Ant Seg Test 2 - Diseases Of The Eyelids

Front 1

madarosis

Back 1

loss of eyelashes

Front 2

hypertrichosis

Back 2

excess eyelashes

Front 3

poliosis

Back 3

whitening of eyelashes

Front 4

trichiasis

Back 4

inward turning of eyelashes

S/S: F.B. sensation, epiphora, normal lid position, inferior lid more involved, F.B. tracking on cornea

Tx: epilation

Front 5

distichiasis

Back 5

accessory row of eyelashes, can arise from meibomian glands

S/S: F.B. sensation, corneal abrasions

Front 6

phthiriasis palpebrarum

Back 6

eyelash pubic lice infestation (can also be infested with head lice, spacing of lashes ideal for pubic lice)

S/S: irritation/itching, Hx of crab lice exposure, crusty lid margins with brownish discoloration, nits (eggs), 2° keratoconjunctivitis

Front 7

allergic blepharitis

Back 7

usually type I (H1-mediated), less often type IV (cell-mediated)

S/S: allergic blepharedema; Hx of allergies, skin conditions, itching, eye rubbing, allergen contact; unilateral with contact, bilateral contact or endogenous, edema, erythema, eczema

Tx: remove allergens, cold compress

Front 8

contact dermatitis

Back 8

type IV (cell-mediated) inflammation 12-72h after direct contact with allergen or irritant

known irritants: local anesthetic, aminoglycosides (neomycin (neosporin)), bacitracin, BAK, Thimerosal, atropine, timolol, nail polish, lanolin, nickel

S/S: scaly eruptions of skin, blepharedema, erythema, crusting, itching, conjunctivitis

Tx: avoidance, OTC hydrocortisone 0.5%, oral anti-H1

Front 9

Herpes Simplex blepharitits (HSV)

Back 9

HSV 1 or 2; primary (usually children), secondary, or recurrent infection

S/S: dry contact, mild lid discomfort, possible cold sores on lip, usually unilateral lower lid, small fluid-filled vesicles (cold sores) which turn yellow over 3-5 days then crust over 7-10 days, ocular surface may be infected

Front 10

Herpes Zoster

Back 10

CN V Varicella infection, chickenpox > shingles, HZV ophthalmicus, "great mimicker"

S/S: tingling of scalp on affected side and itching indicate oncoming attack, pain (potentially severe), unilateral to midline of face, fluid filled vesicles, erythema, usually upper eyelid, lymphadenopathy, post-herpetic neuralgia (pain)

Tx: oral/topical steroids

Front 11

impetigo

Back 11

Strep. or Staph. infection of the lid

Front 12

erysipelas

Back 12

acute skin infection (cellulitis) with raised borders

Front 13

necrotizing fascitis

Back 13

-bacterial infection in which toxins destroy flesh

-DDx includes cellulitis and mucormycosis

Front 14

chronic blepharitis

Back 14

-most common form

-anterior, posterior, meibomionitis

Front 15

anterior blepharitis

Back 15

-affects lashes and ant. lids

-Staph., seborrheic, mixed, mites

Front 16

anterior blepharitis, Staph.

Back 16

S/S: burning, grittiness, crusting and redness of lid margins, worse in morning (due to incubation from ↑ temp. at night), dry eye, hyperemia and telangiectasia (dilated superficial blood vessels) of ant. lid margin and collarettes (hard scales at base of lashes)

Tx: lid hygiene, oral/ointment ABx, ABx-steroid ointment

Front 17

anterior blepharitis, seborrheic

Back 17

problem with oil production/secretion

S/S: burning, grittiness, crusting and redness of lid margins, dry eye (↓ TBUT), hyperemia, greasy lid margins, scales are soft and greasy and located anywhere on lid margin and lashes, madarosis (loss of eyelashes), trichiasis, and poliosis

Tx: lid hygiene BID to QID, treat associated dermatological conditions, art. tears

Front 18

anterior blepharitis, mixed

Back 18

Staph. and seborrheic

S/S: burning, grittiness, crusting and redness of lid margins, worse in morning (due to incubation from ↑ temp. at night), dry eye, S/S related to individual Staph. and seborrheic conditions

Front 19

anterior blepharitis, mites

Back 19

mites are present in everyone, cause problem if they grow out of control and spread bacteria

Front 20

posterior blepharitis

Back 20

-affects meibomian glands -> excessive secretion

S/S: burning, grittiness, crusting and redness of lid margins, worse in morning (due to incubation from ↑ temp. at night), dry eye, capped meibomian glands, foam, tear film instability, keratitis

Front 21

meibomianitis

Back 21

inflammation and obstruction of meibomian glands

S/S: inflammation and obstruction of meibomian glands, chalazions, unstable tear film, bulbar injection

Tx: hot compress, gland expression, art. tears, oral tetracycline (normalizes sebaceous gland secretion)

Front 22

benign nodules and cysts

Back 22

-chalazion
-internal/external hordeolum
-Molluscum Contagiosum (pox virus)
-Xanthelasma
-cysts of Moll
-sebaceous cyst
-milia

Front 23

chalazion

Back 23

meibomian cyst; chronic, sterile, lipo-granulomatous inflammatory lesion caused by a blockage

S/S: gradually enlarging painless nodule, upper lid pressing on cornea > astigmatism, non-tender roundish firm lesion within tarsal plate

Tx: hot compress, digital massage, IL steroid injection, ABx typically useless, if repeated rule out sebaceous gland carcinoma

Front 24

internal hordeolum

Back 24

abscess caused by an acute Staph. infection of meibomian gland

S/S: painful, swelling, lesion within tarsal plate, may enlarge > thin discharge posteriorly through palpebral conjunctiva (usually) or anteriorly through skin (sometimes)

Tx: hot compress QID, oral ABx, stab incision, topical ABx not effective (can't reach lesion)

Front 25

external hordeolum

Back 25

stye; acute Staph. infection of eyelash follicle

S/S: painful (↑ as size ↑), points anteriorly through the skin, multiple lesions may be present

Tx: hot compress (will get bigger then pop), topical ABx, epilation, stab incision, oral ABx only if it spreads

Front 26

Molluscum Contagiosum

Back 26

wart-like growths caused by a pox virus, typically affects children or immunocompromised

S/S: pale waxy umbilicated nodule on lid, possibly in conjunction with conjunctivitis

Tx: excision

Front 27

Xanthelasma

Back 27

yellowish bump/plaque (benign) resulting from buildup of cholesterol/lipids under the skin, usually medial lids, common, often bilateral, middle-aged/elderly or people with hyperlipidemia (recommend have lipid panel done)

Tx: excision

Front 28

cysts of Moll

Back 28

suderiferous (sweat / glands of Moll) cysts

Tx: excision

Front 29

Milia

Back 29

plugged sebaceous glands; whiteheads

Front 30

benign tumors

Back 30

-viral wart (squamous cell papilloma)
-seborrheic keratitis (basal cell papilloma)
-actinic keratitis
-cutaneous horn
-nevi
-keratoacanthoma
-hemangioma (strawberry nevus)
-port wine stain (nevus flammeus)

Front 31

viral wart

Back 31

squamous cell papilloma, verrucae (wart), most common benign tumor of the lids

S/S: pedunculated (cauliflower-looking) or sessile (flat) lesion with a raspberry-like surface

Tx: excision, bichloroacetic acid

Front 32

seborrheic karatosis

Back 32

basal cell papilloma, common slow-growing lesion of the face and lids of the elderly

S/S: brown often raised lesion, greasy in appearance

Front 33

actinic keratitis

Back 33

scab-like lesions resulting from sunburn

Front 34

cutaneous horn

Back 34

hyperkeratotic lesion protruding through skin like a horn

Front 35

nevus (pl. nevi)

Back 35

(nee-vuhs); freckle

Front 36

keratoacanthoma

Back 36

firm dome-shaped lesion, looks like sebaceous cyst (DDx: bleeds, unlike cyst), mild form of squamous cell carcinoma

Front 37

hemangioma

Back 37

strawberry nevus / capillary hemangioma, often 2° to glaucoma

Tx: photodocument, send to dermatologist, laser Sx

Front 38

port wine stain

Back 38

nevus flammeus; vascular birthmark caused by dilated blood vessels

Front 39

malignant tumors

Back 39

caused by UV

-basal cell carcinoma
-squamous cell carcinoma
-sebaceous gland carcinoma
-melanoma

Front 40

basal cell carcinoma

Back 40

most common / least serious malignancy, locally invasive but non-metastasizing, noduloulcerative (most common) or sclerosing (most aggressive; hardening)

Front 41

squamous cell carcinoma

Back 41

clinically indistinguishable and much less common but potentially more aggressive than basal cell carcinoma; plaque-type, nodular, or ulcerating

Front 42

sebaceous gland carcinoma

Back 42

rare, arising from meibomian glands, recurrent chalazion = possible sign

Front 43

melanoma

Back 43

rarely develops on eyelids, can be lethal

Front 44

any lesion that _____, _______, _____, or ______ needs to be looked at by a dermatologist

Back 44

grows, changes, scabs, or bleeds

Front 45

ectropion

Back 45

outward turning of eyelids, can be of involutional (senile), cicatricial (scarring), or paralytic etiology

S/S: chronic epiphora, atonia (loose lid)

Tx: art. tears PRN, bland ointments, bandage CL, lid Sx

Front 46

entropion

Back 46

inward turning of eyelids, esp. lower lid, results in trichiasis, can be of involutional (senile), cicatricial (scarring), or paralytic etiology

S/S: F.B. sensation, spasms, keratitis

Tx: epilation, art. tears, prophylactic ABx, lid Sx

Front 47

ptosis

Back 47

abnormally low upper eyelid, may be congenital or acquired

-neurogenic
-myogenic
-aponeurotic
-mechanical

Front 48

neurogenic ptosis

Back 48

innervation defect such as a CN III nerve

Front 49

myogenic ptosis

Back 49

myopathy of levator muscle or impairment of NMJ function, acquired ptosis occurs in myasthenia gravis and myotonic dystrophy

Front 50

aponeurotic ptosis

Back 50

defect in levator aponeurosis (tendon)

Front 51

mechanical ptosis

Back 51

gravitational effect of a mass or scarring

Front 52

ptosis Hx

Back 52

other symptoms of systemic disease, such as associated diplopia or variability of ptosis throughout the day, point to diseases such as myasthenia gravis and myotonic dystrophy

Front 53

proptosis

Back 53

abnormal protrustion of the globe, may simply be pseudo-proptosis

Front 54

dermatochalasis

Back 54

acquired; redundant eyelid skin (bagginess) in elderly

Tx: surgery (common)

Front 55

blepharochalasis

Back 55

acquired, recurrent episodes of non-pitting edema stretch eyelid skin which becomes redundant (baggy)

Front 56

floppy eyelid syndrome

Back 56

chronic palpebral conjunctivitis; rubbery, floppy, easily inverted upper lid; seen in obese, middle-aged men with sleep apnea, eyelids evert during sleep and eye rubs on pillow (assoc. with keratoconus)

Front 57

lid retraction

Back 57

wide-eyed look

Front 58

myokymia

Back 58

eyelid twitching due to lack of sleep, caffeine, and stress

Tx: anti-H1 drops (reduce muscle latency)

Front 59

essential blepharospasm

Back 59

bilateral involuntary eyelid closure due to contraction of orbicularis oculi, 40s-50s, emotions can exacerbate

Tx: Botox