Lids/Lashes/Lacrimal/Orbit Flashcards
What are the classic signs of carotid cavernous fistula (CCF)?
Remember that there are 2 types of CCF: high and low flow
High flow has the triad of chemises, pulsatile exophthalmos and ocular bruit.
Pt will also have hx of trauma (up to 77% from closed head trauma) (can occur spontaneously from ruptured carotid aneurysm with associated cavernous sinus pathology) with mental status alteration and increased IOP
How is CCF diagnosed through testing?
MRI and angiography
What are signs of orbital cellulitis and what is the treatment for orbital cellulitis?
Immediate hospitalization, IV ceftriaxone and nafcillin until improved. If improved, 10 day oral course of Augmentin 250-500mg TID, Ceclor or Bactrim (for allergies to penicillin). Consult with otolaryngology (ENT) to rule out fungal phycomycosis or mucormycosis in diabetics and immunocompromised.
If conjunctivitis or corneal exposure is present, use topical bacitracin or erythromycin
Describe incision and curettage for a disease like molluscum contagiosum
Surgical method for removing something like a chalazion which requires use of scapel for incision and curette to remove contents.
What is the most common type of skin cancer in the US?
BCCA = 90% of all eyelid malignancies
SCCA is 2nd and is leading malignancy
How do you know if a skin lesion is metastasizing?
Look for lymphadenopathy in pre auricular and submandibular areas. Always look for lid architecture changes, tumor margins, depth, size, and color.
What are signs of sebaceous gland carcinoma?
Yellow, hard tumor on upper eyelid that causes madarosis and thickened red eyelid margins
How is a suspicious BCCA managed?
Refer for complete excision and biopsy
How do you differ between an infectious and sterile corneal ulcer?
Infectious ulcer will have epithelial defect and infiltrate of the same size. Also, pt will present with severe pain, mild AC reaction and conjunctival injection
Sterile ulcer will have a small ulcer with larger underlying infiltrate
How is staph marginal keratitis treated?
Remember it is both an infectious and hypersensitivity reaction to bacterial antigens
Combintaion antibiotic/steroid therapy (Maxitrol, Zylet, Tobradex) Q4h with appropriate f/u
What is the treatment for anterior blepharitis?
Lid scrubs BID until stabilized and then QD thereafter
Bacitracin or erythroycin ung QHS
AzaSite (azithromycin) drops
Combintaion ointment at bedtime if marked redness or inflammation is present
What is the treatment for posterior blepharitis (meibomianitis)?
Warm compresses 5-10 min QID with massage
Lid scrubs BID until stabilized then QD
Combination ointment/gtt short-term
Doxycycline 100mg BID for 1 month, then QD for 3-6months
1-3000mg omega-3 QD
What is the treatment for RCE?
Debridement of loose or heaped up eli
Cycloplegic for pain
Broad-spectrum antibiotic BID-QID
Topical NSAID prn for first 2-3 days
BCL for discomfort unless it is the offending agent
PF ATs Q1H
Optional pressure patching for large abrasions or surgical management with stromal micro puncture, diamond burr polishing, etc.
What is the treatment for corneal ulcer (bacterial, fungal, acanthamoeba)?
Bacterial: most common - Fluoroquinolone q1-2H topically, then taper slowly when reducing in size. Use fortified antibiotics q1-2H for larger ulcers.
Fungal: most common ager traumatic injury from vegetable matter (Aspergillus and Fusarium; Candida is more chronic) - look for infiltrates that are grey with feathery edges and satellite infiltrates. Use Amphotericin B and Natacin QH while awake with taper based upon clinical response. You can add systemic antifungals (ketoconazole or itraconazole) for severe cases. Culture with Sabouraud’s agar.
Acanthamoeba: rare - pain > signs. Perform corneal scrapings for periodc acid schiff, giesma stain or blood/chocolate agar (not well). Use cocktail of PHMB q1h, ketoconazole 200mg or itraconazole 100mg BID, cycloplegic TID, neosporin drops QH and topical steroids (controversial). penetrating keratoplasty is warranted in up to 30% of cases
ALL REQUIRE 1-DAY FOLLOW-UP!!!!
