Lecture 3 - Eye and Eyelid Disorders Flashcards
What are the Glands of Moll?
Modified sweat glands
What are the Glands of Zeiss?
Modified sebaceous glands
What are Meibomian glands?
Modified sebaceous glands that produce the lipid layer of the tear film
What are the functions of the eyelid?
- Protect the anterior surface of the eye
- Regulate light reaching the eye
- Aids in tear flow through pumping action on the conjunctival and lacrimal sacs
- Helps w/ distribution and elimination of tears
What is the conjunctiva?
- Thin, transparent mucous membrane
- Covers inner surface of eyelids and anterior surface of eye
What is the main function of the conjunctiva?
Prevent the eye from drying by secreting a moisturizing mucous
What are some common eyelid conditions?
- Hordeolum (stye)
- Chalazion
- Blepharitis
What can cause conjunctivitis?
- Acute bacterial
- Hyperacute bacterial
- Chronic
- Viral
- Seasonal allergies
What are general red flags for eye disorders (when to refer)?
- Blunt trauma
- Foreign particles trapped/embedded in eye
- Ocular abrasion
- Eye exposure to chemicals or fumes
- Thermal injury (Welder’s eye or snow blindness)
- Blurred vision (not due to ocular ointments)
- Refer if vision is impaired whatsoever
- Pain (not discomfort)
- Photophobia
- Redness around cornea
- Abnormal pupil
- Condition lasting more than 48 hrs (some exceptions)
- Contant lens wearers w/ conjunctivitis
What are the treatment goals for an eye infection?
- Cure
- Prevent transmission
- Prevent reoccurence
What are the treatment goals for dry eye?
- Manage symptoms
- Prevent complications
- Identify any exacerbating factors
What is the pathophysiology of a hordeolum?
- External or internal
- Acute, localized infection involving either the glands of Zeis or Moll or the Meibomian glands of the eyelid
- Most common infecting organism is Staph Aureus
- Results in formation of small cyst or abscess
- Unilateral, localized lid swelling, tenderness & erythema
- Often associated w/ blepharitis
What are the signs and symptoms of an external hordeolum?
- Smaller and more superficial cyst or abscess
- Lesion points toward the skin
What is the treatment for an external hordeolum?
- Warm compresses for 10-15 minutes 3-4 times/day
- Should drain on its own w/in 48 hours
- OTC antibiotic ophthalmic ointment may be applied 3-4 times daily but is not required and not generally recommended
When would you refer an external hordeolum?
Doesn’t drain w/in 48 hours, then may require Rx oral or topical antibiotics
What are the signs and symptoms of an internal hordeolum?
- Involves meibomian glands
- Usually larger and more discomfort than external
- Lesion can point either to skin or conjunctiva
- Often resolves w/in 1-2 weeks
What is the treatment for an internal hordeolum?
Warm compresses for 5-10 minutes several times/day
When should you refer for an internal hordeolum?
- If not resolved in 1 week
- If causing pain or impairing vision
- If not resolved then it may not drain on its own and may require an incision and Rx ophthalmic ointment (bacitracin or erythromycin)
- If infection, severe oral antibiotics may be needed (erythromycin, cloxacillin, tetracycline)
How can you prevent a hordeolum?
- Wash hands before and after contact w/ infected eye
- Avoid touching eyes
- Change towels and compresses after each use
- Proper use of eye drops; clean tip after use
- Avoid use of eye cosmetics during infection (will have to throw away any eye cosmetics that were used prior to diagnosis)
What is the pathophysiology of chalazion?
- Inflammation of meibomian glands (deep chalazion) or Zeis sebaceous glands (superficial chalazion)
- Not an infection but inflammation of area
- Generally chronic
- Nodule develops over a period of weeks (not acute)
- Lesion usually points towards conjunctival surface
Who is more likely to get chalazion?
People w/ blepharitis, acne rosacea, or seborrheic dermatitis
What is the treatment for chalazion?
- Warm compresses 10-15 minutes 3-4 times/day
- Eyelid massage
- Often resolve spontaneously w/in a few days
When should you refer a chalazion?
- No improvement w/in 48 hours of initiating treatment
- Immediate referral if painful or visual impairment
What can be done to prevent recurrence of chalazion?
Regular lid hygiene
What is the pathophysiology of blepharitis?
- Chronic inflammation of eyelids
- Usually bilateral
- Often associated w/ chronic dermatological conditions (acne rosacea, seborrheic dermatitis)
- Long term damage may include physical damage to eyelids and cornea, scarring, vision impairment, or corneal perforation
Is blepharitis contagious?
No
What are the symptoms of blepharitis?
- Red, swollen, itchy lid
- Eyes red and watery
- Landmark sign - scaly eyelid
- Sandy/gritty sensation in eye; worse upon awakening
- Loss of eyelashes
- Symptoms can be unilateral or bilateral
What is the Rx treatment for blepharitis?
- Antibacterial ointments over drops b/c of increased contact time
- Short-term treatment w/ corticosteroids or corticosteroid/antibacterial combinations
- Oral antibiotic treatment may be required
When should you refer for blepharitis?
Initial diagnosis or exacerbations b/c usually a chronic problem
What are some non-Rx treatments for blepharitis?
- Regular and long-term eyelid margin hygiene (recommended 1-2 times/day)
- Warm compresses for 10-15 minutes
- Gentle scrubbing of lid margin
What is the pathophysiology of conjunctivitis?
- Any inflammatory condition of the conjunctiva
- Inflammation can be hyperacute, acute, or chronic
- Caused by viral/bacterial infections, allergies, other irritants, or dryness
What is commonly referred to as pink eye?
Acute bacterial conjunctivitis
Is acute bacterial conjunctivitis contagious?
Highly contagious
When should you refer acute bacterial conjunctivitis?
- Children
- Contact lens wearers
What are the symptoms of acute bacterial conjunctivitis?
- Acute onset
- Usually unilateral
- Mild to moderate foreign body sensation
- Minimal or no itching
- Generalized redness
- Purulent (creamy white or pale yellow) discharge
- Eyelids stick together on awakening; crusting on eyelids
What is the treatment for adults w/ acute bacterial conjunctivitis?
- Mild - Polysporin drops 4-6 times/day or polymyxin B/gramicidin eye ointment to lower lid 4 times/day for 7-10 days
- Treatment should continue for 2 days after symptoms have resolved
- Warm and wet compresses applied in the morning
- Irrigation of conjunctival sac to remove secretions
When should you refer acute bacterial conjunctivitis?
- If no improvement w/in 48 hours
- Symptoms worsen
What are common Rx treatments for acute bacterial conjunctivitis?
- Sufacetamide sodium
- Trimethoprim/polymyxin (Polytrim)
- Erythromycin ointment
What is hyperacute bacterial conjunctivitis?
- Most common in neonates and/or sexually active adolescents and young adults (15-24)
- Severe and sight threatening
- Caused by N gonorrhea or N meningtidis
When should you refer for hyperacute bacterial conjunctivitis?
Always
What are the symptoms of hyperacute bacterial conjunctivitis?
- Copious yellow/green, purulent discharge
- Redness
- Irritation
- Tenderness
What is chronic bacterial conjunctivitis?
- Condition lasting over 4 weeks
- Often associated w/ blepharitis, rosacea, facial seborrhea, or nasolacrimal duct obstruction
When should you refer for chronic bacterial conjunctivitis?
Always for topical or oral antibiotics
What are some non-pharms for chronic bacterial conjunctivitis?
- Similar to blepharitis
- Warm compresses
- Lid scrubs
- Avoid contaminated products
Is viral conjunctivitis contagious?
Highly contagious
Is viral conjunctivitis unilateral or bilateral?
Often starts unilateral and then can become bilateral
What is the most common cause of viral conjunctivitis?
- Adenovirus
- Herpes simplex/zoster can also be the cause
Viral conjunctivitis often occurs in _____ epidemics
Community
Viral conjunctivitis can last from _ to __ weeks
2 to 4
What are the symptoms of viral conjunctivitis?
- Acute red eye
- Conjunctival swelling
- Soreness or mild pain
- Minimal or no itching
- Profuse watery, clear discharge
- Upper respiratory tract infection may be present
What is the treatment for viral conjunctivitis?
- All patients should be referred!
- Cold compresses, ocular lubricants
- If HSV then topical or oral antivirals usually prescribed
- Avoid direct contact w/ others for at least 14 days after onset of symptoms
What is the most common type of allergic conjunctivitis?
Seasonal allergic rhinoconjunctivitis (hay fever)
What is the cause of allergic conjunctivitis?
Allergens such as ragweed, grass pollen, animal dander, etc.
What are the symptoms of allergic conjunctivitis?
- Normally bilateral
- Severe ocular itching
- Minimal redness
- Tearing
- No sign of infection
What is the pathophysiology of dry eye?
- Two major classifications - aqueous tear-deficient dry eye or evaporative dry eye
- Can lead to eyes drying out and becoming inflamed
- Can cause damage to ocular surface, scarring, or reduced vision
What are severe forms of dry eye referred to as?
Keratoconjunctivitis Sicca
What are risk factors for dry eye?
- Environmental (low humidity, high temp., air pollution)
- Occupation (air travel, computer use)
- Age
- Hormonal changes (post-menopausal, pregnant women)
- Contact lens wearers
- Medical conditions (RA, Sjogrens syndrome)
- Ocular disease (blepharitis, allergic conjunctivitis, infection)
- Medications (anticholinergics, beta-blockers, diuretics)
What are the signs and symptoms of dry eye?
- Redness, dryness
- Itchiness or scratchiness
- Burning or stinging
- Excessive tearing
- General discomfort
- Grittiness
- Blurred vision
What are the treatment goals for dry eye?
- Manage symptoms (no cure)
- Prevent complications
- Determine severity of situation
- Rule out other ocular complications
What are some non-pharms for dry eye?
- Environmental changes
- Use humidifier
- Avoid prolonged viewing of computer screens or video games
- Avoid windy outdoor environments w/o eye protection
- Cool, moist compresses placed over closed eyelids for short-term relief
What are some non-Rx treatments for dry eye?
Ocular lubricants - artificial tears or lubricating ointments and gels at night
When should you refer for dry eye?
If symptoms don’t resolve w/in 3-5 days or if they worsen
What are characteristics of an ideal artificial tear?
- Lubricates ocular surface well
- High retention time (caused by higher viscosity)
- No preservative for max. patient comfort
- Contains essential minerals and electrolytes to maintain good corneal health
What is the most common preservative in artificial tear products?
Benzalkonium chloride, but known to be toxic to corneal epithelium so should be avoided in moderate to severe dry eye
What are the most common ingredients in lubricating ocular ointments?
Petrolatum, mineral oil, and lanolin
What should be considered when recommending a product for dry eye?
- Severity of condition
- Frequency of use
- Is the patient using other ocular medications?
- Does the patient wear contact lenses?
What are the monitoring parameters for dry eye?
Expected improvement w/in 3-5 days
What are some counselling tips for patients w/ eye disorders?
- Wash hands before and after touching eye
- Clean eye before applying medication
- Wait 3-5 min btwn drops of same medication
- Wait 5-10 mins btwn drops of different medications (suspensions should be instilled last)
- Dispose unused multidose product after 28 days
- Don’t use eye patch unless instructed by optometrist
- Non-pharms are paramount in eye disorders
