and on the margin
pain, swelling, erythema
external hordeolum
hordeolum treatment
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
internal hordeolum can lead to
cellulitis of the lid
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
chalazion
chalazion treatment
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
granulomatous inflammation of a meibomian gland
it may follow an internal hordeolum
differentiating factor: not tender
chalazion
blocked oil gland on edge of the eyelid
stye
blocked meibomian gland
chalazion
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
ectropion
entropion treatment
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
inward* turning of lower eyelid
common in elderly
causes include:
loss of lid fascia
conjunctival scarring
entropian
ectropion treatment
keep eyes moist (OTC preparations)
surgery if excessive tearing, exposure keratitis or cosmetic issue
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
dacryocystitis
pathogens for acute dacryocystitis
staph aureus, streptococci
acute dacryocystitis
pain, swelling, tenderness, and redness near the tear sac area
purulent material may be expressed
pathogens for chronic dacryocystitis
staph epidermis
streptococci
gram-negative bacilli
chronic dacryocystitis
tearing and discharge are principal signs
mucus or pus may also be expressed
treatment for chronic dacryocystitis
kept latent with systemic antibiotics
relief of obstruction is the only cure
–> dacryocystorhinostomy
treatment for acute dacryocystitis
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
inflammation of the lacrimal gland
dacryoadenitis
caused by noninfectious inflammatory disorders
sjogre’s syndrome, sarcoidosis, thyroid disease
consider neoplastic process (lymphoma of lacrimal gland)
chronic dacryoadenitis
infectious
viral (EBV, mumps, coxsackievirus)
bacterial (S. aureus*, strep, neisseria gonorrhoeae)
acute dacryoadenitis
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
acute dacryoadenitis
can be bilateral
often painless
soft tissue swelling in region of lateral upper lid
chronic dacryoadenitis
acute dacryoadenitis treatment
mild infection
oral first generation cephalosporin (cephalexin)
acute dacryoadenitis treatment
mild infection
MRSA suspected
IV sulfamethoxazole- trimethoprim
linezolid
acute dacryoadenitis treatments
severe infection
IV nafcillin
acute dacryoadenitis treatments
severe infection
MRSA suspected
IV vancomycin
nasolacrimal duct obstruction or narrowing
occurs in 6% of newborns and usually resolves without conservative treatment
dacryostenosis
how to make dacryostenosis diagnosis
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)
epiphora (excessive tearing)
eyelash matting
tears that appear thicker and yellow in color (mistaken for infection)
dacryostenosis symptoms
dacryostenosis treatment
supportive
gentle massage with downward motion 3-4 times daily
if still present > 12 months of age –> dilation of duct by ophthalmology
Chronic dacryoadenitis treatment
lab workup for inflammatory etiology
biopsy gland
treatment depends on cause
