Eyelids and Anterior Segment Flashcards
What are the best treatments for Allergic Conjuctivitis
- Antihistamines drops
- Oral antihistamines
- Cold compression
What is Blepharitis
Chronic inflammation of the eye lids with intermittent exacerbations
What are clinical presentations of Blepharitis
Red eyes Gritty body sensations Crustiness in the lashes Burning Excessive tearing Light sensitive and blurry vision
What would you see on a physical exam with Blepharitis
- Conjunctival injection
- Eyelid margins are red and inflamed
- Crusting of eyelashes
- Collarettes
Treatment for Blepharitis
- Warm compressions
- Eye lids massage
- Lid hygiene
- Topical antibiotics (erythromycin ointments)
Chalazion/Hordeolum is associated with what?
How does it present
Blepharitis
Meibomian gland is swelled up due to back up of fluid in the eyelids
How does Anterior and Posterior Blepharitis differ?
Anterior stems from an infection (S. aureus) or seborrheic component
Posterior stems from meibomian gland dysfunction
Periorbital cellulitis vs Orbital cellulitis Etiologies
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
Periorbital cellulitis is most common in who
Children and more common than orbital cellulitis
Etiology of Periorbital cellulitis
External sources (bug bites, blepharitis, sinusitis)
Etiology of Orbital cellulitis
Caused by an extension of infection from paranasal sinuses (ethmoid sinus)
What does Periorbital cellulitis present like?
- Eye pain
- Eye lid swelling and erythema (reddening)
- No vision changes
- No fever
- No pain with eye movements
How is Orbital cellulitis clinically presented
- Eye pain
- Eyelid swelling and erthema
- Vision changes (+)
- Pain with eye movements
How does Periorbital and Orbital cellulitis differ on a physical exam?
Periorbital
- No proptosis (displacement of the eye)
- No ophthalmoplegia (paralysis of the eye muscles)
Orbital
- Has proptosis
- Has ophthalmoplegia
- Conjunctivitis
What workup is needed to diagnose Periorbital or Orbital cellulitis?
CBC Blood culture (infection) Culture of any discharge
CT scan of the orbits and surrounding sinuses
Treatments for Periorbital cellulitis
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
Treatment of Orbital Cellulitis
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
What is Conjunctivitis? What is the most common cause
Inflammation of the white of the eye
Common cause is viral infection but other causes include bacterial infection, allergies and chemicals
Most common etiologic virus for conjunctivitis?
Adenovirus
Signs and symptoms for Viral conjunctivitis?
How are these relieved?
Pharyngitis Fever Malaise Watery discharge Preauricular adenopathy
Cold compresses
Most common pathogens for Bacterial conjunctivitis
S. pneumonia
H. influenzae
Pseudomonas
Common symptoms of Bacterial conjunctivitis
Discharge and eyes matted shut in the morning
Treatment for Bacterial conjunctivitis
Antibiotic drops/ointment
Erythromycin ointment
Fluoroquinolone drops
-Moxifloxacin
-Ciprofloxacin
How is allergic conjunctivitis presented and treated?
Bilateral redness
Itchiness
Conjunctival injection and swelling (chemosis)
Treatment: Cold compresses, oral antihistamines , drops
What is Dacryocystitis
-Infection of the lacrimal sac, secondary to a nasolacrimal duct obstruction
How is Dacryocystitis treated?
Treated with antibiotics (Clindamycin, IV vancomycin)
What is Entropion?
How is it caused?
Inward turning of the eyelids
Occur with age from degeneration of the id tissues
What damage can occur with Entropion?
How is Entropion treated?
Rubbing of eyelashes can damage the surface
Treatment is lubrication
What is Ectropion?
Outward turning of the eyelids (especially in the lower lid)
How is Ectropion treated?
Surgery if excessive tearing or exposure keratitis
What is Pingueculum?
Who is it common in and how is it treated?
Yellow elevated nodule located on the nasal side of the conjunctiva
Common in people over 35 and does not need treatment
What is Pterygium
Fleshy triangular growth of the conjunctiva that can spread into the cornea or visual axis
How is Pterygium caused?
How is it treated?
Wind, sun and dust exposure
Removal
