Periorbital problems Flashcards
Blepharitis:
What is it?
Presentation:
- Bi/unilateral
- Painful/painless
- What do the patients describe their eye as being?
- What may happen in the morning?
- Is there vision affected?
- Is it chronic or acute?
Inflammation of the eyelids
Bilateral
Painful
Eyelids are red, crusty, and may stick shut on waking
Intermittent blurring of vision
It is a chronic condition with flare ups
Blepharitis:
Management:
Eyelid hygiene - how is this performed?
What topical Rx can be used if hygiene is not enough?
Dry eyes may also present or make it worse. What can be prescribed for this?
Warm compress on closed eyes for 5-10 minutes once or more daily
Remove debris by using a soaked cotton bud
Topical antibiotic (e.g. chloramphenicol)
Lubricating eye drops/ointments
Stye and chalazion:
What causes a stye?
What causes C?
Presentation:
- Obvious symptom - MUMMY
- Stye - painful/painless
- Chalazion - painful/painless
Management:
- Advice given to patients
- What needs to be done if they keep recuring?
Acute eyelid swelling due to infection of eyelash follicle
Acute eyelid swelling due to blockage of meibomian gland
Red lump on eyelid
Painful
Usually painless though may be painful initially or as it grows significantly
Warm compresses 3 times daily - they self resolve
Incision
Dacryocystitis:
What is it?
Presentation:
- Where do you get pain, redness and swelling?
- What may you get purulent discharge coming from?
- You can get epiphora. What is it?
- What could it potentially progress to?
Management:
- Advice - 1
- Meds - 2
- When will it need incision and drainage?
- What can be done if it becomes a chronic problems?
Inflammation of the lacrimal sac, usually due to nasolacrimal duct obstruction and infection.
Lacrimal sac - so inferior medial to the eye
The punctum of the eye - the medial corner basically
An overflow of tears onto the face, other than caused by normal crying. It is a clinical sign or condition that constitutes insufficient tear film drainage from the eyes.
Warm compress
Co-amoxiclav or cefalexin
If extensive
Dacryocystorhinostomy
Periorbital and orbital cellulitis:
What is periorbital cellulitis? What is another name for it?
What is used to dictate if it is periorbital and orbital cellulitis?
What is orbital cellulitis?
Why is orbital cellulitis sight-threatening and why is it potentially life-threatening?
Infection of the periorbital skin and soft tissue, anterior to the orbital septum.
The orbital septum
Infection of the fat or muscles within the orbital cavity
Damage to the optic nerve
Intracranial spread
Periorbital and orbital cellulitis:
What infections could spread to the orbit?
What group of people is it commoner in?
Sinusitis
URTI
Facial cellulitis
Dacryocystitis
Children
Periorbital and orbital cellulitis:
General presentation of both - 3
What would suggest it is orbital? - 4
What pupillary defect may also present?
A painful, red, swollen eyelid
Reduced/painful eye movement
Proptosis - exophthalmos
Visual impairment
Diplopia
Relative afferent pupillary defect
Periorbital and orbital cellulitis:
Investigations:
What type would you investigate further for?
Orbital cellulitis
Periorbital and orbital cellulitis:
What bloods are done for orbital cellulitis?
What imaging should be done?
What can be done to any local discharge?
FBC - baseline - WBC for infection
U&E - baseline
CRP - inflammation
Blood cultures
CT head with contrast - looking for abscesses behind eye and cavernous sinus thrombosis.
Swab for microbiology
Periorbital and orbital cellulitis:
AB for periorbital C? Route?
AB for orbital C? Route?
What monitoring is needed for orbital C?
Why may surgery be needed?
Co-amoxiclav PO
Antibiotics IV (e.g. ceftriaxone)
Visual acuity
Orbital decompression and abscess drainage in severe cases
