Eyelids and Anterior Segment Flashcards
- cold compress
- antihistamine drops
- oral antihistamines
Best treatments for allergic conjunctivitis
Chronic, intermittent inflammation of eyelids
Blepharitis
What are possible causes of blepharitis? (Anterior and Posterior)
- Anterior: infectious (S. Aureus) or seborrheic (dandruff from scalp/eyebrows)
- Posterior: meibomian gland dysfunction
- Red eyes
- gritty FB sensation
- burning sensation
- tearing
- crusty lashes
- photophobia
- +/- blurry vision
Clinical presentation of Blepharitis
- diffuse conjunctival injection
- inflamed/red eyelid margins
- Crusting/matting of lashes
- plugged glands
- collarettes (ring in iris)
PE findings for Blepharitis
- warm compress
- lid massage
- lid hygiene (baby shampoo)
- topical Abx (erythromycin)
- oral Abx if severe
- Omega 3 (prevention)
Tx for Blepharitis
What are the 2 types of blepharitis and how do they present?
- chalazion/stye (painless, rubbery, nodular)
- hordeolum (painful, infected, purulent)
Infection of soft tissue around eye (more common) (does NOT extend into orbit or globe)
Periorbital Cellulitis
What are 2 causes of periorbital cellulitis
- external sources (blepharitis, insect bites, FB)
- sometimes sinusitis
- eye pain
- swelling
- erythema
- (NO fever, vision change, or pain with eye movement)
Presentation of Periorbital Cellulitis
What 2 things are absent on PE for periorbital cellulitis?
- proptosis
- ophthalmoplegia
How should you work periorbital cellulitis up if you are unsure what it is. Order which 4 things?
-Treat like orbital cellulitis! (CBC, blood cultures, culture of discharge, CT orbit/sinus)
How do you treat periorbital cellulitis
- 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
Infection of fat and muscle surrounding globe (does NOT involve globe)
Oribtal Cellulitis
Usually caused by extension of infection from paranasal sinuses (ethmoid)
Orbital Cellulitis
- eye pain
- eyelid swelling/erythema
- *vision changes
- *fever
- *pain with eye movement
Presentation of Orbital Cellulitis
What will you see on orbital cellulitis PE
- *proptosis
- *ophthalmoplegia
- conjunctivitis
- +/- discharge
How do you work up orbital cellulitis?
- CBC
- blood culture
- culture of discharge
- CT orbit/sinuses
- hospitalize and consult ophtho
- Immediate IV broad spectrum abx (vanco+ceftriaxone) until cultures come back
- surgical drainage if abscess forms
Tx of Orbital Cellulitis
Why do you start IV abx immediately in orbital cellulitis?
- Prevent optic nerve damage
- Prevent spread of infection to cavernous sinus, meninges, and brain
Where is the macula located in respect to the optic disc?
macula is temporal to the optic disc
What is conjunctivitis?
inflammation of conjunctiva (white) most commonly due to viral infection (can also be caused by bacteria, allergies, chemical)
How do you transmit conjunctivitis?
direct contact
Most common cause of viral conjunctivitis
Adenovirus
- pharyngitis
- fever
- malaise
- watery dishcarge
- periauricular adenopathy
Viral Conjunctivitis
How do you treat viral conjunctivitis?
Cold compress for discomfort
What 3 organisms commonly cause bacterial conjunctivitis
- S. pneumo
- H. influenza
- Pseudomonas
- copious discharge
- eyes matted shut in morning
Bacterial Conjunctivitis
How do you treat bacterial conjunctivitis?
- erythromycin ointment
- fluoroquinolone drops (floxacin)
- Bilateral
- (seasonal)
- itchiness
- conjunctival erythema
- chemosis (swelling)
Allergic Conjunctivitis
How do you treat allergic conjunctivitis? 3 things
- cold compress
- oral antihistamine
- topical antihistamine drops
Infection of lacrimal sac secondary to nasolacrimal duct obstruction
-more common in children
Dacryocystitis
How do you treat Dacryocystitis
- aggressive abx (clindamycin, IV vanco)
- surgery (NLD probing)
- Inward turning of eyelids (especially lower lid)
- Occurs with lid tissue degeneration from aging
- Occurs w/ childhood facial structure (native americans)
Entropion
Tx for entropion? How can damage occur?
- Lubrication
- Lashes rubbing surface of eye
- Outward turning of eyelids (lower)
- due to lid degeneration w/ aging
Ectropion
How do you treat ectropion?
Surgery may be required if excess tearing or exposure keratitis (corneal inflammation) occurs
- Yellow, elevated nodule (usually on nasal side of conjunctiva)
- Common in 35+ y/o
- Rarely grow
- Do not require treatment
Pingueculum
- Fleshy, triangular growth of conjunctiva that typically spread
- May compromise cornea and visual axis
Pterygium
What 3 things cause pterygium?
wind, sun, dust exposure
How do you treat pterygium?
- artificial tears
- anti-inflammatory meds
- excision (if severe/endangering vision)
