eyes2 Flashcards
what is blepharitis
inflammation of eyelid margins and eyelids
common
often chronic
what are the 2 types of blepharitis
seborrheic- nonulcerative
ulcerative
seborrheic blepharitis characteristics
- erythematous eyelid margins
- dry flakes, oily secretions
- cosmetics and chemicals aggrevate condition
ulcerative blepharitis chracteristics
- Acute/chronic inflammation of glands of lid margins
- Staph aureus and epidermis are causative -mild ulcerations of lid margin
- Loss of lashes or broken lashes
blepharitis hx
Gritty, burning sensation Crusted material on eyelids in a.m. Redness Swelling of lid margins Irritation and itching common Dry or greasy scales on lashes Mild conjunctival irritation and erythema
blepharitis PE
Erythematous eyelid margins Scaly lesions on lashes sclera – white Conjunctivae – usually clear Masses on lids/lid margins (palpate with gloves) Preauricular adenopathy Visual acuity (no change) No diagnostics indicated
blepharitis differential dx
- Conjunctivitis
- Chronic chalazia
- Sebaceous cell carcinoma –rare
- Lice infestation
blepharitis management/tx
Warm water compresses
Eyelid margin scrubs 2-4 x daily (follow with lid massage)
Antibiotic ointment qid to lid margins for 7 days (e-mycin, sulfacetamide sodium)
Doxycycline 100mg bid x 6 weeks for severe infection
Treat co-existing seborrhea of face/scalp with selenium sulfide shampoo
Good hygiene
conjunctivitis is what
inflammation of conjunctiva
aka red eye or pink eye
most common eye disease in primary care- usually self limiting disorder
conjunctivitis etiology
- bacterial
- viral
- allergic
- chlamydia/ trachoma
- other
bacterial conjunctivitis causes
– Staphylococcus aureus – Streptococcus pneumoniae – Haemophilus influenzae – Pseudomonas ( common in contact wearers) – Neisseria gonorrhoeae
viral conjunctivitis causes
– Adenovirus – most common
• Adenopharyngeal conjunctivitis – “swimming pool”
– Herpes simplex
– Herpes zoster
allergic conjunctivitis causes
- environmental- sesasonal
- cosmetics
other causes of conjunctivitis
- trauma
- contact lens wearer- more susceptible than most
- foreign body
- drug induced- silver nitrate, erythromycin, thimerosal
- systemic illness
conjunctivitis mode of transmission
direct contact with contagion or allergen
Contaminated contact lens solution
Mascara/eyeliner, makeup
Exposure to chemical substance
Conjunctivitis History
Mild to moderate redness and irritation
No acute change in visual acuity
Absence of photophobia
Mild discomfort/pain – associated with itching, burning or excessive tearing
Watery to purulent discharge
what is a red flag in conjunctivitis hx
changes in vision
conjunctivitis dx tests and findings
Usually none
Immunofluorescence test for suspected herpes simplex or chlamydia
Culture – only if chronic or if GC suspected
Gram stain – only if GC suspected
conjunctivitis differential dx
Urgent ophthalmic conditions – refer Acute uveitis/iritis Acute glaucoma Corneal abrasion Foreign body
bacterial conjunctivitis presentation
- Mucopurulent discharge
- Thick purulent crust in a.m.
- Unilateral initially
bacterial conjunctivitis tx
• Self-limiting – 10-14 days without treatment, 2-4 with treatment
– E-mycin ointment – thin layer in lower lid qid x5-7d
– Tobramycin 0.3% or gentamycin 0.3% op. solution 1-2 drops qid x7d
– Sodium sulfacetamide 10% ophthalmic solution – 1-2 drops q 4hours or qid x5-7 days
– Ciprofloxacin 1-2 drops q 2-4 hours x 2 days; then 1-2 drops q 4 hours x 5 days
when to refer to ophthalmologist with bacterial conjunctivitis
- herpes
- ulcerations
- hemorrhagic conjunctivitis
Chlamydia Conjunctivitis Management/Treatment
Doxycycline 100mg orally bid x 14 days or Azithromycin 1Gm x1 dose
AND
Erythromycin ointment
Viral Conjunctivitis Management/Treatment
Self-limiting
Topical antibiotics – to prevent secondary bacterial infection
Corticosteroids contraindicated
Allergic Conjunctivitis Management/Treatment
Topical vasoconstrictors/antihistamines
Naphazoline HCL/pheniramine maleate (Naphcon-A) – 1-2 drops qid
Oral antihistamines
Allergen avoidance
Topical antihistamine mast cell stabilizer
Azelastine (Optivar) 0.05% 1drop bid
Olopatadine (Patanol) 0.1% 1 drop bid
NSAID-ophthalmic (for ocular pruritis) – ketorolac tromethamine (Toradol) 0.5% - 1drop qid
Conjunctivitis Patient Education/Prevention
- Cool/warm compresses
- Frequent gentle eye wash to remove discharge
- Artificial tears
- Strict hand washing
- Use separate towels; avoid handshaking
- Contact lens care – clean or change; new solution, avoid tap water solutions
- Avoid eye cosmetics during infection (discard contaminated make-up )– change products frequently
- Refer if no improvement in 48 hours or if vision is impaired
