Eyelids and Anterior Segment

Question 1

• cold compress
• antihistamine drops
• oral antihistamines

Answer 1

Best treatments for allergic conjunctivitis

Question 2

Chronic, intermittent inflammation of eyelids

Answer 2

Blepharitis

Question 3

What are possible causes of blepharitis? (Anterior and Posterior)

Answer 3

• Anterior: infectious (S. Aureus) or seborrheic (dandruff from scalp/eyebrows)
• Posterior: meibomian gland dysfunction

Question 4

• Red eyes
• gritty FB sensation
• burning sensation
• tearing
• crusty lashes
• photophobia
• +/- blurry vision

Answer 4

Clinical presentation of Blepharitis

Question 5

• diffuse conjunctival injection
• inflamed/red eyelid margins
• Crusting/matting of lashes
• plugged glands
• collarettes (ring in iris)

Answer 5

PE findings for Blepharitis

Question 6

• warm compress
• lid massage
• lid hygiene (baby shampoo)
• topical Abx (erythromycin)
• oral Abx if severe
• Omega 3 (prevention)

Answer 6

Tx for Blepharitis

Question 7

What are the 2 types of blepharitis and how do they present?

Answer 7

1. chalazion/stye (painless, rubbery, nodular)
2. hordeolum (painful, infected, purulent)

Question 8

Infection of soft tissue around eye (more common) (does NOT extend into orbit or globe)

Answer 8

Periorbital Cellulitis

Question 9

What are 2 causes of periorbital cellulitis

Answer 9

• external sources (blepharitis, insect bites, FB)
• sometimes sinusitis

Question 10

• eye pain
• swelling
• erythema
• (NO fever, vision change, or pain with eye movement)

Answer 10

Presentation of Periorbital Cellulitis

Question 11

What 2 things are absent on PE for periorbital cellulitis?

Answer 11

1. proptosis
2. ophthalmoplegia

Question 12

How should you work periorbital cellulitis up if you are unsure what it is. Order which 4 things?

Answer 12

-Treat like orbital cellulitis! (CBC, blood cultures, culture of discharge, CT orbit/sinus)

Question 13

How do you treat periorbital cellulitis

Answer 13

• Outpatient: empiric abx (cover S. aureus, S. pneumo, MRSA)
• MRSA not suspected: Augmentin
• Suspected MRSA: oral Bactrim or Clinda PLUS Amoxicillin, Augmentin, Cefdinir, or Cefpodoxime

Question 14

Infection of fat and muscle surrounding globe (does NOT involve globe)

Answer 14

Oribtal Cellulitis

Question 15

Usually caused by extension of infection from paranasal sinuses (ethmoid)

Answer 15

Orbital Cellulitis

Question 16

• eye pain
• eyelid swelling/erythema
• *vision changes
• *fever
• *pain with eye movement

Answer 16

Presentation of Orbital Cellulitis

Question 17

What will you see on orbital cellulitis PE

Answer 17

• *proptosis
• *ophthalmoplegia
• conjunctivitis
• +/- discharge

Question 18

How do you work up orbital cellulitis?

Answer 18

• CBC
• blood culture
• culture of discharge
• CT orbit/sinuses

Question 19

• hospitalize and consult ophtho
• Immediate IV broad spectrum abx (vanco+ceftriaxone) until cultures come back
• surgical drainage if abscess forms

Answer 19

Tx of Orbital Cellulitis

Question 20

Why do you start IV abx immediately in orbital cellulitis?

Answer 20

• Prevent optic nerve damage
• Prevent spread of infection to cavernous sinus, meninges, and brain

Question 21

Where is the macula located in respect to the optic disc?

Answer 21

macula is temporal to the optic disc

Question 22

What is conjunctivitis?

Answer 22

inflammation of conjunctiva (white) most commonly due to viral infection (can also be caused by bacteria, allergies, chemical)

Question 23

How do you transmit conjunctivitis?

Answer 23

direct contact

Question 24

Most common cause of viral conjunctivitis

Answer 24

Adenovirus

Question 25

* pharyngitis * fever * malaise * watery dishcarge * periauricular adenopathy

Answer 25

Viral Conjunctivitis

Question 26

How do you treat viral conjunctivitis?

Answer 26

Cold compress for discomfort

Question 27

What 3 organisms commonly cause **bacterial conjunctivitis**

Answer 27

* S. pneumo * H. influenza * Pseudomonas

Question 28

* copious discharge * eyes matted shut in morning

Answer 28

Bacterial Conjunctivitis

Question 29

How do you treat bacterial conjunctivitis?

Answer 29

* erythromycin ointment * fluoroquinolone drops (floxacin)

Question 30

* Bilateral * (seasonal) * itchiness * conjunctival erythema * chemosis (swelling)

Answer 30

Allergic Conjunctivitis

Question 31

How do you treat allergic conjunctivitis? 3 things

Answer 31

* cold compress * oral antihistamine * topical antihistamine drops

Question 32

Infection of lacrimal sac secondary to nasolacrimal duct obstruction ## Footnote *-more common in children*

Answer 32

Dacryocystitis

Question 33

How do you treat Dacryocystitis

Answer 33

* aggressive abx (clindamycin, IV vanco) * surgery (NLD probing)

Question 34

* Inward turning of eyelids (especially lower lid) * Occurs with lid tissue degeneration from aging * Occurs w/ childhood facial structure (native americans)

Answer 34

Entropion

Question 35

Tx for entropion? How can damage occur?

Answer 35

* Lubrication * Lashes rubbing surface of eye

Question 36

* Outward turning of eyelids (lower) * due to lid degeneration w/ aging

Answer 36

Ectropion

Question 37

How do you treat ectropion?

Answer 37

Surgery may be required if excess tearing or exposure keratitis (corneal inflammation) occurs

Question 38

* Yellow, elevated nodule (usually on nasal side of conjunctiva) * Common in 35+ y/o * Rarely grow * Do not require treatment

Answer 38

Pingueculum

Question 39

* Fleshy, triangular growth of conjunctiva that typically spread * May compromise cornea and visual axis

Answer 39

Pterygium

Question 40

What 3 things cause pterygium?

Answer 40

wind, sun, dust exposure

Question 41

How do you treat pterygium?

Answer 41

* artificial tears * anti-inflammatory meds * excision (if severe/endangering vision)