Eyelids: Part 1

Question 1

Name this condition:

acute bacterial (usually staph) infection of a lash follicle & its assoc. gland of Zeiss (sebaceous gland)/Moll (apocrine sweat glands)

Answer 1

external hordeolum

Question 2

signs & symptoms:
well-defined subcutaneous eyelid nodule

erythematous tender bump w/in the eyelid
—tender swelling in eyelid margin pointing anteriorly

Answer 2

external hordeolum

Question 3

what are treatments for external hordeolum?

Answer 3

warm compresses w/ lid massage 10 min QID

topical antibiotic ointment BID — if concern for 2° bacterial conjunctivitis
—bacitracin, erythromycin

doxycycline 100mg PO QD-BID to facilitate expression (in conjunction w/ compress)

f/u 2-4 weeks to ensure resolution

Question 4

Name this condition:

acute infection (usually staph) of the meibomian glands (secretes lipid portion of tear film)

Answer 4

internal hordeolum

Question 5

signs & symptoms:

• acutely presenting, erythematous tender bump w/in the eyelid
• elevation tends to point posteriorly
• presents more inferiorly compared to external hordeolum

Answer 5

internal hordeolum

Question 6

what are treatments for internal hordeolum?

Answer 6

1) warm compresses w/ lid massage 10 min QID
- topical antibiotic ointment BID (if concern for 2° bacterial conjunctivitis) such as bacitracin, erythromycin
2) doxycycline 100mg PO QD-BID to facilitate expression (in conjunction w/ compress)

f/u 2-4 weeks to ensure resolution

Question 7

name this condition:

• infection of lid tissues around orbit, often w/ local skin defect
• adjacent infection (eg, hordeolum, dacryocystitis)
• can be caused by trauma

Answer 7

preseptal cellulitis

Question 8

signs & symptoms:

• chronic, painless, firm pea-sized nodule
• sterile
• discrete mass within the lid present for 2+ weeks
• inflammation (sometimes)
• bulging, thick secretions may be visible at orifice of assoc. gland
• may be an assoc. conjunctival granuloma

Answer 8

chalazion

Question 9

what are treatments for chalazion?

Answer 9

warm compresses w/ lid massage 10 min QID
consider doxycycline 50mg PO daily (mainly for its anti-inflammatory properties)
if doesn’t resolve after 3-4 wks of medical therapy, refer to oculoplastics for possible

Question 10

name this condition:

posterior misdirection of lashes rubbing against the globe commonly from inflammation

Answer 10

trichiasis

Question 11

symptoms: eyelid/periorbital swelling
— history of sinusitis, skin abrasion, hordeolum, insect bite
— may present w/ a fever

signs: eyelid erythema (warmth, tenderness)
— tense edema
— no proptosis, no EOM restriction/pain, no conjunctival injection

what condition is this?

Answer 11

preseptal cellulitis

Question 12

what are treatments for preseptal cellulitis?

Answer 12

initiate oral antibiotics: trimethoprim/sulfamethoxazole
—kids — 12mg/kg/day divided q12h (every 12 hours)
—adults — 2 double-strength tabs (160 TMP/800SMX) q12h

• warm compresses w/ lid massage in conjunction w/ antibiotics
• daily f/u

Question 13

symptoms: eyelid/periorbital swelling
—red eye
—pain
—blurred vision
—double vision

signs: eyelid erythema (warmth, tenderness)
—conjunctival chemosis & injection
—proptosis
—EOM restriction
—if severe → may have signs of optic neuropathy (+APD, dyschromatopsia (color vision abnormality))

Answer 13

orbital cellulitis

Question 14

what is treatment for orbital cellulitis?

Answer 14

medical emergency → admit to hospital for IV antibiotics

Question 15

name this condition:

inflammatory response following exposure to irritant (usually eye drops or cosmetics)

Answer 15

contact dermatitis

Question 16

signs & symptoms:

• irritation, erythema, & edema
• itching & tearing following exposure
• lid edema, tightness
• chemosis (blister on conj.), papillary conjunctivitis
• punctate corneal epithelial erosions

Answer 16

contact dermatitis

Question 17

what is treatment for contact dermatitis?

Answer 17

-stop exposure to irritant
cool compresses (symptomatic relief)
non-preservative artificial tears

Question 18

signs & symptoms:

can lead to —

• punctate corneal epithelial erosions (PEE)
• ocular irritation that worsens w/ blinking

Answer 18

trichiasis

Question 19

what is treatment for trichiasis?

Answer 19

most common treatment:
—epilation w/ forceps q4-6 wks
—if punctate epithelial erosions: antibiotic ointment TID (bacitracin, erythromycin)

important to determine cause
—trauma, chronic blepharitis, herpes zoster ophthalmicus

make sure to differentiate b/w trichiasis vs. entropion (inward turning of eyelid margin)

Question 20

signs & symptoms:

• bilateral
• yellowish subcutaneous plaques*
• multiple
• usually in medial aspect of eyelids*

what condition is this?

Answer 20

xanthelasma

Question 21

what is treatment for xanthelasma?

Answer 21

• excision
• microdissection
• refer to PCP for cholesterol testing
• chemical peeling
• laser ablation/cryotherapy

Question 22

what can happen if external & internal hordeolum is untreated?

Answer 22

can progress into

• bacterial conjunctivitis
• preseptal cellulitis: infection involving eyelid & periorbital area → can lead to orbital cellulitis
• chalazion: focal inflammation

Question 23

for pts w/ multiple chalazia, what should you consider as treatment?

Answer 23

consider prophylaxis

adults — tetracyclines & kids — macrolides

Question 24

for pts w/ recurrent/atypical chalazia, what should you consider as treatment?

Answer 24

consider referral to oculoplastics for biopsy/removal

—recurrent chalazia can be a sign of carcinoma or ocular rosacea