Lids, Lashes, & Orbital Disease

Question 1

Blepharitis (define)

Answer 1

• eyelid inflammation

- acute or chronic

Question 2

Blepharitis (etiology)

Answer 2

• staph
• seborrheic
• meibomian gland dysfunction

Question 3

Blepharitis (signs)

Answer 3

• erythematous, edematous, greasy, crusty lids
• collarettes
• lash loss
• thick, cloudy secretions with digital pressure on meibomian orifaces

Question 4

Blepharitis (symptoms)

Answer 4

• irritation/burning
• FB sensation
• excessive tearing
• photophobia
• intermittent blurry vision

Question 5

What are collarettes?

Answer 5

• fibrinous scales around lashes

Question 6

Blepharitis (tx)

Answer 6

• warm compress
• improved eyelid hygiene
• topical abx ointment

Question 7

T/F: Blepharitis is a one time disorder.

Answer 7

False; frequently recurs

Question 8

What is another name for a stye?

Answer 8

• Hordeolum

Question 9

stye (symptoms)

Answer 9

• subacute onset

- painful nodule or pustule of eyelid

Question 10

stye (signs)

Answer 10

• tender, erythematous, nodule on skin surface of eyelid

Question 11

stye (etiology)

Answer 11

• staph infection of a sebaceous gland of the lid

Question 12

stye (tx)

Answer 12

• warm compress
• topical abx drops
• I&D if abx fail
• prevent cellulitis

Question 13

How are styes and blepharitis ddx’d?

Answer 13

• no discharge with styes

Question 14

chalazion (symptoms)

Answer 14

• asymptomatic
  or
• minimally tender lid nodule

Question 15

chalazion (signs)

Answer 15

• firm, well-demarcated nodule inferior to lid margin

- grayish conjunctiva

Question 16

chalazion (etiology)

Answer 16

• chronic inflammation of the meibomian gland

Question 17

chalazion (tx - early)

Answer 17

• early: warm compress
• intermediate: steroid injx (synthetic - trimcinolone)
• late: surgery

Question 18

How are chalazion and styes ddx’d?

Answer 18

• chalazion is not tender

Question 19

eyelid HSV (tx - mild cases)

Answer 19

• good hygiene to decrease risk of 2ndary bacterial infection

Question 20

eyelid HSV (tx - moderate to severe cases)

Answer 20

• topical polysporin to keep bacterial count down

- trifluridine drops to prevent 2ndary herpetic keratitis

Question 21

What is dacryocystitis?

Answer 21

• lacrimal sac infection

Question 22

What is dacroadenitis?

Answer 22

• lacrimal gland infection

Question 23

Define entropion

Answer 23

• inversion of the eyelid

Question 24

Define ectropion

Answer 24

• sagging or eversion of the lid

Question 25

ectropion (symptoms)

Answer 25

- irritation - burning - tearing - RB sensation

Question 26

ectropion (signs)

Answer 26

- lower lid turned outward | - visible space seen between globe and lid

Question 27

ectropion (etiology)

Answer 27

- involutional = lower lid laxity 2ndary to aging - paralytic = caused by CN VII palsy - scarring of lower lid - mass on lower lid or cheek

Question 28

entropion (symptoms)

Answer 28

- irritation - burning - FB sensation

Question 29

entropion (signs)

Answer 29

- inturned lower lid

Question 30

entropion (etiology)

Answer 30

- involutional = lower lid laxity caused to aging | - scarring from chemical burn

Question 31

What is ptosis?

Answer 31

- drooping of the upper eyelid - caused by CN III palsy - aka Horner's syndrome

Question 32

xanthelasma (symptoms)

Answer 32

- yellowish deposit around lids | - otherwise asymptomatic

Question 33

xanthelasma (signs)

Answer 33

- bilateral plaque/yellow lesion in medial and upper eyelid

Question 34

Define blepharospasm

Answer 34

- twitching eyelid

Question 35

What innervates the superior rectus?

Answer 35

- CN III

Question 36

What innervates the inferior rectus?

Answer 36

- CN III

Question 37

What innervates the medial rectus?

Answer 37

- CN III

Question 38

What innervates the lateral rectus?

Answer 38

- CN VI

Question 39

What innervates superior oblique?

Answer 39

- CN IV

Question 40

What innervates inferior oblique?

Answer 40

- CN III

Question 41

Describe orbital cellulitis

Answer 41

- inflammation or infection of the orbit spreading from the sinuses

Question 42

orbital cellulitis (symptoms)

Answer 42

- cardinal signs of swelling (warm, red, tender, swollen) | - vision loss & diplopia 2ndary to non-tandem movements of the eye

Question 43

orbital cellulitis (signs)

Answer 43

- low grade fever - elevated WBC - proptosis - restricted motility of the eye

Question 44

orbital cellulitis (etiology)

Answer 44

- URI or sinusitis --> streph, staph, or mixed flora - lid trauma - preseptal cellulitis - superficial lid or conjunctival infections - surgical procedures with contamination

Question 45

orbital cellulitis (ddx)

Answer 45

- orbital preseptal cellulitis - orbital pseudotumor - carotid cavernous fistula

Question 46

orbital cellulitis (workup)

Answer 46

- CBC - culture if open wound - CT - blood culture if systemic source suspected

Question 47

orbital cellulitis (tx)

Answer 47

- IV broad spec abx - surgical drainage - sinus drainage - refer

Question 48

How are thyroid eye disease and orbital cellulitis ddx'd?

Answer 48

- thyroid eye is bilateral

Question 49

thyroid eye disease (symptoms)

Answer 49

- gradual onset - mild: irritation, tearing, burning, FB sensation - moderate: diplopia, achiness, blurred vision - severe: visual loss, pain

Question 50

thyroid eye disease (signs)

Answer 50

- *proptosis/exophthalmos* - *lid lag* - sclera seen above or below iris - restricted EOM - conjunctival dilated blood vessels - lid, conjunctival edema - decreased visual acuity - possible visual field loss

Question 51

thyroid eye disease (etiology)

Answer 51

- thyroid abnormalities (i.e. *hyperthyroidism - Graves*) | - autoimmune (i.e. Hashimoto's)

Question 52

thyroid eye disease (workup)

Answer 52

- thyroid testing including TSH levels - CT/MRI - refer