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Eyelid Disorders Flashcards

1
Q

Pterygium

risk factors

A
  • increased UV light exposure in sunny climates
  • sand, wind, dust exposure
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2
Q

Pterygium

clinical presentation

4 components

A
  • elevated, superficial fleshy, triangular-shaped growing mass
  • starts medially & extends laterally
  • irritation, erythema, foreign body sensation
  • can impair vision
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3
Q

Pterygium

management

3 components

A
  • observation
  • artificial tears
  • surgical removal once vision is impaired
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4
Q

Pterygium

what can occur with recurrent pterygium

A

can cause sx more quickly resulting in more surgery and increased scarring

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5
Q

Pinguecula

risk factors

2

A
  1. eye irritation (dry, windy, sunny conditions)
  2. ocular trauma
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6
Q

Pinguecula

clinical manifestations

4 components

A
  • yellow
  • slightly elevated nodule
  • found on nasal side of sclera
  • does not grow onto cornea
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7
Q

Pinguecula

management

2

A
  • no tx necessary
  • cosmetic: resection
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8
Q

Hordeolum

most common bacteria

A

s. aureus

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9
Q

Hordeolum

pathophys of internal infection

A

inflammation or infection of a meibomian gland found deep from the palpebral margin under the eyelid

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10
Q

Hordeolum

pathophys of external infection

A

infection of an eyelash follicle or sebaceous gland near the lid margin w/ production of pus in the gland of Moll or Zeis

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11
Q

Hordeolum

clinical manifestations

5

A
  • localizaed erythema
  • painful
  • warm
  • tender
  • nodular/pustule on the eyelid
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12
Q

Hordeolum

management

A
  • warm compress
  • may need I&D or abx ointment
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13
Q

Hordeolum

which abx ointment to use

A

erythromycin or bacitracin

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14
Q

Chalazion

pathophys

A

obstruction of Zeis or Meibomian glans

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15
Q

Chalazion

clinical manifestations

3

A
  • non-tender (PAINLESS)
  • localized edema
  • conjunctival nodule
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16
Q

Chalazion

management

2 components

A
  • eyelid hygiene
  • warm compress
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17
Q

Chalazion

what to do if refractory?

A
  • refer to ophthalmology
  • glucocorticoid infection or I&D
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18
Q

Chalazion vs Hordeolum

A

Chalazion is larger, firmer, slower growing, less painful than hordeolum

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19
Q

Ectropian

risk factors

4

A
  • elderly
  • CN 7 palsy
  • congential
  • infectious
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20
Q

Ectropian

pathophys

A

relaxation of orbicularis oculi muscle

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21
Q

Ectropian

PE findings

A

eyelid/lashes are everted (turned outward)

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22
Q

Ectropian

clinical findings

5

A
  • irritation
  • ocular dryness
  • tearing
  • sagging of eyelid
  • increased sensitivity
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23
Q

Ectropian

management

3

A
  • lubricating eyedrops
  • moisture shield
  • surgical correction
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24
Q

Entropion

risk factors

A

elderly

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25
# Entropion pathophys
spasm of the orbicularis oculi muscle
26
# Entropion PE findings
eyelid and lashes are inverted (turned inward)
27
# Entropion clinical presentation | 4 components
* erythema * tearing * increased sensitivity * corneal abrasion/ulceration
28
# Entropion management
* lubricating eyedrops * moisture shield * surgical correction
29
# Blepharitis risk factors | 4
* down syndrome * atopic dermatitis * rosacea * seborrheic dermatitis
30
# Blepharitis pathophys of anterior
* commonly infectious/viral in naure (s. aureus or s. epidermis) * can also be seborrheic
31
# Blepharitis pathophys of posterior
meibomian gland dysfunction
32
# Blepharitis clinical manifestations | 6
* burning * erythema * crusting/scaling * red rimming of the eyelid * gritty sensation * flaking on the lashes/lid margins
33
# Blepharitis potential PE finding
+/- entropion or ectropion
34
# Blepharitis management
* eyelid hygiene (warm compress, scrub, massage, artificial tears)
35
# Blepharitis what to use if severe or refractory | 2
* abx (erythromycin, azithromycin, ofloxacin) * topical glucocorticoid
36
# Dacrocystitis common etiologies | 4
* s. epidermis * s. aureus * GABHS * pseudomonas
37
# Dacrocystitis risk factors | 2
* sjorgen syndrome * thyroid disease
38
# Dacrocystitis pathophys
obstruction of the nasolacrimal duct
39
# Dacrocystitis clinical manifestations of acute disease | 6
* tenderness/pain * tearing * erythema * edema * warm to touch (medial canthal side/lower lid area) * +/- purulent discharge
40
# Dacrocystitis clinical manifestation of chronic | 1 additional
mucopurulent drainage from puncta
41
# Dacrocystitis management acute
abx PO (clindamycin) + warm compress
42
# Dacrocystitis management of chronic
dacrocystorhinostomy
43
# Viral Conjunctivitis most common in who
children
44
# Viral Conjunctivitis mode of transmission
direct contact
45
# Viral Conjunctivitis common source
swimming pools
46
# Viral Conjunctivitis clinical manifestations | 5
* bilateral * foreign body sensation/gritty * ocular erythema * tearing/watery discharge * itching
47
# Viral Conjunctivitis how is vision?
unimpacted
48
# Viral Conjunctivitis PE findings
* ipsilateral pre-auricular lymphadenopathy (enlarged/tender) * copious watery tearing * tarsal conjunctiva may be follicular/bumpy
49
# Viral Conjunctivitis management | 3
* warm/cool compress * artificial tears * anti-histamines (olopatadine)
50
# Bacterial Conjunctivitis causative agents | adults, general, contact use
* adults: s. aureus * general: s. pneumonia, h. influenzae, m. catarrhalis * contacts: pseudomonas
51
# Bacterial Conjunctivitis clinical manifestations | 4 components
* painless * mucopurulent discharge/crusting * conjunctival erythema * "eyelids crusted shut in AM"
52
# Bacterial Conjunctivitis associated vision changes
none
53
# Bacterial Conjunctivitis managment
topical abx * erythromycin * trimethoprim-polymixin B * ofloxacin
54
# Bacterial Conjunctivitis management if contact user
ciprofloxacin or ofloxacin
55
# Allergic Conjunctivitis pathophys
type I (IgE) mediated rxn causing local mast cell degranulation and histamine release
56
# Allergic Conjunctivitis clinical manifestations | 4
* conjunctival erythema * watery discharge * marked pruritis * other allergy sx (nasal congestion, sneezing)
57
# Allergic Conjunctivitis associated vision changes
none
58
# Allergic Conjunctivitis PE Findings | 3
* cobblestone mucosa * watery stringy discharge * conjunctival edema
59
# Allergic Conjunctivitis management
* supportive measures * topical anti-histamine (olopatadine, pherniramine-naphazoline)
60
# Gonococcal Conjunctivitis complications | 2
* meningitis * blindness
61
# Gonococcal Conjunctivitis when is this typically spread
during delivery, sx appear 2-5d later
62
# Gonococcal Conjunctivitis dx
PCR or gram stain
63
# Gonococcal Conjunctivitis clinical manifestations | 6
* conjunctival injection * chemosis * eyelid edema * mucopurulent discharge * globe tenderness * pre-auricular lymphadenopathy
64
# Gonococcal Conjunctivitis preventive management
erythromycin ophthalmic ointment
65
# Gonococcal Conjunctivitis sx management
* IM ceftriaxone * IM cefotaxime
66
# Chlamydial Conjunctivitis leading cause of?
blindness of infectious origin
67
# Chlamydial Conjunctivitis incubation period
2-19 days
68
# Chlamydial Conjunctivitis associated w/
concurrent genital infection
69
# Chlamydial Conjunctivitis dx
PCR or gram stain
70
# Chlamydial Conjunctivitis clinical manifestations | 6
* unilateral * mucopurulent discharge * hyperemic tarsal conjunctiva * marked tarsal follicular response * pre-auricular lymphadenopathy * +/- superior corneal opacity/vascularization
71
# Chlamydial Conjunctivitis management
abx PO (azithromycin or doxy)
72
# Chlamydial Conjunctivitis prevention
treat all partners of pts with this
73
# Keratoconjunctivitis Sicca risk factors | 8
* female gender * increasing age * DM * Sjogrens * Parkinsons * hormonal changes * Vitamin A deficiency * contact lens use
74
# Keratoconjunctivitis Sicca pathophys
* decreased tear production * abnormal meibomian gland pathophys
75
# Keratoconjunctivitis Sicca clinical manifestations | 7
* dryness * irritation * bilat conjunctival infection * foreign body sensation * paradoxical excessive tearing * photophobia * blurred vision
76
# Keratoconjunctivitis Sicca PE findings | 4
* corneal scarring * ec/en tropian * blephritis * reduced blink rate
77
# Keratoconjunctivitis Sicca management | 2 components
* artificial tears, gels, ointments * ophthalmology referral
78
# Orbital/Septal Cellulitis typically secondary to?
sinus infection (ethmoid sinusitis)
79
# Orbital/Septal Cellulitis most common in?
children
80
# Orbital/Septal Cellulitis most common etiologies
* s. aureus * streptococci * GABHS * h. influenzae
81
# Orbital/Septal Cellulitis dx
CT head or clinical
82
# Orbital/Septal Cellulitis clinical manifestations | 5
* ocular pain (esp w/ EOM) * ophthalmoplegia (EOM weakness) * diplopia * proptosis (protrusion of eye) * +/- visual changes
83
# Orbital/Septal Cellulitis management | 4 components
* hosp admission * IV abx (vanco followed by ceftriaxone, ampicillin-sulbactam, piperacillin-tazobactam) * drainage * ENT referral
84
# Preseptal/Periorbital Cellulitis where is infection located
* anterior to the orbital septum
85
# Preseptal/Periorbital Cellulitis commonly due to?
sinusitis or contagious infection of the soft tissues of the eyelid/face
86
# Preseptal/Periorbital Cellulitis what should we think of with these? | PPP?
insect bites
87
# Preseptal/Periorbital Cellulitis common pathogens?
* s. aureus (MRSA) * streptococci * anaerobes
88
# Preseptal/Periorbital Cellulitis dx
clinical & if uncertain then order CT
89
# Preseptal/Periorbital Cellulitis clinical manifestations | 5 components
* unlateral * ocular pain * eyelid erythema * edema * no pain w/ movement/limitation w/ movement
90
# Preseptal/Periorbital Cellulitis management | 2 components
* abx: TMP-SMZ, clindamycin * if younger than 1 y/o, inpatient tx
91
# Bacterial Keratitis causative agents | general, w/ contacts
* general: s. aureus, streptococci * contacts: pseudomonas aeruginosa
92
# Bacterial Keratitis risk factors | 4 components
* improper contact lens wear * dry ocular surface * topical corticosteroid use * immunosuppression
93
# Bacterial Keratitis clinical manifestations | 7
* unilateral * ocular pain * photophobia * redness * vision changes * foreign body sensation * cannot keep affected eye open
94
# Bacterial Keratitis PE findings | 4
* conjunctival erythema * ciliary injection * hazy cornea * hypopyon
95
# Bacterial Keratitis findings w/ slit lamp
increased fluorescein uptake
96
# Bacterial Keratitis management
* ophthalmology referral for corneal culture * topical fluoroquinolone (moxifloxacin)
97
# Bacterial Keratitis what to absolutely avoid!
DO NOT PATCH EYE
98
# HSV Keratitis pathophys
corneal infection and inflammation due to reactivation of HSV in the trigeminal ganglion
99
# HSV Keratitis dx
* fluorescein staining (Slit lamp)
100
# HSV Keratitis slit lamp findings
dendritic corneal ulceration
101
# HSV Keratitis clinical manifestations | 8
* acute onset * unilateral * ocular pain * photophobia * conjunctival erythema * blurred vision * ciliary flush (limbic injection) * pre-auricular lymphadenopathy
102
# HSV Keratitis management
* topical: acyclovir * PO: valacyclovir
103
# Herpes Zoster Keratitis pathophys
after initial zoster infection, it becomes latent in the dorsal root ganglia or trigeminal ganglia where it can reactivate
104
# Herpes Zoster Keratitis dx
* clinical + fluoroscein staining * PCR PRN
105
# Herpes Zoster Keratitis prodrome sx | 4
* HA * malaise * fever * unilateral pain
106
# Herpes Zoster Keratitis describe rash | 4 components
* group vesicles * erythematous base * Hutchinson's Sign (rash on nose) * ocular involvement (hyperemic conjunctivitis, uveitis, episcleritis)
107
# Herpes Zoster Keratitis describe slit lamp findings
dendritic uptake of fluoroscein
108
# Herpes Zoster Keratitis management
* urgent ophthalmology referral * analgesics for pain * atropine * PO anti-viral
109
# Fungal Keratitis common causative agents
* fusarium * aspergillus * candida
110
# Fungal Keratitis pathophys
* fungal infection of cornea * occurs after eye injury
111
# Fungal Keratitis risk factors | 3
* eye injury w/ veg active matter * corticosteroid use * contact lens use
112
# Fungal Keratitis dx
clinical, +/- corneal biopsy
113
# Fungal Keratitis clinical manifestation
* blurry vision * sudden ocular pain * photosensitivity * eye erythema * tearing * blepharospasm
114
# Fungal Keratitis management | 3
* ophthalmology referral * antifungal PO (natamycin, voriconazole) * +/- corneal transplant
115
# Acanthamoeba Keratitis pathophys
rare corneal infection w/ acanthamoeba species
116
# Acanthamoeba Keratitis diagnosis
corneal biopsy or PCR
117
# Acanthamoeba Keratitis clinical manifestations | 8
* unilateral * pain out of proportion to clinical findings * decreased vision * ocular erythema * foreign body sensation * photophobia * tearing * mucopurulent discharge
118
# Acanthamoeba Keratitis slit lamp findings
* radial or ring-like infiltrate * perineural infiltrates
119
# Acanthamoeba Keratitis management
* ophthalmology referral * biguanide + diamidine * miltefosine

CMT (78 decks)

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