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49 Cards in this Set
- Front
- Back
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What does SOAP stand for and give a brief example for each.
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S = Subjective-Everything the patient says
O = Objective-All the doctors observes and all the test results A = Assessment- What is wrong with the patient P = Plan- what is going to be done |
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where is the inflammation with anterior blepharitis?
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centered around eyelashes
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most common type of anterior blepharitis? and two others
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staphylococcal (aureous or epidermadis)
and seborrheic, mixed |
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where is the inflammation with posterior blepharitis?
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involving meibomian gland adn gland orfices. AKA meibomianitis.
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what type of bacteria are staphylococcal?
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gram + cocci
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what are the three types of blepharitis?
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anterior, posterior, and angular
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what is the etiology of staph bleph?
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the overgrowth of normal flora S. aureus or S. epidermidis. this causes an inflammatory response.
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what is the secondary mechanism of inflammation with staph bleph?
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the bacteria produce lipase which breaks down lipids in the tear film creating free fatty acids. this triggers inflammatory and irritative response.
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what makes up pus
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dead PMNs and protein clots
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what are PMN's?
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polymorphonuclear leukocytes (WBC's) that move into the tissues during an inflammation response
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staph bleph subjective responses?
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may be asymptomatic, depends on severity. chronic irritation and burning, FB sen,tender lids (could have recurrent hordeola or chalazia), crusts on lashes, stuck lids, pt may complain of red irritated lids.
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objective findings with staph bleph?
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Crusts along the lash line at the base of the lashes
Dried pus |
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Crust can encircle lash are called what?
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collarette
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will the crusts always be crusty?
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no they could have an oily appearance but there is still the presentation of yellow goodness.
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loss of lashes due to staph bleph is called what?
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Madarosis- I am mad as hell b/c I am losing my lashes from a bacterial infection.
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scoops out of the epi at the base of the lashes is called what? in this case dealing with staph bleph
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ulcerated lid margin
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staph bleph can also cause a misdirection of the lashes called? the tx for this is?
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trichiasis, epilation
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red and thickend lid margins mostly seen with chronic staph bleph is known as? adn the lids may become ____over time?
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called tylosis and the lids may become hard over time.
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the pt may have _____ secondary to staph bleph. and it has two names.
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conjunctivitis that is usually papillary and it may also be called staph blepharoconjunctivitis
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PEE is a possible objective finding of staph bleph. how is this formed?
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The baceria produce exotoxins that damage the cornea.
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what is the difference b/t PEE and an ulcer of the cornea?
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PEE is only missing epi. an ulcer is hole that has missing epi and dermis (or stroma).
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tx of staph bleph includes?
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lid hygiene, remove crusts, remove bacteria, increase blood flow by performing a warm compress and lid scrub.
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when staph bleph is severe you may need to use an antibacterial ointment. name four of them?
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bacitracin (classic), erythromycin (good for pressure patching), gentaicin, and tobramycin (best <allergy)
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how many times should a pt apply the antibiotic ointment for moderate and severe staph bleph?
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Moderate: qhs or bid
Severe: tid or qid |
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If the staph bleph is extremely severe you may need to use?
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oral antibiotics such as doxycycline 100 mg PO bid for 7-10 days
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how can antibiotics like tetracycline or doxycycline be helpful even if the bacteria is resistant to it? (staph bleph)
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tetracyclines inhibit the lipase synthesis by the bacteria and doxycycline inhibits exotoxin induced cytokines and chemokines. they also have an antiinflammatory response.-good for rosacea.
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how long should you wait for a follow up if the cornea is not involved and if it is when dealing wiht staph bleph?
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1-3 weeks depending on severity when its not and only days if it is.
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important points for patient education when talking about staph bleph?
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Chronic condition - Usually exacerbations and remissions
Goal: to control not cure Importance of daily lid hygiene Medication for acute flare-ups |
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a pt with staph bleph may have WBC's infiltrate their cornea. where are they located can they do damage?
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in the periphery b/t the epi and the stroma. they can damage the cornea when they die b/c they release enzymes.
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when a pt has staph bleph and they also have WBC deposits in the cornea this is reffered to as?
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staph bleph associated marginal infiltrate.
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marginal infiltrates are usually found in what part of the cornea?
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typically in the lower regions b/c they fall to the bottom. but they can be found on the top.
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does a marginal infiltrate stain with flourocine?
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no not unless the epi has been broken for some reason. usually you will just see a pooling due to a low spot on the surface.
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tx for marginal infiltrate associated with staph bleph?
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treat the staph bleph and also add a topical steroid q2h to qid such prednisolone acetate, dexamethasone or loteprednol. or use a combo antibiotic/steroid like tobradex or zylet.
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what is the name of a raised white lesion due to hypersensitivity to staph toxins and where is it located?
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phlyctenule. may be on the conj limbus or cornea and may move across the cornea pulling vessles with it and creating a scar.
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How do you treat a phlyctenule associated with staph bleph?
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treat the staph bleph and also add a topical steroid q2h to qid such prednisolone acetate, dexamethasone or loteprednol. or use a combo antibiotic/steroid like tobradex or zylet.
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what was the most common cause of phlyctenule several years ago? what is it now? why?
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was TB, now it is staphylococcus. b/c we are better at controling TB.
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seborrheic blepharitis is often associated with what?
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seborrheic dermatitis a disorder of the skin in areas with abundant sebaceous glands. also dandruf (scurf)
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subjective associations for seborrheic blepharitis?
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Frequently asymptomatic
Possible morning “mattering” Dry eye complaints (poor tear film), Symptoms may depend on other concurrent processes |
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objective findings for seborrheic blepharitis
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greasy, waxy scales at the base of the lashes that flake off easily (scurf). skin of the lids a little greasy.
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what kind of corneal damage can occur due to seborrheic blepharitis?
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Interpalpebral PEE that is located more centrally.
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Tx for seborrheic bleph?
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plain jane. lid hygiene, lubricants, follow up 2-4 weeks, patient ed on chronicity.
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Mixed bleph is a combo of whay?
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staph bleph and seborrheic bleph.
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Tx for mixed bleph?
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same as just staph bleph. use an antibiotic such as tobramycin.
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functionally what is going on with meibonian seborrheic blepharitis?
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excessive oil production, and quality of oil is abnormal. sujective complaint is dry eye.
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objective findings for meibomian seborrheic blepharitis?
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frothing os tears, oil slick, TBUT may be reduced conj injection, lie tissue is normal
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Tx for meibomian seborrheic bleph?
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keep lid margins clean and lubricants.
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angular blepharitis what is it?
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Localized eczematoid inflammation of the lid at the outer canthus and sometimes medial canthal region. may also involve the conj.
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there are two types of angular bleph. what are they
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1 staphylococcal form, dry and scaly
2 moraxella form, wet, macerated lid with whitish frothy discharge. |
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Tx for Angular blepharitis?
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treat with an antibiotic ointment.
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