Lid and Lacrimal Disorders Flashcards
Karatoconjunctivitis Sicca (KS)
- Lacrimal gland dysfunction or destruction
- Increased evaporation loss
- commonly caused by meibomian gland dysfxn
- structural abnormalities
- decreased blink fxn
KS Findings
Conjunctival injection
Excessive tearing
Blepharitis
Often need optho referral
KS Tx
Blepharitis: Eye hygiene Avoidance if allergies True KS: 1. Fake tears 2. Environmental strategies? 3. Topical cyclosporine (Restasis)
Dacrocystitis
An infection of the lacrimal sac and is often associated with a blocked duct.
Dacrocystitis Causes
Nose injury Eye infxn/tumor Nasal inflammation Old Age Blocked tear duct Obstruction of nasolacrimal duct
Dacrocystitis Tx
Warm compress
Oral antibiotics (bactrim, clindamycin)
Careful follow up
If persistent, refer to optho
Dacrostenosis
Nasolacrimal duct obstruction
- Can occur anywhere in lacrimal drainage system
- Most common at membrane of Hanser
Dacrostenosis is seen primarily in which population?
Newborns and infants
- Persistent tearing
- Acular discharge
Dacrostenosis Tx
Massage 2-3 times/day
Probing(?) by an optho
Don’t get weird
Hordeolum (Stye)
A localized infection OR inflammation of the eyelid margin involving either:
- Hair follicles of eye lashes (external)
- Meibomian Glands (internal)
Which bacteria is most often associated with a stye?
Staph Aureus in 90-95% of cases
Both internal and external styes can srise as a secondary complication to which other disease?
Blepharitis
Chalazion
AKA meibomian gland lipogranuloma
A PAINLESS mass arising from chronic granulation of a stye.
- If large enough can cause visual disturbance.
- generally disappear w/o tx in a few months, and certainly within 2 years
Pertinent negatives for styes
Absence of constitutional symptoms
Absence of periborbital involvement
Preauricular lymph nosed are NOT enlarged
Stye Tx
Generally self-limiting
Warm compresses
Abx if infection spreads beyond initial area
Consider eyelash removal to help with draining
Should the patient squeeze the stye?
Really? No.
Blepharitis
Inflammation involving structures of the lid margin and involves:
- erythema
- scaling
- crusting
Often associated with systemic conditions
Blepharitis Patho
Bacterial colonization of the eyelids
Direct invasion of tissues
Generally seen in ages 50 and older
Blepharitis presentation
- Burning, watering, crusting of lashes and medial canthus, scaling, erythematous eyelids.
- chronic course with intermittent exacerbations
- May be some conjunctival injection
Blepharitis Tx
Eyelid margin hygiene!
Application of heat
Antibiotic ointment (erythro)
Blepharitis can be easily cured: T or F
False, it is a chronic condition. educate the patients about this.
Ectropion
Eversion of the eyelid margin away from the globe.
Generally requires surgical repair
Eyedrops and ointments can be used to treat symptoms and protect eye.
Causes of ectropion
Aging, scarring, loss of tone, infxn, palsy of facial nerves
Entropion
Inversion of the eyelid toward the globe.
- muscle weakness, scarring, infections
Entropion tx
Surgery, lubricants
Pterygium
A corneal proliferative disease associated with UV exposure that arises form limbus and proliferates
- Can move to cornea
- Generally asymptomatic and zero consequence
Pinguecula
- Often associated with pterigium
- Appears as yellowish growth of scleral conjunctiva adjacent to limbus.
- Will not encroach onto cornea
- Generally asymptomatic
Capillary Hemangomia
Superficial tumor that develops strawberry appearance
1/3 diagnosed at birth
90% visible by 6 months
Capillary Hemangomia Complications
- Amblyopia, astigmatism
- Superinfection, ulceration
Capillary Hemangomia Tx
- Steroids, interferon
- Radiation therapy
- Surgical rescection
Conjunctival Hemangomia
Red blood-filled growth on conjunctiva
Conjunctival Hemangomia Tx
May not need tx
May cause amblyopia, strabismus
Almost all disappear by age 9
Laser can remove in some cases
Lacrimal Gland Tumors
- Enlargement of lacrimal fossa, no inflammatory signs
Pleomorphic Adenoma
Benign mixed Lacrimal tumor
20-50 years of age
Excision Tx
Painless globe displacement
Adenoid Cystic Carcinoma
Most common malignant lacrimal tumor.
Pain and numbness
50% mortality, requires agressive surgery
Basal Cell carcinoma (BCC)
Most common human malignancy Usually effects elderly Does not metastasize 90% of head or neck 90% of eyelid malignancies Tx is excision
Squamous Cell carcinoma
Less common but more aggressive than BCC
Arise from solar damage
Most common of bottom eyelid
Tx: Excision, radiation
Meibomian Gland Carcinoma
AKA sebaceous cell carcinoma Lethal eyelid malignancy Error and delay in dx is common Commonly occur in upper eyelid 50% mortality Tx: Excision and radiation
Melanoma
Very aggressive, rapid spread.
Affects choroid, conjunctiva, ciliary body, eyelid.
Tx: excision and possibly radiation
Karposi Sarcoma
- Malignant, vascular tumor that occurs mainly is AIDS patients.
- Usually associated with advanced disease
Tx: chemo, radiation
Merkel Cell Carcinoma
Rare, agressive malignancy Metastasizes early to lymph nodes Intact overlying skin Most common on upper eyelid treatable if caught early Tx: excision, radiation, chemo
