Eyelids & Anterior Segment Flashcards
3 most important things to check when doing an eye exam?
Vision
pupils
tonometry
What is Blepharitis?
chronic condition
inflammation of the eyelids w/ intermittent exacerbations
Anterior blepharitis is caused by? (2)
infectious (S. aureus)
or
seborrheic component
Posterior blepharitis is caused by?
meibomian gland dysfunction
Clinical presentation of Blepharitis?
red eyes gritty/foreign body sensation burning excessive tearing crustiness in lashes light sensitivity \+/- blurry vision
What might you see in a PE in a pt with Blepharitis?
diffuse conjunctival injection eyelid magins=inflamed and red crusting or matting of lashes plugged glands w/ magnification Collarettes (flakes on eyelashes)`
Tx of Blepharitis
warm compress lid massage lid hygiene topical abx (erythromycin ointment) oral abx in severe cases
describe Chalazion vs Hordeolum
Chalazion- painless, rubbery, nodular
Hordeolum- painful, infected, purulent
Does periorbital cellulitis extend into the orbit?
No!
it is an infection of soft tissue AROUND the eye
What types of tissue does orbital cellulitis involve?
the fat and muscle tissue surrounding the globe
Do either periorbital or orbital cellulitis involve the globe?
NAHHH
Is periorbital or orbital cellulitis more common? Who gets it the most?
periorbital
childrens
What causes periorbital cellulitis?
external sources (blepharitis, insect bites, FB), sometimes sinusitis
Most common cause of orbital cellulitis?
An extension of infection from the paranasal sinuses (ethmoid sinuses)
What might you see on clinical presentation of a patient with periorbital cellulitis?
Eye pain
eyelide swelling/erythema
(No vision change, fever, or pain with eye movement)
What might you see on clinical presentation of a patient with orbital cellulitis?
eye pain eyelid swelling/erythema vision changes (possible diplopia) fever pain with eye movement
What might you see on PE of a patient with orbital cellulitis that you would not see in pt with periorbital cellulitis?
Proptosis
Ophthalmoplegia (paralysis of the muscles within or surrounding the eye)
You would also see:
conjunctivitis
+/- discharge
If in doubt if periorbital vs orbital cellulitis what should you treat it as?
ORBITAL!
Tx of periorbital cellulitis (outpt or hospital)
outpatient
What pathogens do you need to cover with empiric tx of periorbital cellulitis?
S. aureus
S. pneumoniae
MRSA
Abx for periorbital cellulitis for non MRSA? MRSA?
Non MRSA:
oral clindamycin or amocicillin-clavulanic acid
MRSA:
oral trimethoprim-sulfamethoxazole (Bactrim)
PLUS either:
Amoxicillin, Amoxicillin-Clavulanic acid, Cefdinir, Cefpodoxime
Tx of orbital cellulitis:
outpatient vs inpatient?
Abx?
Hospitalization w/ ophthalmologist consult
start IV abx immediately
(broad spectrum- vancomycin + ceftriaxone)
Surgical drainage is abscess formation
What is the most common eye disease?
Conjunctivitis
what is conjunctivitis? What is it caused by?
inflammation of the white of the eye
Viral infection is most common (others= bacterial, allergies, chemical)
How is conjunctivitis spread?
Direct contact
Most common cause of viral conjunctivitis?
Adenovirus
Usual symptoms of viral conjunctivitis?
bilateral pharyngitis fever malaise watery discharge preauricular adenopathy
How do you treat viral conjunctivitis?
Give cold compress for discomfort
It’s viral- obvi NOT with abx
Most common cause organisms in bacterial conjunctivitis? (3)
S. pneumoniae
H. influenzae
Pseudomonas
Characteristic findings in bacterial conjunctivitis
unilateral
Copious dischage
“eye matted shut” in the morning
Tx for bacterial conjunctivitis
Abx eye drops or ointment
- Erythromycin ointment
- Fluoroquinolone drops
Is allergic conjunctivitis usually unilateral or bilateral?
Bilateral
Characteristics of Allergic conjunctivitis
chronic (seasonal)
itchiness
conjunctival injection
swelling (chemosis)
Tx of allergic conjunctivitis
cold compress
oral antihistamines
drops
What do you want to educate your patient about in regards to conjunctivitis?
handwashing
no sharing eye drops
throw away eye makeup
What is dacryocystitis and who is it more common in?
infection in the lacrimal sac, usually 2/2 a nasolacrimal duct obstruction
children
Tx of Dacrocystitis
agressive abx (clindamycin, IV vancomycin) may require surgery
What is entropion vs ectropion?
Entropion- inward turning of eyelids (especially lower lid)
Ectropion- outward turning of the eyelids (especially the lower lid)
Cause of entropion vs ectropion
Entropion- may occur w/ age as result of degeneration of lid tissue, or due to childhood facial structure
ectropion- may occur w/ age as result of degeneration of tissue
How do you treat entropion?
lubrication
because damage may occur w/ rubbing of lashes on eye
How do you treat ectropion?
May require surgery of excessive tearing or exposure keratitis
Describe a pingueculum (shape, color, nasal or temporal side)
yellow
elevated nodule
mostly on the nasal side
What age are pingueculums most common and what is the treatment?
over age 35
trick question:
they rarely grow, don’t require treatment
Describe pterygiums (color, shape, complications)
fleshy
triangular
growth of the conjunctiva that typically spreads and may threaten cornea and visual axis
What are pterygiums caused by?
associated with wind, sun, dust exposure
Tx of pterygium
artificial tears, anti-inflammatories may be helpful
pingueculum vs pterygium, which one is serious?!
Pterygium!!
