Eyelids and Anterior Segment Flashcards
A 21 year old male complains of one week of red and irritated eyes. He admits to having severe pruritis of the eyes and mild mucoid discharge. He hasn’t taken any medications. What is the most likely diagnosis?
allergic conjunctivitis
A 21 year old male complains of one week of red and irritated eyes. He admits to having severe pruritis of the eyes and mild mucoid discharge. What are the best treatments for this patient?
It sounds like allergic conjuctivitis. Cold compresses, antihistamine drops like olopatadine and ketotifen, and oral antihistamines like diphenhydramine and loratidine.
If a patient presents with red eye, what are some possible inflammatory etiologies (7)?
blepharitis, chalazion/hordeolum, cellulitis, conjunctivitis, dacryoadenitis/dacryocystitis, corneal ulcer (keratitis), uveitis
If a patient presents with red eye, what are some possible traumatic etiologies (4)?
hyphema
foreign body
subconjuctival hemorrhage
corneal abrasion
Besides inflammatory and traumatic etiologies, what are two other reasons for red eye?
glaucoma or tumor
If a patient presents with red eye, what kinds of history questions do we ask?
How long? Inciting factors (trauma or chemical exposure) Associated symptoms like vision change, discharge, pain (foreign body) or systemic conditions? Are you using contacts?
What are three parts of the exam that we would perform for a patient presenting with red eye?
- vision
- pen light or slit lamp (looking for systematic, pattern of redness)
- tonometry
blepharitis
chronic condition characterized by inflammation of the eyelids, usually with intermittent exacerbations
Anterior blepharitis may have either a __ or ___ component.
infectious or seborrheic
Anterior blepharitis could be caused by what bacteria?
S. aureus
anterior vs. posterior blepharitis – differences and similiarty?
anterior = infectious or seborrheic posterior = meibomian gland dysfunction
They are both treated the same way!
How does blepharitis present?
red eyes, gritty or foreign body sensation, burning sensation, excessive tearing, crustiness in lashes, sensitivity to light, +/- blurry vision
What will a physical exam reveal in a patient with blepharitis (5 possible things)?
diffuse conjunctival injection eyelid margins often inflamed and red crusting/matting of eyelashes plugged glands upon magnification collarettes
How is blepharitis treated?
warm compress lid massage lid hygiene topical antibiotics like erythromycin oral antibiotics if severe
What can blepharitis cause on the eyelid?
hordoleum/chalazion/stye
periorbital vs. orbital cellulitis: definition
periorbital = infection of soft tissues around the eye that doesn't extend into the orbit orbital = infection of fat and muscle tissue surrounding the globe
Neither orbital or periorbital cellulitis involve infection of the ___.
globe
Which is more common – orbital or periorbital cellulitis?
periorbital
In what groups are periorbital and orbital cellulitis more common in?
children > adults; treatment is different due to different complications
periorbital vs. orbital cellulitis: etiology
periorbital = external sources like insect bites, FB, blepharitis); sometimes sinusitis orbital = most often caused by extension of infection from paranasal (ethmoid) sinuses
Periorbital cellulitis is pre-___.
pre-septal
periorbital vs. orbital cellulitis: presentation
periorbital = eye pain, eyelid swellling and erythema, no vision change, no fever, no pain with eye movement orbital = also has eye pain, also has eyelid swelling and erythema, BUT there is vision change, fever, and pain with eye movement
periorbital vs. orbital cellulitis: physical exam
periorbital = NO proptosis, NO ophthalmoplegia orbital = proptosis, ophthalmoplegia, conjunctivitis, +/- discharge
How do you diagnose orbital vs. periorbital cellulitis?
If in doubt, treat as orbital!
Work up includes CBC, blood culture, culture of any discharge, CT scan of orbits and sinuses
