Eyelids and Anterior Segment

Question 1

What are the best treatments for Allergic Conjuctivitis

Answer 1

1. Antihistamines drops
2. Oral antihistamines
3. Cold compression

Question 2

What is Blepharitis

Answer 2

Chronic inflammation of the eye lids with intermittent exacerbations

Question 3

What are clinical presentations of Blepharitis

Answer 3

Red eyes 
Gritty body sensations
Crustiness in the lashes 
Burning 
Excessive tearing 
Light sensitive and blurry vision

Question 4

What would you see on a physical exam with Blepharitis

Answer 4

• Conjunctival injection
• Eyelid margins are red and inflamed
• Crusting of eyelashes
• Collarettes

Question 5

Treatment for Blepharitis

Answer 5

• Warm compressions
• Eye lids massage
• Lid hygiene
• Topical antibiotics (erythromycin ointments)

Question 6

Chalazion/Hordeolum is associated with what?

How does it present

Answer 6

Blepharitis

Meibomian gland is swelled up due to back up of fluid in the eyelids

Question 7

How does Anterior and Posterior Blepharitis differ?

Answer 7

Anterior stems from an infection (S. aureus) or seborrheic component

Posterior stems from meibomian gland dysfunction

Question 8

Periorbital cellulitis vs Orbital cellulitis Etiologies

Answer 8

Periorbital is an infection of the soft tissues around the eye and does not extend into the orbit itself

Orbital cellulitis is an infection of the fat and muscle tissue around the globe of the eye

Question 9

Periorbital cellulitis is most common in who

Answer 9

Children and more common than orbital cellulitis

Question 10

Etiology of Periorbital cellulitis

Answer 10

External sources (bug bites, blepharitis, sinusitis)

Question 11

Etiology of Orbital cellulitis

Answer 11

Caused by an extension of infection from paranasal sinuses (ethmoid sinus)

Question 12

What does Periorbital cellulitis present like?

Answer 12

• Eye pain
• Eye lid swelling and erythema (reddening)
• No vision changes
• No fever
• No pain with eye movements

Question 13

How is Orbital cellulitis clinically presented

Answer 13

• Eye pain
• Eyelid swelling and erthema
• Vision changes (+)
• Pain with eye movements

Question 14

How does Periorbital and Orbital cellulitis differ on a physical exam?

Answer 14

Periorbital

• No proptosis (displacement of the eye)
• No ophthalmoplegia (paralysis of the eye muscles)

Orbital

• Has proptosis
• Has ophthalmoplegia
• Conjunctivitis

Question 15

What workup is needed to diagnose Periorbital or Orbital cellulitis?

Answer 15

CBC
Blood culture (infection)
Culture of any discharge 

CT scan of the orbits and surrounding sinuses

Question 16

Treatments for Periorbital cellulitis

Answer 16

Managed as an outpatient

• Empiric antibiotics to cover pathogens (S. aureus, S. pneumonia, MRSA)
• If no MRSA treat with Clindamycin or Amoxicillin-Clavulanic acid

-If MRSA is suspected treat with Oral Trimethoprim-sulfamethoxazole (Bactrim) + 
Amoxicillin, 
Amoxicillin-Clavulanic acid
Cefdinir or 
Cefpodoxime

Question 17

Treatment of Orbital Cellulitis

Answer 17

Needs Hospitalization and ophthalmologist

• Immediately start IV antibiotics to prevent infection of optic nerve and spread to cavernous sinus and the meninges/brain
• Broad antibiotics until culture is returned (Vancomycin + Ceftriaxone)
• Surgical drainage if abscess formations

Question 18

What is Conjunctivitis? What is the most common cause

Answer 18

Inflammation of the white of the eye

Common cause is viral infection but other causes include bacterial infection, allergies and chemicals

Question 19

Most common etiologic virus for conjunctivitis?

Answer 19

Adenovirus

Question 20

Signs and symptoms for Viral conjunctivitis?

How are these relieved?

Answer 20

Pharyngitis
Fever
Malaise
Watery discharge
Preauricular adenopathy

Cold compresses

Question 21

Most common pathogens for Bacterial conjunctivitis

Answer 21

S. pneumonia
H. influenzae
Pseudomonas

Question 22

Common symptoms of Bacterial conjunctivitis

Answer 22

Discharge and eyes matted shut in the morning

Question 23

Treatment for Bacterial conjunctivitis

Answer 23

Antibiotic drops/ointment

Erythromycin ointment
Fluoroquinolone drops
-Moxifloxacin
-Ciprofloxacin

Question 24

How is allergic conjunctivitis presented and treated?

Answer 24

Bilateral redness
Itchiness
Conjunctival injection and swelling (chemosis)

Treatment: Cold compresses, oral antihistamines , drops

Question 25

What is Dacryocystitis

Answer 25

-Infection of the lacrimal sac, secondary to a nasolacrimal duct obstruction

Question 26

How is Dacryocystitis treated?

Answer 26

Treated with antibiotics (Clindamycin, IV vancomycin)

Question 27

What is Entropion?

How is it caused?

Answer 27

Inward turning of the eyelids

Occur with age from degeneration of the id tissues

Question 28

What damage can occur with Entropion?

How is Entropion treated?

Answer 28

Rubbing of eyelashes can damage the surface

Treatment is lubrication

Question 29

What is Ectropion?

Answer 29

Outward turning of the eyelids (especially in the lower lid)

Question 30

How is Ectropion treated?

Answer 30

Surgery if excessive tearing or exposure keratitis

Question 31

What is Pingueculum?

Who is it common in and how is it treated?

Answer 31

Yellow elevated nodule located on the nasal side of the conjunctiva

Common in people over 35 and does not need treatment

Question 32

What is Pterygium

Answer 32

Fleshy triangular growth of the conjunctiva that can spread into the cornea or visual axis

Question 33

How is Pterygium caused?

How is it treated?

Answer 33

Wind, sun and dust exposure

Removal