Eye Conditions Flashcards
What are the roles of eyelids and lashes
- protect the globe (eyeball) from foregin bodies and maintain wet corneal surface
*skin of eyelid is among the thinnest anywhere on the body which allows for mobility of eyelids.
- underneath the skin of the eyelid = loose areolar tissue capable of significant edema and swelling
- under that is orbicularis oculi responsible for closing eyelid
- behind eyelid is tarsus, dense fibrous connective tissue supposting the lid margin
What is a stye?
Description,
signs and symptoms
onset
- Description
- Acute infection of 1 or more eyelid glands (meibomian, Zeis or Moll)
- Signs and symptoms
- Unilateral painful lesion, localized lid swelling, tenderness, erythema
- Onset
- acute (days)
What is chalazion?
Description,
signs and symptoms
onset
- Description
- Sterile, focal, chronic inflammation of the lid
- due to obstructed meibomian gland
- Signs/symptoms
- Non-tender (painless), rubbery nodule, localized lid swelling, often unilateral
- Onset
- Gradual enlargement (days to weeks)
What is Blepharitis?
Description,
signs and symptoms
onset
- Description
- Chronic inflammation of the lid margins
- associated with infection, dermatological conditions or meibomian gland dysfunction
- Signs and symptoms
- Irritated possibly reddened lid margins
- greasy, scaly and/or flaky
- usually bilateral
- Onset:
- Gradual irritation (weeks to months)
Describe the pathophsiology of a stye
- aka hordeolum -> msot common eyelid infection
- bacterial infection of eye lid glands
- most common infecting organism = staphylococcus aureus
- treatment usually just drainage of lesion -> dont nee dot culture
*styles assocaited with blepharitis and acne rosacae have tendency to reoccur
internal vs external stye
- External
- involves glands of zeis or Moll
- smaller more superficial infection
- lesion always points towards skin
- Internal
- larger area of sweeling
- involves meibomian glands
- lesion can point either to skin or to sonjunctival surface
- more porlonged course than external
what are the goals of therapy for stye
Resolve infection
Prevent recurrence
Prevent transmission to other eye or to household contacts
How do you assess patients with hordeolun or chalazion
- if NOT associated with pain, photophobia, vision disturbances, blunt trauma, chemical exposure, imbedded foreign body, heat exposure, eye protrcution are are contract lens wearer
- see if red/irritated eye or if an eye lid problem, if eye lid problem
- see if lid is swollen with nodule
*then probably hordeolum or chalazion
recc self care, needs medial assess is no imporement after 48 h
*chalazion can be assesses if no pain
How do you assess patients with Blepharitis
– symptoms of blepharitis = irritation, photophobia, burning/ itching of lid margins, crust on the eyelashes, and eyelid sticking
- can be foreign bosy sensation in eyes
- sandy/gritty snesation usually worse upon awakening bc during sleep inflamed lids lie against corea, tear secretion dec and inflammatory mediators ahve several hours to act on surface of eye
*if symptoms worsen in evening, liekly dry eye disease
How to prevent a Hordeolum
* use to avoid infecting other eye or ransmitting to other persons
- Avoid touching the eyes; wash the hands after any contact with the infected eye.
- Change compresses, towels and pillowcases after each use.
- Do not share makeup with others.
- Do not wear makeup or contact lenses until the stye resolves.
- Replace eye makeup, contact lenses and contact lens case after stye resolves.
- Do not allow the tip of eye drop bottles or ophthalmic ointments to touch the eye or eyelashes. If this occurs, discard them due to contamination.
*Conscientious attention to treating symptoms of blepharitis may help to decrease the incidence of recurrent stye
non pharmacologic therapy of styes
- external usually drain spontaneously within 48h
- warm compress applied 10-15 min 3-4x/day can help speed up
*dont microwave cloth, risk of burning, just warm water
- after apply warm compres, gently massage eyelid towards lid margin
*hard boiled egg kept in shell retains heat longer -> wrap in thin cloth, can reboil the egg
- can also use bead filled eye masks
what do do once stye drains
- remove excress discharge by cleaning eye lid with warm water and face towel, or cotton swab sipped in diluted baby shampoo
*seek medical advice is external styes dont drain spontaneously in 48h -> may need incision and drainage
how long does it take acute interal styes to resolve
- 1-2 weeks
- warm compress can be used but not clinical trails to demonstrate effectivness of non surigcal innervations for acute internal styes
- seek medical advice if internal sye doesnt resolve in 1 week
What is pharmacologic therapy for a stye
- self medication with non-rx opthalmic antibacterials is not necessary and not recommended bc most drain spontaneously
- if incisiona nd drainage req, an opthalmic antibacterial like erythromycin applied to conjunctival sac several times a day is common to prevent further infection
*neomycin, polymyxin B and framicidin ineffective to provide significant benefit
what is preseptal cellulitis
- infection from stye spead locally
- presents as generalized swelling and redness of eyelid rather than localized leiosn
- requries assessemnt by ophthalmolosist with systemic antibacterials
describe anterior blepharitis
- classified as staphylococcal or seborrheic, most common to have mix of both
- either form of anterior blepharitis are predisposed to developing conjunctivitis
- Staphlyococcal
- caused by S. aureus or Staphylococcus epidermidis
- patients present with inflammation and erythema along anterior margin of eye lid
- lid margins are scaly with crusts and tiny ulcerations around lashes
- if chonic, loss of eyelashes can occur
- complications: recurrent chalazia, epithelial keratitis and marginal corneal infiltrates.
- Seborrheic blepharitis (non ulcerative)
- less inflammation and redness along anterior border of eyelid
- scales are more oily and greasy than in staphylococcal blepharitis
- associated with seborrheic dermatitis affecting other parts of the body.
Goals of Blepharitis therapy
Reduce inflammation and discomfort associated with blepharitis
Reduce risk of recurrence of severe symptoms
Reduce risk of complications such as conjunctivitis and keratitis
describe posterior blepharitis
- caused by Meibomian gland dysfunction -> inflammation of posterior aspect of eyelid
- bilateral chonic conditions, can coexist ith anterior blepharitis
- two types : meibomian seborrhea or meibomianitis.
Meibomian Seborrhea
- excessive glandular secretions
- symptoms: photophobia, burning feeling, excesively oily and foamy tear film and froth on lid margin
Meibomianitis
- inflammation and obstruction of meibomian glands
- signs: diffuse or localized inflammation of posterior lid margin
- in chronic - gland orifices can be obstructed and posterior lid may be thick, rounded and notces
- when pressure applied over glands, a soft cheese substance is expressed
How to assess blepharitis
general symptoms: irritation, photophobia, burning and itching of the lid margins, crust on the eyelashes, and eyelid sticking
- can be foreign body sensation in eyes
- patients may complain of sandy/gritty sensation, worse upon awakening
- if symptoms worse in evening -> more likely dry eye disease
*often can coexist
- patients benefit from axamination by eye acre professional -> slit lamp biomicroscopy to evaluate tear film, anterior lid margin, lashes, poteriod lid margin, tarsal conjunctiva, bulbar conjunctiva and cornea
