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Foundations II > Eyelids and Anterior Segment > Flashcards

Eyelids and Anterior Segment Flashcards

1
Q

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?

A

allergic conjunctivitis

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2
Q

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?

A

It sounds like allergic conjuctivitis. Cold compresses, antihistamine drops like olopatadine and ketotifen, and oral antihistamines like diphenhydramine and loratidine.

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3
Q

If a patient presents with red eye, what are some possible inflammatory etiologies (7)?

A

blepharitis, chalazion/hordeolum, cellulitis, conjunctivitis, dacryoadenitis/dacryocystitis, corneal ulcer (keratitis), uveitis

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4
Q

If a patient presents with red eye, what are some possible traumatic etiologies (4)?

A

hyphema
foreign body
subconjuctival hemorrhage
corneal abrasion

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5
Q

Besides inflammatory and traumatic etiologies, what are two other reasons for red eye?

A

glaucoma or tumor

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6
Q

If a patient presents with red eye, what kinds of history questions do we ask?

A

How long? Inciting factors (trauma or chemical exposure) Associated symptoms like vision change, discharge, pain (foreign body) or systemic conditions? Are you using contacts?

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7
Q

What are three parts of the exam that we would perform for a patient presenting with red eye?

A
  1. vision
  2. pen light or slit lamp (looking for systematic, pattern of redness)
  3. tonometry
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8
Q

blepharitis

A

chronic condition characterized by inflammation of the eyelids, usually with intermittent exacerbations

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9
Q

Anterior blepharitis may have either a __ or ___ component.

A

infectious or seborrheic

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10
Q

Anterior blepharitis could be caused by what bacteria?

A

S. aureus

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11
Q

anterior vs. posterior blepharitis – differences and similiarty?

A 
anterior = infectious or seborrheic
posterior = meibomian gland dysfunction

They are both treated the same way!

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12
Q

How does blepharitis present?

A

red eyes, gritty or foreign body sensation, burning sensation, excessive tearing, crustiness in lashes, sensitivity to light, +/- blurry vision

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13
Q

What will a physical exam reveal in a patient with blepharitis (5 possible things)?

A 
diffuse conjunctival injection
eyelid margins often inflamed and red
crusting/matting of eyelashes
plugged glands upon magnification
collarettes
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14
Q

How is blepharitis treated?

A 
warm compress
lid massage 
lid hygiene
topical antibiotics like erythromycin
oral antibiotics if severe
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15
Q

What can blepharitis cause on the eyelid?

A

hordoleum/chalazion/stye

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16
Q

periorbital vs. orbital cellulitis: definition

A 
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
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17
Q

Neither orbital or periorbital cellulitis involve infection of the ___.

A

globe

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18
Q

Which is more common – orbital or periorbital cellulitis?

A

periorbital

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19
Q

In what groups are periorbital and orbital cellulitis more common in?

A

children > adults; treatment is different due to different complications

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20
Q

periorbital vs. orbital cellulitis: etiology

A 
periorbital = external sources like insect bites, FB, blepharitis); sometimes sinusitis
orbital = most often caused by extension of infection from paranasal (ethmoid) sinuses
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21
Q

Periorbital cellulitis is pre-___.

A

pre-septal

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22
Q

periorbital vs. orbital cellulitis: presentation

A 
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
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23
Q

periorbital vs. orbital cellulitis: physical exam

A 
periorbital = NO proptosis, NO ophthalmoplegia
orbital = proptosis, ophthalmoplegia, conjunctivitis, +/- discharge
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24
Q

How do you diagnose orbital vs. periorbital cellulitis?

A

If in doubt, treat as orbital!

Work up includes CBC, blood culture, culture of any discharge, CT scan of orbits and sinuses

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25
Q

When performing a fundoscopic exam, is the macula located temporally or nasally in relation to the optic nerve?

A

The macula is located temporal to the optic disc!

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26
Q

What pathogens could cause periorbital cellulitis?

A

S. aureus, S. pneumoniae, or MRSA!

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27
Q

How do we treat periorbital cellulitis depending on the infectious agent?

A

can be managed as outpatient; use empiric antibiotic therapy to cover pathogens; if MRSA is not suspected use oral clindamycin or amoxicillin-clavulanic acid; if MRSA is suspected use oral trimethoprim-sulfamethoxazole (Bactrim) PLUS one of the following: amoxicillin, amoxicillin-clavulanic acid, Cefdinir, Cefpodoxime

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28
Q

How do you treat orbital cellulitis?

A

hospitalization and consult with ophthalmologist to start immediate IV antibiotics (broad spectrum until cultures are returned; vancomycin + ceftriaxone); surgical drainage if there is an abscess

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29
Q

What can orbital cellulitis lead to if untreated?

A

optic nerve damage and spread of infection to cavernous sinus –> meninges –> brain

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30
Q

What is the purpose of administering the erythromycin ointment to neonates?

A

To prevent gonococcal conjunctivitis! This type of conjunctivitis can lead to corneal damage and even perforation of the globe.

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31
Q

Conjunctivitis is inflammation of…

A

the white of the eye = conjunctiva

32
Q

What is the most common eye disease?

A

conjunctivitis

33
Q

What is the most common cause of conjunctivitis? What are other causes?

A

virus (also could be bacteria, allergy, chemical)

34
Q

How is conjunctivitis transmitted?

A

direct contact

35
Q

The most common etiologic agent of viral conjunctivitis is…

A

adenovirus

36
Q

What are the signs and symptoms of a viral conjunctivitis?

A

pharyngitis, fever, malaise, watery discharge, preauricular adenopathy

37
Q

How is a viral conjunctivitis treated?

A

cold compress for discomfort

38
Q

What are three of the most common organisms that cause bacterial conjunctivitis?

A

S. pneumoniae
H. influenzae
Psuedomonas

39
Q

What kind of conjunctivitis is associated with copious discharge and eyes matted shut in the morning?

A

bacterial

40
Q

How is bacterial conjunctivitis treated?

A

erythromycin ointment, fluoroquinolone drops (moxifloxacin, ciprofloxacin)

41
Q

Is allergic conjunctivitis usually bilateral?

A

Yes!

42
Q

Can allergic conjunctivitis be seasonal?

A

Yes!

43
Q

What are symptoms of allergic conjunctivitis?

A

itchiness, conjunctival injection, and swelling

44
Q

chemosis = ?

A

swelling

45
Q

How is allergic conjunctivitis treated?

A

cold compresses, oral antihistamines, drops

46
Q

patient education for conjunctivitis

A

handwashing
don’t share eye drops
throw away make up

47
Q

viral vs. bacterial vs. allergic conjunctivitis: onset

A

viral and bacterial = acute onset

allergic = chronic (seasonal)

48
Q

viral vs. bacterial vs. allergic conjunctivitis: laterality

A

viral and allergic: bilateral

bacterial: unilateral

49
Q

viral vs. bacterial vs. allergic conjunctivitis: symptoms

A 
viral = burning and soreness
bacterial = burning and general irritation
allergic = itching
50
Q

viral vs. bacterial vs. allergic conjunctivitis: injection

A 
viral = mild to severe
bacterial = moderate to severe
allergic = mild to moderate
51
Q

viral vs. bacterial vs. allergic conjunctivitis: discharge

A 
viral = watery
bacterial = mucopurulent
allergic = stringy and mucoid
52
Q

viral vs. bacterial vs. allergic conjunctivitis: other symptoms

A 
viral = URI, preauricular LAN
bacterial = adherent lids
allergic = swelling/chemosis
53
Q

viral vs. bacterial vs. allergic conjunctivitis: diagnostic tests

A 
viral = none
bacterial = culture or Gram
allergic = none specific, maybe patch testing on skin
54
Q

viral vs. bacterial vs. allergic conjunctivitis: treatment

A 
viral = tears, compresses, vasoconstrictors
bacterial = topical antibiotics with or without systemic antibiotics
allergic = artificial tears, topical antihistamines, mast cell stabilizers
55
Q

viral vs. bacterial vs. allergic conjunctivitis: duration

A

viral/bacterial could be days to weeks, allergic could be weeks to months

56
Q

What STDs could we suspect with bacterial conjunctivitis?

A

GC/chlamydia

57
Q

Dacryocystitis is an infection in the ___, usually secondary to a ____.

A

infection in lacrimal sac usually secondary to nasolacrimal duct obstruction

58
Q

Dacryocystitis is more common in what group?

A

kids

59
Q

How do we treat dacryocystitis?

A

aggressive antibiotics like clindamycin and IV vancomycin; MAY require surgery (NLD probing)

60
Q

Entropion and ectropion are disorders of what?

A

eyelids

61
Q

What are two conjunctival disorders?

A

pingueculum and pterygium

62
Q

What is entropion?

A

inward turning of eyelids, especially lower eyelid

63
Q

Entropion may occur due to what?

A

may occur with age as a result of degeneration of lid tissues, or due to childhood facial structure

64
Q

What is entropion a bad thing?

A

damage may occur as lashes rub on the surface of the eye

65
Q

How do you treat entropion?

A

lubrication

66
Q

What is ectropion?

A

outward turning of the eyelids, especially lower lid

67
Q

What can cause ectropion?

A

may occur with age due to degeneration of lid tissues

68
Q

How and when do we treat ectropion?

A

surgery may be required if excessive tearing or exposure keratitis occurs

69
Q

What does a pingueculum look like and where is it usually located?

A

yellow, elevated nodule, commonly located on the nasal side of the conjunctiva

70
Q

How are pingueculums treated?

A

rarely grow so do not require treatment; surgery on the conjunctiva is painful!

71
Q

pterygium vs. pingueculum

A

pterygium = progress; pingueculum = do not progress

72
Q

What is a pterygium?

A

fleshy, triangular growth of conjunctiva that spreads and may threaten visual axis and cornea

73
Q

Pterygiums are associated with exposure to what?

A

wind, sun, dust

74
Q

How are pterygiums treated?

A

artificial tears and anti-inflammatories; excision may be warranted

75
Q

What endocrine anomaly should be suspected in a patient with bitemporal hemianopsia?

A

pituitary tumor

76
Q

What condition may occur in patients with Marfan’s Syndrome?

A

lens dislocation

Foundations II (11 decks)

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