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185 Cards in this Set
- Front
- Back
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What does Blepharitis refer to
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a variety of infectious and inflammatory disorders of the eyelid margin
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What is Staphylococcal Blepharitis caused by
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many different bacteria: staphylococcus epidermis, Staphylococcus aureus, Propionibacterium acnes, Corynebacterium species, and
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What are the clinical signs and symptoms of Staphylococcal Blepharitis
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Hard brittle scales surrounding the lashes and on the eyelid margin / Hyperemia of lid margin
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If staphylococcal blepharitis is chronic what signs may you see
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madarosis, trichiasis, poliosis, tylosis ciliaris / ulceration / sometimes may cause associated conjunctivitis, evidence by papillary reaction upper lid / PEK
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What do the patients complain of with staphylococcus blepharitis
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FBS, crusting of lids especially in a.m., itching, tearing, burning
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What is the treatment for staphylococcus blepharitis
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Lid Hygiene / antibiotic ung BID-QID.
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What is the treatment for severe staphylococcus blepharitis
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add oral antibiotics (bacitracin, polysporin, erythromycin), topical steroid-antibiotic ung, request a dermatology consult to control infection. Stress to the patient this may become chronic must do lid hygiene
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Describe conditions associated with Seborrheic Blepharitis
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associated with generalized seborrheic disorder. The patient may show oily skin, eyebrows etc.
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what are the clinical signs and symptoms of seborrheic blepharitis
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similar to staph bleph but scales and flakes are much greasier and softer.
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what is seborrheic blepharitis associated with
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meibomian gland dysfunction (MGD)
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what is the treatment for seborrheic blepharitis
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lid hygiene, may need to refer pt to PCP for treatment of systemic condition, use shampoo for seborrhea
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which drugs may be given in severe cases of seborrheic blepharitis
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doxycycline or tetracycline because the side effects of these drugs are anti-seborrheic
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Describe Meibomian Seborrhea (with seborrheic blepharitis)
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seborrhea refers to an increase in the amount of normal meibomian secretions being liberated into the tear film and onto the lid margins
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c/o meibomian seborrhea
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burning, itching, tearing, FBS. Patients complaints often seem out of proportion to clinical picture
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clinical s/s for meibomian seborrhea
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biggest clue is foam in the tear meniscus and oil slick appearance to tear film. May cause decreased vision due to altered viscosity of the tear film
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what is the treatment for mebomian seborrhea
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lid hygiene with extra emphasis on vigorous lid massage; add artificial tears after hygiene to remove extra oils / in severe cases use tetra or doxycycline to decrease lipid secretions (not as an antibiotic)
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s/s of meibomianitis
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stagnation or solidification of meibomianitis secretions. Doomed caps. thickened red lid margins with oily texture. Reduced tear break up time
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what other condition will present often times with meibomianitis
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seborreah blepharitis
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is meibomianitis localized or scattered
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may have scattered gland involvement or may involve all glands
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treatment for meibomianitis
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lid hygiene. In resistant cases add doxycyline or oral tetracycline as an antiseborrheic
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how long does it take to treat meibomianitis
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several weeks. In moderate to severe cases a lower maintenance dose may be necessary for long-term treatment
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what is the catagory most cases of blepharitis will fall into
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mixed seborrheic-staphylococcal blepharitis
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treatment for seborrheic-staphylococcal blepharitis
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treat for staph bleph alone. Try not to use ointment because this will exacerbate an already oily lid
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what is angular blepharitis caused by
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Moraxella or Staphylococcus species
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s/s of angular blepharitis
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chronic hyperemia, desquamation and ulceration of lateral and medial canthal regions. c/o redness, tenderness of affected area
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treatment of angular blepharitis
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zinc sulfate 0.25% ointment / erythromycin ointment as an alternative
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what is phthiriasis palpebrarum
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pubic lice infestation of eyelids and eyelashes
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what does phthiriasis palpebrarum cause
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chronic blepharitis
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treatment of phthiriasis palpebrarum
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use stye ung (yellow mercuric oxide) or bland ointment. Remove cilia to which nits are attached with forceps. Clean lids and other hair with RID or Kwell. Instruct on hygiene, lauder linens, towels etc.
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what is bland ointment
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unmedicated eye ointment normally used for lubrication
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what does the treatment for phthiriasis do and how long does it take
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it smothers the lice. It takes 10 days.
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what causes internal hordeolum
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staphylococcal infection of meibomian glands deep within the lid
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s/s of internal hordeolum
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prolonged onset and course vs. external hordeolum. May have an preauricular lymph node on same side. More common on upper lid
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what other disease is this associated with
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preseptal cellulitis. Staph Bleph
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cheif complaint of patient for internal hordeolum
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moderate to severe pain and warm sensation of entire lid with a very painful nodule within the inflamed lid
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treatment for mild internal hordeolum
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hot compress alone BID-QID
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treatment for moderate to severe cases for internal hordeolum
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Hot compress with oral antibiotics (dicloxacillin, amoxicillin or erythromycin)
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Why do you need to monitor an internal hordeolum closely
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because any time you add heat to a tissue it increases bld flow to and from that tissue and in this case you could spread the infection to adjacent tissues
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can you use topical antibiotics for and internal hordeolum
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NO. doesn't work won't reach site of infection
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When is surgery necessary for an internal hordeolum
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a surgical incision is necessary only in resistant cases and is usually done after the lesion is as quiet as possible with medical therapy to avoid spreading of infection to entire lid (preseptal cellulitis)
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what causes an external hordeolum
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an acute staph infection of glands of zeis or moll
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s/s of external hordeolum
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localized areas of redness, tenderness, and inflammation at lid margin. May have a yellow pt on tip of bump. Looks like a zit
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c/c of patient external hordeolum
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pain of acute and recent onset
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treatment for external hordeolum
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usually drain w/o assistance in 3-4 days of pointing. Hot compress may hasten pointing. May epilate 1-2 lashes to create a drainage channel. May puncture with stirile needle to facilitate draining
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for an external hordeolum what must be done in all cases
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antibiotic ung (gentamicin) during acute phase to prevent the material infecting surrounding ocular tissue when drain
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what is a chalazion
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a chronic sterile (noninfected) lipogranulomatous inflammation of meibomian gland due to the abnormal retention of normal oily secretions.
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Does a chalazion occur spontaneously?
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It may occur spontaneously or may follow an internal hordeolum infection
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what other disease is this associtated with a chalazion
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meibomian lid disease and acne rosacea
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characteristics of a chalazion
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hard, immobile, nontender lump. Can point towards external lid surface or inwards toward palpebral conjunctiva
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treatment for a mild chalazion
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25% will resolve spontaneously without treatment over 6 months.
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treatment for a mild to moderate chalazion
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use hot compress with vigorous digital massage QID for 4-6 weeks.
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treatment for a severe to resitant chalazion
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many will require a more aggressive treatment in the form of steroids injected directly into the granuloma or lance and drain
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what is an example of a steroid that is used for a chalazion
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kenalog-10
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why are steroids used for a chalzion
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steroids are used because the cells involved are inflammatory and therefore susceptible to steroids
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why don't topical or systemic antibiotics work for a chalazion
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because the lesion is sterile
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what is a key differential diagnosis for a chalzion
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sebaceous cell carcinoma. If chalzion is recurrent in the same location or if lose lashes. Must do biopsy in these cases
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what is preseptal cellulitis
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infection of eyelid anterior to orbital septum
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what preexsting infections can lead to preseptal cellulitis
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dacryocystitis, conjunctivitis, or internal or external hordeolum. A penetrating lid injury
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s/s for preseptal cellulitis
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lid is red, swollen,painful, and warm to touch, may have Preauricular lymph node swelling on same side. If H. flu will have a fever
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what bacteria causes preseptal cellulitis usually
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strep or H. flu in kids; staph in adults
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What is the treatment for preseptal cellulitis
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Hot compresses with oral antibiotic
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which antibiotics do you use for preseptal cellulitis
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oral amoxicillin, dicloxacillin (staph) or cephalosporin (h. influ)
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why may you need to hopspitalize someone with preseptal cellulitis
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for a lumbar puncture if suspect meningitis (high fever stiff neck)
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what are h. influ preseptal cellulitis associated with and treatment for it
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meningitis. IV antibiotics are required in these cases
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What must preseptal cellulitis be differentiated from
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orbital cellulitis
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what are the key differences between preseptal cellulitis and orbital cellulitis
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in orbital cellulitis you see in addition to the findings for preseptal cellulitis proptosis and limitation of extra ocular motility, extreme pain, decreased vision, and an APD
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Describe Coloboma
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a rare condition in which there is an absence of a portion of the eyelid.
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what part of the eyelid does coloboma effect usually
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usually unilateral and involves upper lid usually the medial to middle third
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what are some of the signs of having coloboma
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exposure keratopathy (happens when 30% or more of the lid is absent)
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treatment for coloboma
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protect the cornea with artificial tear drops and ointments, use antibiotic ointment if corneal infection is present or is a risk. refer for lid replacement surgery when appropriate
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when the lid is 75% missing in coloboma what is the treatment
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need surgery within 48 hours of birth if less severe postpone surgery until 306 months of age
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Distichiasis
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accessory row of lashes which originate at meibomian orifices
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how is distichiasis inherited
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A/D
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signs of distichiasis
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may see corneal staining from the lashes scraping the cornea. Accessory lashes are generally smaller, shorter and more delicate than regular lashes
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treatment for distichiasis
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none unless cornea is involved.
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treatment for distichiasis if mild to severe
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mild cases: lubrication of cornea. more advaced: epilation, electrolysis, cryotherapy
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Describe epicanthal folds
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a redundant fold of skin in medial canthus
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what does epicanthal folds mimic
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esotropia
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treatment for epicanthal folds
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none
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definition of ptosis
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drooping eyelid. 2mm or more of the superior cornea being covered by the upper lid
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what else is ptosis called
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blepharoptosis
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what are the important measurements for diagnosing ptosis
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interpalpebral fissure, lid crease height, margin pupillar distance, levator excursion
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what are the important measurements for diagnosing ptosis use abreveations
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IF, LC, MPD (MRD), Levator excursion
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describe interpalpebral fissure measurement
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measure at its widest point
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what is the normal measurement for the interpalpebral fissure
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the upper lid is about 1mm below the superior limbus
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describe lid crease height measurement
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margin of lid to the crease (crease is where levator muscle inserts)
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what is an epiblepharon
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an extra lid crease
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describe the margin pupillary measurement
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from pupillary reflex to lid margin
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what is another name for margin pupillary measurement
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margin reflex distance
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levator excursion measurements
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full excursion in mm of upper lid, measured from complete down gaze to complete upgaze
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what are the two types of ptosis
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aquired and congenital
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what is a sign of aquired ptosis
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the upper lid of affected eye is lower than normal eye in downgaze
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what are the 3 types of aquired ptosis
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neurogenic, mechanical, myogenic
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which neurogenic problems are ptosis associated with
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3rd nerve palsy, horner's syndrome
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s/s of 3rd nerve palsy
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eye is down and out (diplopia)
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when does 3rd nerve palsy become serious
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when the pupil is involved. Send person to neurologist STAT
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treatment for 3rd nerve palsy
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if pupil is not involved follow daily for at least a week to make sure doesn't become involved
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why does 3rd nerve palsy happen
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usually because of vascular orgin (tiny emboli)
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what is horner's syndrome
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interruption of sympathetic innervation to Mueller's
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what is horner's associated with
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ipsilateral miosis and facial anhydrosis (can be aquired or congenital)
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what is a mechanical aquired ptosis
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caused by excess weight of lid swelling, tumors, masses, conjunctival scarring
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what is an example of mechanical aquired ptosis
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dermatochalasis
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what is dermatochalasis
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draping of superior lid over septum or lid margin
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who is dermatochalasis seen in and why
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older patients from loss of elastin the effect of gravity and weak connective tissue
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what must you distinguish dermatochalasis from
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blepharochalasis and steatoblepharon
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describe blepharochalasis
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a RARE intermittent lid edema seen in young patients; the edema causes a relaxation of eyelid tissue and subsequent atrophy
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describe steatoblepharon
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herniation of orbital fat through a weakenend orbital septum (from age)
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what causes aquired myogenic ptosis
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aponeurotic, myasthenia gravis
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why does aponeurotic cause myogenic aquired ptosis
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the levator insertion has been pulled back or it has lost its grip on the lid
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how do you diagnose aponeurotic myogenic aquired ptsosis
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lid crease increase. can treat with surgery easily
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how does myasthenia gravis cause ptosis
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loss of ACh receptors. It is variable ptosis
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what are the treatments for aquired ptosis
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ptosis crutch, surgical correction, treat underlying condition, phenylephrine for mild horner's
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congenital ptosis
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developmental anomaly of levator
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sign of congenital ptosis
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lid lag in down gaze. If the right eye is ptotic in straight gaze the left eyelid will be lower than the right in downgaze
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treatment of congenital ptosis
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delay surgery until apprx. age 4 unless severe
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s/s floppy eyelid syndorme
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soft rubbery tarsal plate; upper eyelid is easily everted
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what happens during sleep with someone who has a floppy eyelid syndrome
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during sleep palpebral conj rubs against bedding and causes a superior palpebral papillary response and possibly SPK
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what is floppy eyelid syndrome caused by
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loss of elastin in the tarsus
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who is floppy eyelid syndorme seen in mostly
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obese males
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how do you treat floppy eyelid syndrome
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antibiotic ointment (bacitracin, gentamicin) to cover for infections, tape lids or use eye shield during sleep, follow q 3-7 days until stable, surgery
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s/s blepharospasm
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episodic involuntary contractions of orbicularis oculi muscle, uncontrolled blinking, twitching, or closure of eyelids BILATERAL. Patients can be functionally blind from this
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treatment for blepharospasm
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treat any underlying ocular disorder (blepharitis,dry eye). Inject botulinum toxin in severe cases; surgical removal of orbicularis muscle
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Lid myokymia
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spontaneous fascicular tremor (twiching)
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what is myokymia precipitated by
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any type of disease fatigue or stress
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treatment of lid myokymia
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reassurance, antihistamines, small amounts of quinine found in tonic water
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mafor sign of ectropion
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outward turning of eyelid
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etiology (causes) of ectropion
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involutional or age related, CN VII palsy, cicatricial, mechanical, allergic, congenital
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pt c/o in ectropion
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tearing, eye irritation, FBS,
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other s/s of ectropion
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may see PEK, conj injections keratinization
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what should you check in ectropion
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muscle function
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what is the treatment for ectropion
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lubricate. Antibiotic ung if area seems at risk for infection. Follow up 1-2 weeks. Tape lids. Do surgery
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major sign of entropion
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inward turning of eyelid
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etiologies of entropion
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involutional or age related, cicatricial, spastic, congenital
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what does involutional mean
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loss of elasticity
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what does the patient complain of with entropion
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tearing, irritation, red eyes, PEK, conj injection
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what is the treatment for entropion
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antibiotic ung, tape lids, superglue lids, epilate lashes if trichiasis is mild; surgery. F/U as needed for risk of infection
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what is trichiasis
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the misdirection of lashes.
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what does the patient complain of with trichiasis
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FBS, irritaition, tearing PEK, conj injection
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etiologies of trichiasis
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chronic blepharitis, entropion, idiopathic
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treatment of trichiasis
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remove offending lashes by epilation, electrolysis, cryotherapy; If PEK is present cover cornea with antibiotic ung
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what is lagophthalmos
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incomplete lid closure during relaxed lid closure
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etiologies of lagophthalmos
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nocturnal (during sleep); orbital/proptotic; mechanical; paralytic
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description of a suspicious lesion should include what
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size, color, location, texture, mobile or fixed, vascularization, +/- presence of cilia, borders, symmetry
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describe cyst of moll
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benign, clear fluid-filled lesion at eyelash margin.
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treatment for cyst of moll
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excise
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another name for cyst of moll
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sudoriferous cyst
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cyst of zeis
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similar to cyst of moll but color is more opaque (oil-filled)
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sebaceous cyst
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benign, yellowish white usually multiple lumps in skin; has central punctum which may appear as blackhead.
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multiple lesions of a sebaceous cyst are known as
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milia
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treatment for sebaceous cyst
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excise
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xanthelasma
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benign, deposits of cholesterol and other lipids within skin.
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if you see xanthelasma in a young patient what should you look for
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investigate for hperlipidemia
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if you see xanthelasma in old patient what should you do
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counsel and reassure
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should you excise a xanthelasma
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if you excise they tend to recur
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molluscum contagiosusm
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viral wart
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who mostly gets molluscum contagiosum
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children and immunocompromised adults
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how does molluscum contagiosum look
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small unbilicated lesion with umbilicated centers; cheesey core that often spontaneously drains (clean with alcohol). May be multiple
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treatment for molluscum contagiosum
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can puncture and express in office (remove contents and clean afterwards with alcohol); resolves without scar
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what must you test for for people with molluscum contagiosum
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you must rule of basal cell carcinoma
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papilloma other wise known as
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verrucae papillomata
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describe papilloma
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a benign overgrowth of epithelial cells. Karatin may build up and cause a cutaneous horn. Has rough surface, may be pedunculated (on a stalk)
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when a papilloma is on a stalk what is it called
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verruca vulgaris
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if the papilloma is flat what is it called
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varruca plana
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what does the papilloma look like
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a rough cauliflower-like surface
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etiology of papilloma
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viral; viral papilloma tend to be recurrent
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keratoacanthoma
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rapidly growing epithelial lesion with central core of keratin
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what is the characteristic growth pattern of a keratoacanthoma
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grows vigorously over 3 months and then spontaneously involutes.
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treatment of keratoacanthoma
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excise if no resolution because a small portion may progress to squamous cell carcinoma
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what is hemangioma
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a local or generalized mass with vascular changes
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what does hemangioma arise from
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the capillary system
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treatment for hemangioma
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it may involute spontaneously but can surgically excise if cosmesis or visual function is compromised
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describe hemangioma in children
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it is markedly worse during cying
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actinic keratosis
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this is a PRE-MALIGNANT lesion leads to cancer; yellowish rough crusty lesion that tend to bleed easily
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what does actinic keratosis lead to
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it is pre-malignant lesion which may lead to squamous cell carcinoma
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what causes actinic keratosis
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overexposure to the sun
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treatment for actinic keratosis
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excise promptly
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what may actinic keratosis be confused with
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sebaceous keratosis, which is a benign lesion that may look a little greasier than actinic lesions
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squamous cell carcinoma
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deeply ulcerated lesion with elevated edges. destroys lashes, lid tissue. second most common form of skin cancer
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whay is squamous cell carcinoma the most dangerous
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because it can metastise to the lymph nodes
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treatment for squamous cell carcinoma
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requires radical excision
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what is the most common malignancy of the eyelid
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basal cell carcinoma. comprises 90% of eyelid tumors
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what is basal cell carcinoma associated with
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UV exposure
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where is basal cell carcinoma more prevalent
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the lower lid
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how does basal cell carcinoma look
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pearly borders, ulcerated center, variably pigmented.
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does basal cell carcinoma metastasize
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may be highly invasive to surrounding tissues but does not metastasize as a rule.
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