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185 Cards in this Set

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