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NBEO Part 2 > Lids/ Lashes > Flashcards

Lids/ Lashes Flashcards

1
Q

RTC for phthiriasis palpebrarum?

A

1 day

Because eggs may be hard to see and missed, eggs hatch daily, therefore need to monitor daily to ensure complete removal of eggs and lice

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2
Q

Tx of angioedema

A

Oral antihistamine and cold compress 4-6x/ day

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3
Q

RTC for angioedema

A

2-3 days to ensure resolution

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4
Q

Symmetrical bilateral ptosis onset around 20 years old is seen in which condition?

A

CPEO
Chronic progressive external ophthalmoplegia

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5
Q

Chloasma

A

Increased pigmentation around eyes and cheeks in pregnant women
*”mask of pregnancy”

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6
Q

What is Epiblepharon?

A

A congenital condition characterized by the absence of a lower lid crease, causing eyelashes to be oriented vertically.

Commonly observed in individuals of Asian descent and those with a high body mass index.

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7
Q

What are potential causes for Epiblepharon?

A

It may occur secondarily to:
* Surgical procedure
* Trauma
* Graves’ disease (leads to hyperthyroidism)

It can also be congenital.

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8
Q

What symptoms are associated with Epiblepharon?

A
  • Foreign body sensation
  • Ocular irritation
  • Reflexive tearing
  • Patients may be asymptomatic

Symptoms can vary in severity.

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9
Q

What are the clinical signs of Epiblepharon?

A
  • Vertical misdirection of lashes towards the globe
  • Mild corneal scratches
  • Superficial punctate keratitis (SPK)
  • Associated scarring of the cornea

The upper eyelid is rarely involved.

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10
Q

At what age may Epiblepharon spontaneously resolve in children?

A

By the age of 6 to 7 years

This resolution is secondary to facial elongation.

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11
Q

True or False: Epiblepharon can lead to decreased vision.

A

True

Decreased vision is exacerbated by down gaze due to corneal irritation.

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12
Q

Fill in the blank: Epiblepharon is characterized by the absence of a _______.

A

lower lid crease

This absence causes the eyelashes to misdirect vertically.

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13
Q

What are some treatment options for Epiblepharon?

A
  • Rotating the lid margin and taping it away from the globe
  • Application of a soft contact lens to protect the cornea
  • Epilation of the offending lashes (if there is only a small number)
  • Full-thickness suturing of the eyelid to create a normal eyelid crease (oculoplastics)

These options vary based on the severity and specific circumstances of the condition.

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14
Q

What should be prescribed in the presence of superficial punctate keratitis (SPK)?

A

Prescription of an age-appropriate topical antibiotic to ensure corneal health

This is important to prevent further complications associated with corneal involvement.

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15
Q

What type of artificial tears are recommended for patients with Epiblepharon?

A

Preservative-free artificial tears

These are preferred to avoid any irritation or adverse reactions that preservatives may cause.

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16
Q

When is surgery warranted for Epiblepharon?

A

If there is a significant degree of corneal involvement

Surgical intervention may be necessary to prevent further damage to the cornea.

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17
Q

Under what condition does epiblepharon not require urgent attention?

A

If the cornea is clear and there is no potential for lash misdirection onto the corneal surface

In such cases, patients may simply be monitored intermittently.

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18
Q

What is the primary approach to managing Epiblepharon if there is no corneal involvement?

A

The patient may simply be monitored intermittently to safeguard against future corneal involvement

This approach focuses on observation rather than immediate intervention.

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19
Q

What causes phthiriasis?

A

Phthiriasis is caused by pubic lice, also known as crab lice.

The scientific name for the organism is Phthirus pubis.

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20
Q

What is the size and body structure of Phthirus pubis?

A

Phthirus pubis measures roughly 2 mm in length and possesses a broad, flat body.

This small organism is specifically adapted to live in pubic hair.

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21
Q

How does pediculosis differ from phthiriasis?

A

Pediculosis is caused by a different form of louse that has greater mobility and is typically found on the scalp, while phthiriasis is caused by P. pubis, which is slow-moving and rarely found on the scalp.

Pediculosis is more easily transmitted between individuals.

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22
Q

What indicates the transmission of phthiriasis?

A

Phthiriasis transmission requires close contact between individuals.

This is often associated with overcrowding or inferior hygiene.

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23
Q

What are common symptoms of phthiriasis?

A

Patients may report ocular itching and potentially conjunctival injection.

These symptoms are indicative of an infestation affecting the eye area.

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24
Q

What clinical signs may be observed during a slit lamp exam for phthiriasis?

A

Clinical signs may include:
* Lice clinging to the base of the eyelashes
* Small brown deposits on the lid margin (feces)
* Dried blood along the base of the eyelashes
* Small circular translucent nits (eggs)
* Conjunctival injection and follicles
* Potential preauricular lymphadenopathy
* Marginal keratitis in extreme cases
* Dermal blue spots (maculae caeruleae) from lice saliva

These signs help in diagnosing phthiriasis.

25
Q

What is the first step in the treatment of phthiriasis?

A

Mechanical removal of all nits and lice with jeweler’s forceps.

The lice should be placed onto an alcohol wipe for immediate disposal.

26
Q

What topical treatments may be beneficial after lice removal?

A

A bland ophthalmic ointment such as bacitracin or erythromycin applied tid for 10 days after removal is beneficial.

This helps in managing any residual infection or irritation.

27
Q

What is a potential prescription option for phthiriasis treatment?

A

1% mercuric oxide qid for 14 days may be prescribed.

However, patient compliance can affect the treatment’s effectiveness.

28
Q

What side effects are associated with mercuric ointment?

A

Ocular irritation, lens discoloration, and other side effects.

These can discourage patients from using the treatment as directed.

29
Q

What alternative treatment involves physostigmine?

A

Two applications of 0.25% physostigmine applied 7 days apart may be prescribed.

This medication is also associated with ocular side effects.

30
Q

Are anti-lice shampoos approved for ocular use?

A

No, anti-lice shampoos are not approved for ocular use.

Patients should wash their hair with anti-lice shampoo but avoid applying it to the eyes.

31
Q

What additional hygiene measures should patients take if they have phthiriasis?

A

Patients should wash all bedding and towels that they may have used and consider cutting the lashes to the base to remove possible lice adhesion sites.

This helps prevent re-infestation.

32
Q

What follow-up care is recommended for patients with phthiriasis?

A

Patients should be monitored every day because the eggs may be difficult to observe and any missed nits will hatch daily.

Regular follow-up is crucial for effective treatment.

33
Q

What must be evaluated in a child diagnosed with phthiriasis?

A

A child diagnosed with phthiriasis must be evaluated for possible sexual abuse.

This is due to the nature of transmission and potential risk factors.

34
Q

What is Meibomian gland dysfunction (MGD)?

A

A condition resulting from dysfunctional sebaceous glands

Also known as posterior blepharitis.

35
Q

What conditions commonly occur alongside Meibomian gland dysfunction?

A

Anterior blepharitis and seborrheic dermatitis

These conditions can exacerbate MGD.

36
Q

Which bacteria are believed to aggravate Meibomian gland dysfunction?

A

S. aureus and S. epidermidis

These are gram-positive bacteria that release lipases affecting lipid production.

37
Q

What is the effect of lipases released by bacteria on the ocular surface?

A

They hydrolyze lipids, producing free fatty acids that irritate the ocular surface

This leads to dry eye symptoms.

38
Q

List some common symptoms of Meibomian gland dysfunction.

A
  • Stinging
  • Dryness
  • Itching
  • Excessive tearing
  • Burning
  • Photophobia
  • Foreign body sensation
  • Decreased visual acuity
39
Q

What clinical signs may be observed in a patient with Meibomian gland dysfunction?

A
  • Excessively oily and frothy tear film
  • Inspissated secretions
40
Q

What are some long-term complications of Meibomian gland dysfunction?

A
  • Chalazion
  • Trichiasis
  • Madarosis (missing lashes)
  • Thickening and notching of eyelid margins
  • Telangiectasia
41
Q

What are the primary treatments for Meibomian gland dysfunction?

A
  • Warm compresses
  • Eyelid massage
  • Eyelid scrubs
  • Antibiotic ointments
  • Transient topical steroid use
42
Q

How often should warm compresses and massage be performed initially for MGD?

A

Twice a day

This should continue until the condition stabilizes.

43
Q

When might oral antibiotics be required in the treatment of Meibomian gland dysfunction?

A

When MGD is unresponsive to other treatments, severe, or if there is poor compliance

44
Q

Fill in the blank: The tear film in Meibomian gland dysfunction may appear excessively _______.

A

[oily and frothy]

45
Q

What is Meibomian Gland Dysfunction (MGD)?

A

A disorder affecting the meibomian glands, leading to dry eye symptoms.

46
Q

What is the first step in treating anterior blepharitis?

A

Complete lid scrubs to remove bacteria.

47
Q

What is the recommended treatment order for posterior blepharitis?

A

Perform massage first, then lid scrubs.

48
Q

What advanced treatments may be required for severe cases of MGD?

A

In-office gland expression using technologies like LipiFlow® or iLux®.

49
Q

What types of topical ointments may be prescribed for MGD?

A

Bacitracin, tetracycline, or erythromycin.

50
Q

What is AzaSite® and why is it beneficial?

A

A topical azithromycin that is lipophilic and gel-forming, providing longer ocular retention.

51
Q

What is the typical dosage for tetracycline in MGD treatment?

A

250 mg q.i.d.

52
Q

What is the modified dosage for doxycycline that maintains efficacy?

A

20-50 mg.

53
Q

What is included in the Alodox® Convenience Kit?

A
  • Low dose doxycycline (20 mg)
  • OcuSoft® lid hygiene pads
  • Tranquileyes® moist heat therapy goggles
54
Q

What OTC supplement is suggested to improve dry eye associated with MGD?

A

Omega-3 fatty acids at a dosage of 2-3 g per day.

55
Q

How has Restasis® proven beneficial for MGD patients?

A

It reduces lid margin inflammation in patients with MGD and/or rosacea.

56
Q

True or False: The usage of Restasis® for MGD is considered on-label.

A

False.

57
Q

RTC for MGD dx

A

3-4 weeks
* pt should be educated about how MGD is chronic, likely will need to continue eyelid scrubs and massage indefinitely

58
Q

Adverse side effects of Kenalog eyelid injection (tx resistant chalazia and expedite resolution)

A
  • de pigmentation at injection spot
  • elevated IOP
  • retinal and/or choroidal vascular occlusion
  • pain on injection
  • temporary skin atrophy

NBEO Part 2 (15 decks)

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