Ophthalmology - Eyelids/Oculoplastics

Question 1

What is orbital cellulitis?

Answer 1

Infection around the eyeball that involves tissues behind the orbital septum → life threatening emergency!

Question 2

What are the 3 important features that distinguishes orbital cellulitis from preseptal/periorbital cellulitis?

Answer 2

1. Pain on eye movement
2. Diplopia
3. Visual impairment

Question 3

What is preseptal cellulitis?

Answer 3

This is an eyelid and skin infection in front of orbital septum (does not spread past orbital spectrum).

Question 4

Give some features of orbital cellulitis

Answer 4

• Pain on eye movement
• Diplopia
• Visual impairment
• Reduced eye movements
• Abnormal pupil reactions
• Proptosis
• Fever

Question 5

1st line imaging in orbital cellulitis?

Answer 5

CT scan

Question 6

Management of orbital cellulitis?

Answer 6

• IV antibiotics
• ?surgical drainage

Question 7

How can orbital cellulitis lead to vision loss?

Answer 7

Due to compression of optic nerve or optic neuritis

Question 8

How can orbital cellulitis lead to death?

Answer 8

Due to cavernous sinus thrombosis or intracranial spread of infection

Question 9

What is the cause of preseptal cellulitis?

Answer 9

Sinusitis or damage to overlying skin.

Question 10

Typical presentation of preseptal cellulitis?

Answer 10

Child with erythematous swollen eyelid, mild fever and erythema surrounding the orbit.

Question 11

What is another name for a chalazion?

Answer 11

Meibomian cyst

Question 12

What causes a Meibomian cyst?

Answer 12

Occurs when a Meibomian gland becomes blocked and swells up (non-infectious).

Question 13

Presentation of a Meibomian cyst?

Answer 13

Swelling in eyelid – typically not tender (but can be tender and red).

Question 14

Management of a chalazion?

Answer 14

Hot compresses and eyelid cleaning regularly indefinitely plus simple eye lubricants (tend to resolve in a few weeks)

Question 15

What is a stye?

Answer 15

Abscess at an eyelash follicle often caused by staphylococcus.

Question 16

What pathogen typically causes a stye?

Answer 16

Staphylococcus

Question 17

Presentation of a stye?

Answer 17

‘Red hot lump’ that points outwards, causing pain and local inflammation.

Question 18

What is another name for a stye?

Answer 18

External Hordeolum

Question 19

What is blepharitis?

Answer 19

Inflammation of the eyelid margins.

Question 20

Which dermatological condition is often associated with blepharitis?

Answer 20

Acne rosacea

Question 21

Cause of blepharitis?

Answer 21

Can be associated with dysfunction of Meibomian glands (responsible for secreting oil onto surface of eye).

Question 22

Presentation of blepharitis?

Answer 22

• Sore, itchy eyelid margins with a crusty appearance at base of eyelashes
• ‘Gritty’ sensation in eyes

Question 23

What can blepharitis lead to?

Answer 23

Can lead to styles and chalazions.

Question 24

Management of blepharitis?

Answer 24

Lubricating eye drops e.g. Hypromellose

Question 25

What is a blocked nasolacrimal duct?

Answer 25

Blocked tear duct means tears can’t drain normally.

Question 26

Who does a blocked nasolacrimal duct typically present in?

Answer 26

Newborns - usually resolves in first year of life

Question 27

Presentation of a blocked nasolacrimal duct?

Answer 27

• Watery, irritated eye
• Dacrocystitis – inflammation of the lacrimal sac 2ary to obstruction within the duct, causing the backup and stagnation of tears

Question 28

What is dacrocystitis?

Answer 28

inflammation of the lacrimal sac 2ary to obstruction within the duct, causing the backup and stagnation of tears

Question 29

What is the most common type of skin cancer of the eyelid?

Answer 29

Basal cell carcinoma (often appears in lower lid)

Question 30

Where does sebaceous carcinoma of the eyelid arise from/

Answer 30

Meibomian glands