Eyes (chalazion, hordeolum, conjunctivitis, subconjunctival hemorrhage, corneal abrasion) Flashcards
Eyes
Chalazion vs hordeolum/stye
What is it
Age
Pathogen
What is it:
Chalazion: chronic inflammation of meibomian gland
Hordeolum: infection of meibomian gland or eyelash follicle (eyelid folliculitis!)
Age:
Chalazion: 30-50’s
Hordeolum: children/teens
Pathogen:
Chalazion: none
Hordeolum: staph aureus
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patho, risk factors & S/S for hordeolum (stye)
Risk factors:
recurrent blepharitis, seborrheic dermatitis, rosacea, diabetes, hyperlipidemia
Patho:
infection/abscess
S/S:
red, painful/tender lump
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patho, risk factors & S/S for chalazion
Risk factors:
increased androgen/sebaceous gland secretion
Patho:
Localized inflammation/abscess (sterile) from occlusion of gland ducts
S/S:
non-tender, rubbery nodule (no redness)
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S/S preseptal cellulitis vs orbital cellulitis
preseptal/periorbital cellulitis:
eye pain/tenderness, periorbital redness & swelling
orbital cellulitis:
above +
pain w/ EOM
can also have chemosis, fever, dipoplia, vision loss, EOM palsy…
Afferent pupillary defect (swinging light test) = impending visual loss!!
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What is blepharitis?
Inflamed flaky greasy eyelid margin… no nodule/abscess/localized inflammation
fun fact: linked w/ oral retinoid use!
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Tx & follow-up for chalazion
Warm, moist compress QID
If large and infected, f/u in 1 week… if does not resolve refer to opth (I&D)
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Tx & follow-up for hordeolum (stye)
warm compress QID
treat underlying condition
hygiene (wash hands before touching eyes, change eye make-up Q6 weeks etc)
F/U in 48 hours
Refer to ophtho if not responding to warm compresses within 1-2 weeks
Refer to ER if cellulitis
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Corneal abrasion
What is it
Age
Sex
defect in corneal epithelium
20-29
M>F
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Corneal abrasion red flags
penetrating trauma (metal!!!) large nonreactive/irregular pupil hyphema hypopyon visual disturbance ciliary flush with ring-like appearance around iris (iritis!)
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Hx for corneal abrasion
- visual changes (blurred, diplopia, field of vision)
- mechanism of injury
- work? Sports? Hobbies?
- eye protection
- degree of pain, headache, photophobia, redness, itching
- contact lens use: sleeping in contacts? Poor hygiene?
- timing: recurrent corneal erosions will wake up middle of the night with pain or have pain first this in AM when trying to open eyes
- Td immunization
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Exam for corneal abrasion
- visual acuity (before floresceine/tetracaine)** if abnormal ?? penetrating trauma
- penlight exam (swinging)
- corneal surface (look for shadow on surface of iris)
- fundoscopy (confirm red reflex)
- always evert eyelid to look for FB
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Pertinent positive and negative findings for corneal abrasion
normal anterior chamber contour round small reactive pupil mild conjunctival injection or ciliary flush no discharge FB sensation sudden onset eye pain no infiltrate/corneal opacity no hyphema or hypopyon
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ddx for corneal abrasion
- acute angle glaucoma
- HSV infection (will have ↓ corneal sensation)
- recurrent corneal ulceration
- ulcerative keratitis
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Tx and f/u for corneal abrasion
Foreign body removal:
- irrigation after instilling topical anesthetic
- try to remove with swab
- if unable to remove, will need to refer to ophtho to remove FB within 24 hours
- in meantime do topical antibiotic ointment QID and no patch
Patching NOT needed for uncomplicated small abrasions, contraindicated with recent contact lens wear
Deep abrasions will need patch to prevent lid motion for 24-48 hours
No contact lens until healed
Topical abx
F/U in 24 hours àcornea usually heals overnight within 24-48 hours àcontinue rx ointment for 4+ days to help with healing
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referral for corneal abrasion
if large/central lesions, corneal opacity or ulceration, hypopyon, hyphema, irregular pupil or deep/penetrating wounds or open globe
Refer ophtho if still symptomatic in 48 hours
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If contact lens-wearer, what pathogen do you need to cover for and with what topical abx gtts? (conjunctivitis/corneal abrasion)
pseudomonas (anaerobic)
treat with fluoroquinolone (cipro) first choice/ aminoglycoside (tobramycin, gentamycin)
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If not contact lens wearer what are first-line topical opth abx gtts? (conjunctivitis/corneal abrasion)
Erythromycin 0.5%, Sulfacetamide 10% ointment, Trimethoprim-polymyxin B drops
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What is a subconjunctival hemorrhage + risk factors
blood patches on conjunctiva
risks:
HTN, clotting disorders, emesis, acute conjunctivitis
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Red flag for subconjunctival hemorrhage
bullous elevation of conjunctiva
ocular pain, visual disturbance, etc
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ddx for subconjunctival hemorrhage
Conjunctivitis Hyphema Blood dyscrasias Trauma to eye HTN
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common pathogens for bacterial conjunctivitis
Acute:
H. influenzae, S. pneumoniae, S. aurea,
* think skin & resp
Hyperacute:
N. gonorrhoeae, and Chlamydia.
Contact lens:
Pseudomonas aeruginosa
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common pathogens for viral conjunctivitis
Adenovirus, coxsackievirus, and enteric cytopathic human orphan (ECHO)
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most common type of conjunctivitis
viral 80%
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S/S bacterial conjunctivitis
Purulent discharge Crusted in morning No corneal involvement Diffuse Erythema, Unilateral or bilateral Involvement of tarsal conjunctiva
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S/S viral conjunctivitis
Systematic signs and symptoms: sore throat, bilateral lymphadenopathy (CTC), fever (UTD)
Burny/sandy feeling (UTD)
Bilateral involvement within 24-48 hours (UTD), diffuse erythema
Watery discharge +/- mucus (UTD)
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S/S allergic conjunctivitis
Watery/clear mucoid discharge Pruritis Bilateral diffuse erythema No corneal involvement Systemic allergy symptoms: sneezing, rhinorrhea, wheezing, history of allergies (UTD)
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Most common age for conjunctivitis
Viral: adenovirus (20-40)
HSV/varicella (infants/peds)
bacterial: 3 mo to 8 years
allergic: any age
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What type of hypersensitivity rxn is allergic conjunctivitis?!
Type 1! IgE mediated (mast cells… histamine, eosinophils, etc)
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Conjunctivitis time course
Bacterial: 7-10 days (or 2-4 days w/ tx). Refer if not resolved in 2 weeks.
Viral: 5-7 days. Refer if not resolved in 3 weeks.
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conjunctivitis red flags
Pupil abnormalities Painful eye Blurred vision Headache Vomiting Coloured halos Trauma (CTC) Ciliary flush (UTD) Photophobia
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ddx conjunctivitis
tarsal conjunctiva is spared: keratitis, iritis, and angle-closure glaucoma (UTD)
Dry eye syndrome
blepharitis
viral/allergic/bacterial/hyperacute
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bacterial conjunctivitis return to school/work
24 hours of abx therapy prior to returning or resolution of eye discharge
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non-pharm tx conjunctivitis
Cold compress
Hand hygiene
Not sharing
Stop wearing contacts until resolved
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viral conjunctivitis pharm tx
carboxymethycellulose (refresh tears)… or Refresh Plus (no preservative)
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Allergic conjunctivitis pharm
tetrahydrozoline (visine)
antihistamine/mast cell stabilizer
alpha adrenergic receptors, reducing ocular congestion and redness
no more than 3 weeks
precaution w/ HTN, glaucoma, hyperthyroid, T2DM (may cause IOP)
bepotastine besilate (bepreve)
antaganizes H1, inhibit histamine release from mast cells
topical opth gtts antihistamines, mast cell stabilizer
use for no more than 3 weeks
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tx for bacterial conjunctivitis
refer hyperacute!
acute:
erythromycin/trim-polymyxinB/gramcidin-polymyxinB
