Lid and Lacrimal Disorders

Question 1

Conjunctivitis

Answer 1

Inflammation of the conjunctiva
Conjunctiva.
MOST COMMON diagnosis in a patient with a red eye AND discharge

Question 2

Injection

Answer 2

term used to describe the fine blood vessels that cause the conjunctiva to look pink or red

Question 3

Bacterial Conjunctivitis

Answer 3

Spread by direct contact
***Purulent discharge continues throughout the day 
From:
Staph aureus (adults)
Strep pneumo
Haemophilus influenzae(children)
Moraxella catarrhalis(children)

Question 4

Viral Conjunctivitis

Answer 4

Spread by direct contact
Usually unilateral
MAY BE part of a systemic viral illness (***doesn’t have to be)
Typically more of a watery discharge
Course: Generally self limited, parallels that of the common cold

From:
adenovirus

Question 5

Allergic Conjunctivitis

Answer 5

Cause: airborne allergens contact the eye, get local mast cell degranulation and release of chemical mediators (including histamine)
Typically presents the same way as viral conjunctivitis but is **BILATERAL from the start and there will be **itching

Question 6

Red Flags for Eyes

Answer 6

Reduction of visual acuity
Severe deep eye pain (NOT irritation)
Ciliary flush (injection)
Photophobia
Severe foreign body sensation that prevents keeping the eye open
Corneal opacity
Fixed pupil
Severe headache with nausea

Question 7

N. Gonorrhoeae

Answer 7

Hyperacute Bacterial Conjunctivitis Caused by Neisseria gonorrhoeae
Transmission usually from genitalia to hands to eyes

Characterized by profuse purulent discharge

Question 8

Keratoconjunctivitis sicca

Answer 8

(Dry Eye Syndrome)
Multifactorial disease of the tears and ocular surface
Decreased tear production, Increased evaporative loss

Question 9

Dacrocystitis

Answer 9

is an infection of the lacrimal sac and is often associated with a blocked duct

Question 10

Hordeolum (Stye)

Answer 10

A localized infection OR inflammation of the eyelid margin involving either:
Hair follicles of the eyelashes (External Hordeolum)
Meibomian glands (Internal Hordeolum)

Question 11

Hordeolum (Stye) Pathophysiology

Answer 11

Infectious Staph Aureus implicated the great majority of the time (90-95%)
Arises from blockage

Question 12

Chalazion

Answer 12

a meibomian gland lipogranuloma
painless nodule
Will disappear without treatment within a few months and will reabsorb within two years
They can be injected with a corticosteroid or surgically removed in extreme cases

Question 13

Blepharitis

Answer 13

Inflammation involving the structures of the lid margin, involves: Erythema, Scaling, Crusting
Disease often associated with systemic conditions such as rosacea and seborrheic dermatitis

Question 14

Blepharitis treatment

Answer 14

**Systematic and long-term commitment to a program of eyelid margin hygiene!!
Application of heat (warm compresses)
Baby shampoo with warm water and gentle washing of the eyelid margins
Antibiotic ointment applied to eyelid margin (such as erythromycin) during exacerbations
**Patients must understand this is a chronic condition characterized by intermittent exacerbations

Question 15

Ectropion

Answer 15

eversion of the eyelid margin Causes: aging, scarring, infection, palsy of the facial nerves
Leads to corneal and conjunctival exposure and oftentimes tearing

Eyedrops and ointments can be used to manage symptoms and protect the cornea until a permanent treatment is done
Most cases of ectropion require surgery

Question 16

Entropia

Answer 16

inversion of the eyelid toward the globe
Multiple causes:
Muscle weakness, scars or previous surgeries, skin diseases and infections

Treatment: lubricating agents, surgery

Question 17

Pterygium

Answer 17

corneal proliferative disease associated with UV exposure that arises from the limbus and proliferates
This condition CAN move onto the cornea
asymptomatic

Question 18

Pinguecula

Answer 18

Appears as a yellowish growth of the scleral conjunctiva and is usually adjacent to the limbus
As it is confined to the conjunctiva, this will NOT encroach onto the cornea

Question 19

Capillary Hemangioma

Answer 19

superficial tumor that develops “strawberry” appearance

Enlarge with Valsalva

Question 20

Conjunctival Hemangioma

Answer 20

Blood in conjunctiva
Treatment: 
May not need treatment
Eyelid may cause problems with vision
May go away on their own
Half go way by age 5
Almost all disappear by age 9
Laser used to remove in some cases

Question 21

Lacrimal Gland Tumor

Answer 21

Enlargement of lacrimal fossa with displacement of globe and no inflammatory signs
50% mortality, requires aggressive surgical Tx

Question 22

Basal Cell Carcinoma

Answer 22

Most common human malignancy
Usually affects the elderly
Slow-growing, locally invasive
Does not metastasize 90% occur on the head and neck
Of these, 10% occur on the eyelid
Treat by excision

Question 23

Squamous Cell Carcinoma

Answer 23

Less common but more aggressive than BCC
The majority arise in solar-damaged skin and premalignant lesions (actinic keratoses)
Account for about 4% of all primary eyelid malignant neoplasms
treat by excision and radiation

Question 24

Meibomian gland carcinoma

Answer 24

AKA Sebaceous cell carcinoma 
Lethal eyelid malignancy 
Error or delay in diagnosis is common, and this tumor carries a significant mortality rate with metastasis
aggressive tumor with 50% mortality
mainly on upper eyelid

Question 25

Melanoma

Answer 25

Very aggressive, spreads rapidly
can affect: Choroid, Ciliary body, Conjunctiva, Eyelid
Excessive exposure to sunlight is an major risk factor. Fair-skinned and blue-eyed people are most often affected
Treatment: excision and radiation and chemotherapy

Question 26

Merkel Cell Carcinoma

Answer 26

Rare but aggressive, metastasizes early to regional lymph nodes
Fast-growing, well demarcated nodule
Intact over-lying skin
on the upper eyelid
Highly treatable and curable if caught in the early stages
Treatment includes excision and radiation and chemotherapy

Question 27

Dacrostenosis

Answer 27

Nasolacrimal obstruction.
Seen primarily in newborn, persistant tearing.
treat with massage