Ophthalmology - Eyelid Disorders Flashcards
What is blepharitis? Name some features
-Inflammation of the eyelid margins, can be associated with dysfunction of the meibomian glands and can lead to styes and chalazions Features -Usually bilateral -Grittiness/discomfort -Red eyelid margins with stinging and tearing -Eyes may be sticky in the morning
How do you manage blepharitis?
-Hot compresses and gentle cleaning of the eyelid margins to remove debris using cotton wool dipped in sterilised water and baby shampoo -Can provide lubricating eye drops to relieve symptoms
What is a stye? Describe the two types
-Hordeolum externum: infection of glands of Zeis (sebaceous glands at the base of eyelashes) or glands of Moll (sweat glands at the base of the eyelashes) resulting in tender red lump along the eyelid which may contain/ooze pus. -Hordeolum internum: infection of the meiboman glands that tends to be deeper, more painful and may point inwards towards the eyeball underneath the eyelid
How are styes treated?
-Hot compress and analgesia -Only give topical antibiotic (eg chloramphenicol) if it is associated with conjunctivitis or is persistent
What is a chalazion? How do they present?
-Also known as meibomian cyst -Non-infective granulomatous inflammation of meibomian gland - occurs when gland becomes blocked and swells up. -Presents are form and mobile lump under the eyelid.
What is the treatment for chalazion?
-Hot compress, analgesia, massage and lid scrubs -Consider topical antibiotic if acute inflamed -If conservative management fails, may need surgical drainage (rare)
What is entropion?
-Eyelid turns inwards with lashes against eyeball -Causes pain and can lead to corneal damage and ulceration
How do you manage entropion?
-Taping the eyelid down to present it turning inwards + lubricanting eye drops to prevent it from drying out -Surgery is definitive management
What is ectropion? What is a complication?
-Eyelid turns inwards with the inner aspect of the eyelid exposed (usually affects bottom lid) -Can result in exposure keratopathy: eyeball is exposed and not adequately lubricated/protected
How is ectropion managed?
-Mild cases don’t need treatment -Regular lubricating eye drops help protect eye -Significant cases: surgery
What is periorbital cellulitis? How does it present?
-Pre-septal cellulitis -Presents with swelling, redness and hot skin around the eyelids and eye -Treatment: systemic antibiotics (PO/IV) or admission if young patient or immunocompromised patient. *Must differentiated it from orbital cellulitis: CT head
What is orbital cellulitis? How does it present?
-Infection around the eyeball that involves tissues behind the orbital septum -Most commonly originates from sinus disease (bacteria erode through thin ethmoid bone into orbit), tooth abscesses or fungal infections (immunocompromised) Features -Pain on eye movement -Reduced eye movements: intraocular muscle inflammation -Changes in vision: pressure on optic nerve -Eyelid oedema/Ptosis
What investigations should you perform for suspected orbital cellulitis? How do you managed this patient?
-FBC: raised WCC -Clinical exam + complete ophthalmological assessment (decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema and erythema) -Blood culture + microbiology swabs (most common organisms are strep, staph aureus and HIB) -CT head to evaluate extent of infection Admit patient for IV antibiotics and possible surgical drainage if abscess present.
What is this?
Blepharitis
What is this?
A stye
What is this?
A chalazion
What is this?
Entropion
What is this?
Ectropion
What is this?
Periorbital cellulitis
What is this?
Post-septal cellulitis
