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168 Cards in this Set
- Front
- Back
what is blepharitis?
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infection or inflammation of the lids, lid margins, and/or lashes
|
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staph bleph =
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staphylococcal blepharitis
|
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most common type of blepharitis?
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staph bleph
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what is staph bleph?
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bacterial colonization of the lids and lashes
|
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which bacteria cause staph bleph?
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1) staphylococcus epiderMIDIS
2) staphylococcus aureus 3) corynebacterium 4) propionibacterium acnes |
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what is the most prevalent flora organism?
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staphylococcus epidermidis
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most common pathogen in ocular disease in US adults?
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staphylococcus aureus
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pathology of staph bleph?
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exact pathology unknown
1) direct microbial invasion of tissues 2) immune-system mediated damage 3) damage from bacterial exotoxins, waste products, and/or enzymes 4) demodex |
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what is demodex?
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intradermal parasite that is associated w/ staph bleph
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where does demodex live?
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in sebaceous glands and hair follicles of humans and animals
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demodex may cause, contribute to, play a role in, or be a consequence of __
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bacterial blepharitis
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T/F: controversy exists as to whether demodex is incidental, or whether its presence contributes to, or is even the primary cause of blepharitis and other skin infxns
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true
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T/F: demodex may be a side effect of a different primary infection w/ other microbes
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true
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how does demodex contribute to bacterial-related blepharitis?
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- by mechanical blockage
- host immune response (in pts w/ lowered immune system) |
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Tx for demodex?
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- Tx of non-ocular tissues is w/ topical antibiotics:
*** metronidazole gel and ointment (MetroGel) 2) tea tree oil 3) sodium sulfacetamide |
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oral version of MetroGel?
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flagyl
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T/F: metronidazole gel is FDA approved for ocular use
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false. however, it has been used to treat other eyelid conditions (acne, ocular rosacea)
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benefits and cons of sodium sulfacetamide?
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benefit - cost-effective
con - high allergy rate |
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causes of blepharitis?
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bacterial, seborrheic, viral , allergic, etc
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signs of staph bleph?
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1) scurfs or collarettes
2) hyperemia of lid margin 3) if chronic --> madarosis, trichiasis, poliosis, and tylosis ciliaris 4) if severe --> ulcerative blepharitis 5) can cause associated conjunctivitis --> papillary rxn on conj 6) may see corneal defects (inferior PEK) |
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complaints associated w/ staph bleph
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1) FBS
2) crusting of lids (esp in a.m) 3) itching, tearing, burning 4) symptoms associated w/ associated conjunctivitis (if present) |
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what are hard, brittle scales surrounding the lashes and on the lid margin
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scurfs or collarettes
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what is madarosis?
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loss of lashes
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what is poliosis?
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whitening of lashes
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what is tylosis ciliaris?
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thickening of lid margin
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what is it called when the lid margin thickens?
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tylosis ciliaris
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what is ulcerative bleph?
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ulceration of the lid margin when crusts are removed
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what are collarettes?
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lid debris from staph bleph;
surround the base of lashes |
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what are sleeves?
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long collaretes; more severe presentation
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what are scurves or scurfs?
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general debris around/on lashes, not specific for any diagnosis
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__ are general debris around the lashes while __ are debris from staph bleph
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scurfs;
collarettes |
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if you have ulcerative blepharitis, what drug should you use?
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antibiotic OINTMENT, not drop
|
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what are the corneal changes seen in staph bleph?
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1) inferior PEK
2) marginal infiltrates, ulcers, pannus, and phylctenues |
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what is the most common corneal defect seen in staph bleph?
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inferior PEK
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in what part of the cornea are changes associated w/ staph bleph most commonly seen?
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@ points where lids most frequently intersect the cornea
(2, 4, 8, 10 o clock) |
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Tx for staph bleph?
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1) lid hygiene (HOT compress, lid massage, lid scrubs) for almost all forms of bleph
2) may need Antibiotic to eradicate bacterial colonization of lid |
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T/F: azasite antibiotic drops BID is an off label use of the drug that is nevertheless commonly used
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true
|
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what drugs would you prescribe to a patient w/ staph bleph
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1) azasite antibiotic drops BID
2) antibiotic ung applied w/ a clean fingertip or sterile Qtip to the lid margin BID-QID (1/4 to 1/2 INCH RIBBON APPLIED TO LID MARGIN qhs) 3) sodium sulfacetamide (alone or in combo w/ steroid) 4) steroid-antibiotic combo ung when inflamm is as predominant as the infectious signs 5) severe --> oral antibiotics or request dermatology consult to control the infxn |
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staph bleph may become ___, leading to complications. careful compliance w/ lid hygiene instructions is necessary
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chronic
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___ compress is first
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warm
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vertical massage if any __component
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meibomian or seborrheic
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lid scrub instructions
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scrub gently w/ eyes CLOSED; DILUTED baby shampoo (1:1 w/ H2O)
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__ are available for lid scrubs
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commercial preps
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when would you consider scrubbing the eye w/ only H2O?
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W/ older pts or pts w/ sensitive skin types
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MGD =
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meibomian gland dysfunction
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MGD is a family of conditions that includes...
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1) SEBORRHEIC bleph
2) meibomianitis 3) meibomian seborrhea |
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another name of meibomianitis?
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meibomitis
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staph bleph is more of a ___ bleph while meibomianitis is more of a __ bleph
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anterior;
posterior |
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describe seborrheic bleph
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oily flakes and debris on eyelids and lashes
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what other conditions is seborrheic bleph usually associated w/?
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1) generalized seborrheic disorder (like acne rosacea or seborrheic dermatitis)
2) oily skin, eyebrows, etc |
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S/S of seborrheic bleph?
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1) scales and flakes (greasier than staph belph)
2) often associated w/ other MGD such as obstruction of the meibomian glands 3) BURNING |
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what is the primary symptom in all forms of MGD?
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burning
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what is seborrhea?
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an increase in the amt of normal meibomian secretions (oil) being liberated into the tear film and onto the lid margins
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___ is almost always seen in association w/ seborrheic bleph?
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meibomian seborrhea
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S/S of seborrheic bleph?
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1) burning (CC)
2) itching, tearing 3) FBS 4) *** foam in tear meniscus & oil slick appearance to tear film 5) may cause dec'd VA due to altered viscosity of tear film |
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T/F: for staph bleph, complaints often seem out of proportion to the clinical picture
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true
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___ is known as posterior bleph
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meibomianitis
|
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what is meibomianitis?
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stagnation or solidification of meibomian secretions
|
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does meibomianitis involve all the glands?
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- primary involves all glands
- secondary has scattered gland involvement |
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S/S of meibomianitis?
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1) domed caps on meibomian glands
2) thickened red lid margins w/ oily texture 3) reduced TBUT 4) seborrheic bleph |
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what happens when capped meibomian glands are expressed?
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a thick creamy material is liberated
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why do pts w/ posterior bleph have a reduced TBUT?
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b/c the outermost lipid layer of the tears is disrupted
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___ will most likely also be present in pts w/ meibomianitis?
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seborrheic bleph
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T/F: All stages of MGD are treated in the same way
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true
(Tx for seb bleph = Tx for meibomian seborrhea = Tx w/ meibomianitis) |
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Tx for MGD?
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1) careful lid hygiene - emphasize the compress/massage
2) use AT liberally 3) sometimes use oral meds 4) topical steroids 5) restasis if chronic 6) if systemic disease - co-manage w/ PCP, need topical and/or oral steroids and other systemic drugs 7) suggest shampoo for seborrhea |
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how would your lid instructions be diff for a pt w/ seb bleph compared to a pt w/ staph belph? why?
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for seb bleph, emphasize the compress/massage to loosen and liberate the secretions of the meibomian glands
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why would you use AT liberally after the hygiene procedure for pts w/ MGD?
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to wash out the oils that have been liberated
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why are oral meds sometimes necessary for MGD? what drugs can we use?
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- decrease oil secretions
- oral doxycycline and tetracycline are anti-seborrheic agents |
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would you ever use topical steroids for Tx of MGD?
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yes, it can be used SHORT-term to reduce significant ocular inflamm if it is present
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what is restasis? why would you use it to treat MGD?
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- restasis = cyclosporine A
- treats CHRONIC MGD as an option to steroids in ROSACEA |
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cyclosporine A is also known as __
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restasis
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use of __ for MGD is an off label Tx
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restasis
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what's an example of a systemic disease that is sometimes present in MGD pts?
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acne rosacea
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what might you suggest a pt with MGD to do?
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use Selsun on the scalp and eyebrows if necessary
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in what category do most cases of bleph fall into?
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mixed seborrheic-staphylococcal bleph
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Is the Tx for mixed seb-staph bleph the same as Tx for seb bleph or Tx for staph bleph?
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NO, neither
(no ung for mixed when seb is predominant!) |
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Tx for mixed seb-staph bleph
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1) lid hygiene
2) w/ or w/o antibiotics (dont use ung when seb is predominant) |
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when should you not use ointments? why?
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for mixed seb-staph bleph b/c ointments are greasy and may exacerbate an already oily lid, WHEN SEBORRHEA IS PREDOMINANT as opposed to bacterial
|
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when is lid scrub contraindicated?
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ulcerative bleph
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usual causes of angular blepharitis?
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moraxella or staphylococcus species
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S/S of angular bleph?
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1) chronic hyperemia
2) desquamation 3) ulceration of lateral and medial canthal regions 4) redness and tenderness of affected area |
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Tx for angular bleph?
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1) best - zinc sulfate 0.25% ointment (zincfrin)
2) alternative - erythromycin |
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how can zinc sulfate 0.25% be purchased?
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OTC w/o Rx
|
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brand name of zinc sulfate 0.25%?
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zincfrin
|
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what is phthiriasis palpebrarum?
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public lice infestation of lids and lashes
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______ is public lice infestation of lids and lashes
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phthiriasis palpebRARum
|
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S/S of phthiriasis palpebrarum?
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1) chronic bleph
2) FBS 3) itching 4) irritation 5) hyperemia 6) etc associated w/ other types of bleph |
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what does phthiriasis palpebrarum causes?
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chronic bleph
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Tx for phthiriasis palpebrarum?
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1) Stye ung (yellow mercuric oxide) or bland ointment for a min of 10 days
2) use forceps to manually tweeze to remove cilia to which nits are attached 3) clean lids/head/genitalia with RID (OTC) or kwell (Rx, avoid eye) shampoo 4) instruct on proper hygiene (launder linens, towels, etc) |
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how do you smother lice and their eggs on the lids and lashes?
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by slathering a thick layer of Stye ung or bland ointment for min of 10 days
|
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what is stye ung?
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yellow mercuric oxide
|
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what is bland ointment?
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unmedicated eye ointment normally used for lubrication
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what parts of the body should ppl with phthiriasis palpebrarum shampoo?
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1) lids
2) head 3) lice |
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difference b/c RID and Kwell
|
- they are shampoos for lice
- RID is OTC but kwell needs Rx - for kwell, must avoid eye area |
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what is an internal hordeolom?
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bacterial infection of the meibomian glands, deep w/in the lid
|
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what is bacterial infection of the meibomian glands, deep w/in the lid?
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internal hordeolum
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which has a prolonged onset and course, internal or external hordeolum?
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internal hordeoloum
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internal hordeolum may be associated w/ ___ and __
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preseptal cellulitis and staph bleph
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s/s of internal hordeolum?
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1) associated preseptal cellulitis or staph bleph
2) moderate to severe PAIN and WARM sensation of entire lid w/ very painful nodule w/in the inflamed lid 3) if severe - swollen PAN on SAME side |
|
PAN + pain and warmth in lid
Dx? |
internal hordeolum
|
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s/s of internal hordeolum are more common in the __ lid
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upper
|
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Tx for internal hordeolum?
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1) mild - hot compress, BID-QID w/ monitoring
2) moderate-severe - hot compresses as soon as ORAL antibiotics are on board 3) in resistance cases - surgical incision after lesion is quiet |
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MOA of hot compress?
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increases blood flow to area --> brings immune system component in more frequent proximity to the infxn
|
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why must you monitor pts w/ internal hordeolum closely?
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b/c hot compress can inadvertently spread the infxn to adjacent tissues if the infxn is too much for the immune system to neutralize on its own
|
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why don't topical antibiotics work for internal hordeolum?
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b/c they don't reach the infected lesion, which is within the meibomian glands
|
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internal hordeolum is bacteial infxn of __
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meibomian glands
|
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when is surgical incision done for pts w/ internal hordeolum? why?
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- only after the lesion is as quiet as possible w/ medical therapy
- to avoid spreading of infxn to entire lid (preseptal cellulitis) |
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describe the use of PAN to Dx internal hordeolum
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- PAN indicates moderates or severe (so use oral antibiotics)
- no PAN indicates mild |
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what is a stye?
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external hordeolum
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you must follow up w/ a pt w/ internal hordeolum for signs of __
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preseptal cellulitis
|
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difference b/w internal hordeolum and preseptal cellulitis?
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internal hordeolum is isolated to only a few glands but preseptal cellulitis involves the whole lid
|
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differentiate b/w internal hordeolum, external hordeolum, and chalazion
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- internal and chalazion both affect the meibomian glands while external affects the glands of zeis of moll
- internal and external are both bacterial infections while chalazion is lipogranulomatous inflamm |
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what is external hordeolum?
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acute bacterial infxn of a gland or glands of zeis or moll
|
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what type of bacteria usually cause external hordeolums?
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staphylococcal
|
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external hordeolum is almost always associated w/ ___
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staph bleph
|
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S/S of external hordeolum?
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1) localized area of redness, tenderness, and inflamm at LID MARGIN, rt adjacent to or surrounding a lash
2) yellow point 3) PAIN of acute and recent onset 4) associated w/ staph bleph 3) |
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what type of hordeolum involves pain of acute and recent onset?
|
external
|
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T/F: internal hordeolum is painful while external is not
|
FALSE
- both painful - prolonged onset for internal, recent onset for external |
|
Tx for external hordeolum?
|
1) usually drains w/o assistance w/in 3-4 days of pointing
2) HOT compress may hasten pointing 3) epilate 1-2 involved lashes to create drainage channel from infected glands OR puncture w/ a sterile needle THEN COVER W/ ANTIBIOTIC UNG |
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what is "pointing"?
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white capping (seen in external hordeolum)
|
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external hordeolum is a stye at __
|
the lid margin (adjacent to or surrounding a lash)
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what are 2 important differences b/w chalazion and hordeolums?
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1) chalazions are STERILE (NOT INFECTED)
2) chalazions are not painful |
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what is a chalazion?
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chronic, sterile, lipogranulomatous inflamm of meibomian gland due to abnormal retention of normal oily secretions
|
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cause of chalazion?
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abnormal retention of normal oily secretions
|
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chalazions may occur __ or may follow __
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spontaneously;
an internal hordeoloum infxn |
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what is chalazion commonly associated with?
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1) other meibomian lid disease
2) acne rosacea 3) concurrent or past belpharitis |
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how does a chalazion look like?
|
like a hard, immobile, NONTENDER lump. it can point...
1) towards external lid surface --> looks like lump on lid 2) inwards toward palpebral conj --> more visible w/ lid eversion |
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25% of cases of __ will resolve spontaneously over 6 months
|
chalazion
|
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how long does it take chalazions to resolve without treatment?
|
25% will resolve over 6 months
|
|
Tx for chalazion?
|
1) new and small - hot compress w/ vigorous digital massage QID x 4-6 wks
2) hard or large - directly INJECT steroids (injected from palpebral conjunctival side, not from skin side) 3) resistant - lanced (cut) and drained |
|
why are steroids used for chalazions w/ long-standing presence?
|
b/c the cells involved are inflammatory (so they're susceptible to steroids)c
|
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what does lanced mean?
|
cut
|
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why do antibiotics not work on chalazions?
|
b/c it's sterile and not infected
|
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what is a key differential Dx fo chalazion?
|
sebaceous cell carcinoma
|
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when should you suspect sebaceous cell carcinoma instead of chalazion?
|
1) it the chalazion is recurrent in the same location
2) if associated w/ LOSS OF LASHES (refer out - lesion needs to be lanced and biopsied) |
|
T/F: there is a high mortality rate w/ sebaceous cell carcinoma
|
true
|
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is sebaceous cell carcinoma, a rare or common tumor?
|
rare tumor
|
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what does sebaceous cell carcinoma involve?
|
the meibomian glands,
or less commonly the zeiss glands |
|
what can sebaceous cell carcinoma mimic?
|
chalazia, bleph, etc
|
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what is pyogenic granuloma?
|
highly vascular lesion that occurs after trauma or surgery, or more rarely an infxn
|
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super-responsive scar tissue is known as __
|
pyogenic granuloma
|
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how can pyogenic granuloma look like?
|
an internal hordeolum or chalazion
|
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T/F: pyogenic granuloma can appear in spots that previously had an internal hordeolum or chalazion
|
true
|
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pyogenic granuloma is mostly ___, NOT ___
|
small capillaries;
NOT REALLY PYOGENIC OR A GRANULOMA |
|
Tx for pyogenic granuloma
|
surgical excision
|
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what is preseptal cellulitis?
|
infxn of the eyelid anterior to the orbital septum and beneath the skin
|
|
what is the orbital septum?
|
the superficial surface lid tissue
|
|
general cause of preseptal cellulitis?
|
arises from pre-existing infxn in the anterior portion of the ocular structures
|
|
give examples of infxns (diseases) that can cause preseptal cellulitis?
|
dacryocystitis, conjunctivitis, internal/external hordeolum
|
|
what is dacryocystitis?
|
infxn in the lacrimal sac
|
|
how can infected material enter lid tissues (which causes preseptal cellulitis)?
|
a penetrating lid injury
|
|
S/S of preseptal cellulitis?
|
1) red
2) swollen 3) PAINFUL 4) WARM to touch 5) can have PAN on same side |
|
what organisms cause preseptal cellulitis?
|
1) KIDS - strep or H. flu
2) ADULTS - staph |
|
patients w/ preseptal cellulitis have an associated acute fever if they are infected w/ __
|
H. flu
|
|
Tx for preseptal cellulitis?
|
1) oral antibiotics
2) warm compress (once on oral Ab) 3) blood cultures 4) if suspect meningitis, hospital for lumbar puncture --- require IV antibiotics |
|
__ can help to identify the organism causing preseptal cellulitis if response to antibiotics is __
|
blood cultures;
slow or absent |
|
when would you suspect meningitis in a preseptal cellulitis pt?
|
if they have high FEVER or STIFF NECK
|
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if you suspect meningitis in a pt w/ __, the pt may be __
|
preseptal cellulitis;
hospitalized for a lumbar puncture |
|
some __ infections are associated w/ meningitis.
what drugs would be required in these cases? |
H. flu;
IV antibiotics |
|
what condition must you rule out when suspecting preseptal cellulitis?
|
orbital cellulitis
|
|
orbital cellulitis most often arises from __
|
sinusitis
|
|
which of the following is life-threatening, preseptal or orbital cellulitis? both? neither?
|
orbital cellulitis
|
|
in orbital cellulitis, you see the findings for preseptal cellulitis in addition to...
|
1) proptosis
2) limitation of EOMs 3) extreme pain 4) obliteration of the lid crease 5) dec'd VA 6) APD |
|
if there is any question about the diagnosis for preseptal/orbital cellulitis, what should you do?
|
hospitalize the pt immediately and/or seek a 2nd opinion STAT
(immediate referral to ER/hospital for IV antibiotic Tx) |
|
which of the following conditions are a medical emergency?
|
1) 3rd nerve palsy w/ pupil involvement
2) orbital cellulitis |
|
T/F: orbital cellulitis enlarges the lid crease?
|
FALSE; obliterates it
|
|
T/F: preseptal cellulitis is not painful, but orbital cellulitis is.
|
FALSE
both painful (but orbital is worse) |
|
external hordeola involve the __, at the glands of __
|
lid margin;
zeis and moll |