Infection & inflammation of eye & surrounding

Question 1

What is an entropion?

Answer 1

Inversion of eyelid margin

Question 2

What are the Sx of an entropion?

Answer 2

Ocular irritation
Blepharospasm
Tearing
Redness & FB sensation

Question 3

What are the causes of an entropion?

Answer 3

Involution
Cicatricial
Secondary to ocular irritation: infectious, inflammatory, traumatic

Question 4

How is an entropion treated?

Answer 4

Lubricating drops
Botox injections
Surgical correction
Taping can provide temporary relief

Question 5

What is an ectropion?

Answer 5

Eversion of eyelid margin

Conjunctival & corneal exposure lead to irritation

Question 6

What are the causes of an ectropion?

Answer 6

Involuted: Age-related
Paralytic: CN VII palsy
Mechanical: Tumour
Congenital

Question 7

How does an ectropion appear?

Answer 7

Asymptomatic
Itchy
Irritated 
Red & watery
May complain of dry eye

Question 8

How is an ectropion treated?

Answer 8

Lubricating drops- artificial tears

Surgery: Only corrective measure

Question 9

What is the most common cause of a watery eye in infants?

Answer 9

Nasolacrimal duct obstruction

Question 10

How is nasolacrimal duct obstruction treated?

Answer 10

Lacrimal duct massage

Sx tend to resolve in 1yr

Question 11

What is a chalazion?

Answer 11

AKA Meibomian cyst
Blocked meibomian gland
Normally secretes sebum to hydrate eye
Leads to granulomatous inflammation in eyelid

Question 12

How common are meibomian cysts?

Answer 12

Most common lid lump

Question 13

What is a hordeolum?

Answer 13

AKA Stye
OR
Infective abscess

Question 14

What are the types of stye?

Answer 14

Internal: Meibomian gland infected leads to abscess
External: Acute infection of lash follicle

Question 15

What are the risk factors for a stye?

Answer 15

Chronic blepharitis
Rosacea
Seborrhoeic dermatitis
Pregnancy
DM

Question 16

How does a chalazion present?

Answer 16

Gradually enlarging round firm lesion
UPPER eyelid
2-8mm diameter
Multiple or single
Painful initially- MOSTLY non-tender
YELLOW
IMMOBILE when lid inverted

Question 17

How long does a chalazion take to reabsorb?

Answer 17

2-8w

Absorbs through inner eyelid

Question 18

How does a stye present?

Answer 18

Yellow, Tender swelling
Gradually enlarging
Tender on palpation
At base of eyelashes
Discharges anteriorly
May develop: Fevers/rigors

Question 19

When should a lump be referred to an ophthalmologist?

Answer 19

Visual disturbances

Associated w/cellulitis

Question 20

How is a meibomian cyst be treated?

Answer 20

1) Warm compress: BD massage lids
2) Resection under LA if refractory
3) Triamicinolone injection
Persistent: Doxycycline 50mg OD

Question 21

How is a stye treated?

Answer 21

1) Warm compress
2) TOP Choramphenicol
3) Curetting
Cellulitis: Flucloxacillin

Question 22

What is conjunctivitis?

Answer 22

Inflammation of the conjunctivitis

Question 23

What are the causes of conjunctivitis?

Answer 23

Infectious: Adenovirus 80%, staph

Non-infectious: Allergic, mechanical, immune-mediated, neoplastic, irritative

Question 24

How does conjunctivitis present?

Answer 24

Red eye
Irritation
Grittiness
Discomfort
Discharge
Sticky eye lids

Question 25

What can the consistency of eye discharge tell you about the type of conjunctivitis?

Answer 25

Viral: Watery/serous Allergic: Mucoid/string Bacterial: Sticky/purulent

Question 26

When does conjunctivitis warrant a referral to ophthalmology?

Answer 26

Severe purulent discharge Follicular Neonatal (Safe-guarding) Refractory to conventional Tx

Question 27

How is viral conjunctivitis treated?

Answer 27

Self-limiting: 1-2w Symptomatic relief TOP artificial tears + antihistamines

Question 28

How is bacterial conjunctivitis treated?

Answer 28

TOP Chloramphenicol 0.5% 4-6hrs OR Fusidic acid drops 1w

Question 29

How is allergic conjunctivitis treated?

Answer 29

Cold press | TOP antihistamines

Question 30

How does episcleritis present?

Answer 30

Red eye associated with tearing & photophobia | Engorged episcleral vessels extending radially

Question 31

How is episcleritis treated?

Answer 31

Spont resolves Usually lasts 7-10days NSAIDs Artificial tears

Question 32

What is episcleritis & what are the types?

Answer 32

Episcleritis involves inflammation of the episclera. SIMPLE: Vascular congestion on even surface NODULAR: Discrete elevated area of inflamed episclera.

Question 33

What conditions can episcleritis be associated with?

Answer 33

UC & Crohn's | CT disorders

Question 34

What is scleritis?

Answer 34

Severe inflammation that occurs throughout the entire thickness of the sclera.

Question 35

How is scleritis categorised?

Answer 35

98% ANTERIOR: Diffuse, Nodular, Necrotising (Sklerokeratitis) POSTERIOR: See lid oedema & proptosis

Question 36

What conditions is scleritis usually associated with?

Answer 36

RA Granulomatosis CT disease- may be 1st Sx Other: Gout, Churg-Strauss, Syphilis

Question 37

How does scleritis present?

Answer 37

``` Sudden Boring eye pain can radiate to forehead, worse at night & w/eye movements Watering Local or diffuse redness Photophobia Gradual ↓vision ```

Question 38

Should scleritis be investigated?

Answer 38

YES- assume underlying cause until proven otherwise | RULE OUT: Systemic vasculitis (can be life-threatening)

Question 39

How is scleritis managed?

Answer 39

URGENT REFERAL NSAIDS Prednisolone 80mg OD: NSAIDs ineffective Immunosuppression: Methotrexate/ Ciclosporin