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CLIN MED 3 - HEENT > Eyelid and lacrimal disorders - waldron > Flashcards

Eyelid and lacrimal disorders - waldron Flashcards

1
Q

what are the eyelids composed of

A

4 layers:
skin and subcutaneous tissue
striated muscle (orbicularis oculi)
tarsus
conjunctiva

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2
Q

what are the glands found within the eyelid

A

eccrine glands
lacrimal gland of Krause and Wolfring
apocrine gland of Moll
sebaceous gland - meibomian glands and gland of Zeiss

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3
Q

what is the tarsi

A

firm plates composed of dense connective tissue; meibomian glands are embedded in connective tissue of tarsal plates

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4
Q

what is the posterior eyelid surface

A

lined by palpebral conjunctiva composed of epithelium and subepithelial stroma - substantia propria

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5
Q

where are goblet cells found on the eyelid

A

epithelium of tarsi

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6
Q

what is the stroma composed of

A

fibrovascular connective tissue

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7
Q

what is hordeolum

A

sudden-onset localized swelling of eyelid initially causes eyelid hyperemia, edema, swelling and pain
usually caused by infection
remains painful and localized to eyelid margin

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8
Q

what is chalazion

A

sudden-onset localized swelling of eyelid initially causes eyelid hyperemia, edema, swelling and pain
non-infectious meibomian gland becomes small non-tender nodule in eyelid center
incision of intralesional corticosteroids may be used to hasten resolution

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9
Q

how are hordeolum and chalazions diagnosed

A

clinically
during first 2 days - they may be clinically indistinguishable

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10
Q

what is the treatment for hordeolum and chalazion

A

treatment primarily with hot compresses - both improve spontaneously
chalazion - incision or intra-lesional corticosteroids may be used
Hordeolum: systemic abx (dicloxacillin or erythromycin) indicated when cellulitis present

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11
Q

what is the clinical presentation of chalazion

A

eyelid diffusely swollen
102 days localized to body of the eyelid
usually small, nontender nodule or lump develops
usually drains through inner surface of eyelid or spontaneously absorbed over 2-8 weeks; rare to persist longer
depending on size and location - may indent cornea resulting in slightly blurred vision

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12
Q

what is the clinical presentation of Hordeolum (stye)

A

acute, localized swelling of eyelid that may be external or internal
EXTERNAL:1-2 days localized to eyelid margin
tearing, photophobia, FB sensation may be present. usually small yellow-ish pustule develops at base of eyelash
within 2-4 days, lesion ruptures and discharges material relieving pain and resolving lesion
INTERNAL: pain, redness, edema localized to posterior tarsal surface, inflam, recurrence is common (RARE)

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13
Q

What is Blepharitis

A

inflammation of eyelid margins, acute or chronic
itching and burning of eyelid margins with redness and edema

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14
Q

What is the etiology of acute blepharitis

A

usually bacterial infections (staph) of eyelid margin at origins of eyelashes - more crusting
may have viral source - usually more clear, serous discharge

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15
Q

what is acute non-ulcerative blepharitis

A

usually caused by allergic reactions involving same areas (intense itching, rubbing, rash)

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16
Q

what is the etiology of chronic blepharitis

A

non-infectious inflammation of unknown cause

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17
Q

what is the clinical presentation of blepharitis

A

itching and burning of eyelid margins
conjunctival irritation with lacrimation, photosensitivity, FB sensation
acute: small pustules, crusting
chronic: dilated swollen gland, exudate waxy, thick, yellowish
easily removable scales on eyelids

18
Q

what is the workup/diagnostics used for Blepharitis

A

usually by slit-lamp examination (ophtho)
chronic blepharitis that does not response to treatment may require biopsy

19
Q

what is the treatment of acute ulcerative blepharitis

A

abx ointment: bacitracin/polymyxin B, erythromycin, gentamicin QID x 7-10 days

20
Q

what is the treatment of acute viral ulcerative belpharitis

A

acyclovir 400mg po TID x 7days
famciclovir 500mg po TID or valacyclovir 1gm po TID x 7days

21
Q

what is the treatment of acute non-ulcerative belpharitis

A

avoiding offending action or substance
warm compresses over closed eyelid
if swelling persists > 24 hours, topical fluorometholone ophthalmic ointment x 7 days

22
Q

what is the treatment of meibomian gland dysfunction chronic blepharitis

A

prevention of secondary keratoconjunctivitis sicca
warm compress and eyelid massage to extrude trapped secretions and coat ocular surface

23
Q

what is the treatment of seborrheic chronic blepharitis

A

gentle cleansing of eyelid amrgin (lid scrubs) BID with cotton swab dropped in dilute solution of baby shampoo
topical abx ointment (erythromycin, bacitracin/polymyxin B or sulfacetamide) x 3 months

24
Q

what can usually accompany chronic blepharitis

A

secondary keratoconjunctivitis sicca

25
Q

What is entropion

A

inversion of an eyelid
caused by age-related tissue relaxation, post-infectious changes, post-traumatic changes or blepharospasm
eyelashes rub against eyeball and may lead to corneal ulceration and scarring

26
Q

what is ectropion

A

eversion of lower eyelid
caused by age-related tissue relaxation, CN 7 palsy, post-traumatic or post-surgical changes
tearing (poor drainage of nasolacrimal system) and symptoms of dry eyes

27
Q

what is the definitive treatment for entropion

A

surgery

28
Q

what is the treatment for ectropion

A

symptomatic: tear supplements and at night ocular lubricants
definitive treatment: surgery

29
Q

what is Dacryocystitis

A

infection of lacrimal sac that may lead to abscess formation
usually caused by (staph or strep species

30
Q

what is acute dacryocycstitis

A

presents with pain, redness, edema around lacrimal sac
diagnosis based on s/sx and with pressure over lacrimal sac reflux of mucoid material through puncta

31
Q

what is the treatment of acute dacryocycstitis

A

mild: warm compress/oral abx
severe: IV abx
abx usually 1st gen cephalosporin or penicillin
abscess may be drained, abx changed based on cx results

32
Q

what is chronic dacryocycstitis

A

present with mass under medial canthal tendon and chronic conjunctivitis

33
Q

what is the treatment of chronic dacryocycstitis

A

usually surgery: create passage between lacrimal sac and nasal cavity (dacryocycstorhinostomy)

34
Q

what are the types of eyelid tumors

A

epithelial and melanocytic tumors

35
Q

what is the most common malignant eyelid tumors

A

basal cell carcinomas in Caucasians
sebaceous gland carcinoma in asians

36
Q

what are the benign eyelid tumors

A

squamous papilloma: m/c benign epithelial tumor of eyelid
seborrheic keratosis
keratoacanthoma
cutaneous horn (non-specific keratosis)

37
Q

what are premalignant/malignant tumors

A

actinic keratosis - m/c precancerous lesion - may become SCC
xeroderma pigmentosum
BCC - m/c malignancy
SCC - UV light primary risk factor

38
Q

what are benign malanocytic eyelid tumors

A

freckles (ephelis)
lentigo simplex
solar lentigo
eyelid nevi: congenital vs acquired

39
Q

what are the cystic eyelid tumors

A

sweat gland tumors
hair follicle tumors
sebaceous gland tumors
stromal tumors

40
Q

what is xanthelasma

A

common, benign deposit of yellow-white flat plaques of lpid material subcutaneous on upper and lower eyelids
about 1/3 have dyslipidemias, most do not
middle aged and elderly
dx: clinical
no treatment needed, removal for cosmetic

41
Q

What are vascular eyelid tumors

A

capillary (infantile) hemangioma - m/c
nevus flammeus (port-wine stain)
kaposi’s sarcoma

42
Q

what are neurogenic eyelid tumors

A

solitary neurofibroma - may resemble chalazion

CLIN MED 3 - HEENT (8 decks)

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