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Opthalmology > Eyelid disorders > Flashcards

Eyelid disorders Flashcards

1
Q

Define blepharitis

A
  • Inflammation of eyelid margins/edges.
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2
Q

Describe pathophysiology of blepharitis.

A
  • staph, HSV, VZV infection.
  • allergies/ skin reactions
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3
Q

How does blepharitis present?

A
  • gritty, itchy, dry eye.
  • eyelids may look greasy, and inflamed.
  • sticky discharge - stuck together in the morning.
  • crusts develop at base of eyelashes.
  • erythema.
  • bilateral and chronic.
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4
Q

How is blepharitis managed?

A
  • hot compression and cleaning.
  • massage of meibomian glands to push oily fluid out.
  • avoid contact lens during flare up.
  • lubricating eye drops - 1st line = Polyvinyl alcohol , 2nd line = hypromellose.
  • Abx - doxycycline.
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5
Q

Define hordeolum.

A

aka stye

  • Bacterial infection of eyelid – causes a painful bump on inside or outside of eye.
  • can be internal or external.
  • staph aureus infection
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6
Q

Pathophysiology of external hordeolum.

A

infection of glands of zeis OR glands of Moll.

  • Infection in root of eyelash – starts as small red lump and develops into little abscess (yellow pus filled).
    o Glands of Zeis = sebaceous glands at base of eyelashes.
    o Glands of Molls = sweat glands at base of eyelashes.
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7
Q

Pathophysiology of internal hordeolum.

A
  • Infection of Meibomian glands.
  • Swelling points towards inside of eyeball and is more painful.
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8
Q

Risk factors for hordeolum.

A

itchy eyelid/ rub a lot - ext more likely.
- blepharitis.

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9
Q

How does hordeolum present?

A
  • Red, hot lump.
  • Pain
  • Local inflammation.
  • Int style – dull aching in the eyelid and sometimes get sensation of a lump.
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10
Q

How are hordeolum’s managed?

A
  • hot compression and analgesia.
  • Head/ point usually burst within 3-4 days, can take 1-2 wks to completely resolve.
  • ext stye - epilation of eyelash
  • int stye = surgical drainage
  • Abx (i.e. chloramphenicol) if associated with conjunctivitis or persistent
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11
Q

Define chalazion

A
  • Blockage and swelling of meibomian gland.
  • aka meibomian cyst.
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12
Q

Pathophysiology of a chalazion?

A
  • Meibomian glands – under inner surface of eyelid – make oily fluid called meibum to lubricate eye.
  • If gland becomes blocked – meibum cannot escape into tears – causes gland to swell into cyst and leak into eyelid tissue – overtime inflammation causes lump to form in eyelid.
  • Lump if firm and solid – called chalazion.
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13
Q

Risk factor of chalazion?

A
  • Blepharitis
  • Eczema
    o BECAUSE in both cases meibum is thicker – therefore more likely to block gland.
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14
Q

How does chalazion present?

A
  • eyelid swelling.
  • mild pain and irritation.
  • can become infected - red, swollen and painful.
  • if too big - press on the eyeball and affect vision.
  • most common on the upper eyelid and can have several on eyelid.
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15
Q

Mx of a chalazion?

A
  • lasts 2-6 months, if no symp no Tx needed.
  • warm compression, hygeine, masage and analgesia.
  • Abx if infected (chloramphenicol).
  • surgical drainage.
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16
Q

Define entropian.

A
  • ## Eyelid (normally lower eyelid) rolls inwards so that eyelashes touch surface of eye (cornea).
17
Q

define trichiasis.

A

Eyelash turning in against eye

18
Q

Pathophysiology of entropion.

A
  • Weakness of small muscles around eyelid.
  • Trachoma (e.g chlamydia trachomatis) – infection that causes scaring and disruption of eyelid – makes it turn in.
  • Injury - chemical burns.
19
Q

Risk factors for entropion.

A
  • old age
  • ocular irrtation
  • past eye surgery,
20
Q

How does entropion present?

A
  • Pain, irritation and watery eye.
  • Foreign body sensation.
  • If left untreated - Corneal damage and ulceration – blurry vision.
21
Q

Mx of entropion.

A
  • tapping eyelid to cheek.
  • botulinum toxin injecion to eyelid muscles.
  • lubricating ointment, bandage contact lens, epilation of eyelash,
  • same day referral to opthal if risk to sight.
  • surgery
22
Q

Define ectropion.

A
  • Eyelid (usually lower) turns outwards.
23
Q

Pathophysiology of ectropion.

A
  • Age related weakness of muscles.
  • Scaring +/ - contracture of skin and underlying tissues – trauma, burns, skin tumours, chronic blepharitis.
  • Conditions causing weakness of facial nerve and muscles +/ - facial paralysis – e.g bells palsy, parotid tumour, stroke, head and neck malignancy.
24
Q

How does ectropion present?

A
  • Sore, red eye.
  • Watery eye – excessive tearing to protect cornea and keep eye lubricated.
  • Usually affects one eye BUT AGE RELATED AFFECTS BOTH.
  • Inner lining of eye that droops forwards – dry and sore.
  • Punctum visible with slit lamp.
  • Since eyelid doesn’t close properly – dry and sore cornea and cornea not protected – corneal ulcer and visual disturbances
25
Q

Mx of ectropion.

A
  • avoid rubbing eye
  • lubricating ointment
  • tape lower and upper eyelid shut
  • surgery to tighten skin and muscles around eyelid.
    same day referral to opthal is=f risk to sight.
26
Q

Complication of ectropion?

A
  • Exposure keratopathy (aka exposure keratitis) – damage to cornea due to dryness caused by incomplete closure of eyelid.
27
Q

Define peri-orbital cellulitis.

A
  • Eyelid and skin infection in front of orbital septum.
28
Q

Risk factors for pre-orbital cellulitis.

A
  • < 10 yrs
  • trauma
  • Sinusitis, dacryocystisis, hordeolum.
29
Q

How does peri-orbital cellulitis present?

A
  • Swelling, redness, hot skin around eyelids and eye.
  • Fever
30
Q

How do you distinguish between peri-orbital and orbital cellulitis? (signs, symp and Ix).

A
  • Signs that suggest pre-orbit, rather than orbital C:
    o No proptosis, normal eye movements, no chemosis, normal optic nerve function, no impaired vision.
  • CT orbit gold standard
31
Q

Mx of peri-orbital cellulitis?

A
  • systemic Abx
  • vulnerable groups - severe cases and children - admission and monitoring due to high risk of progression to orbital cellulitis.
32
Q

Define orbital cellulitis.

A
  • Infection around eyelid involving tissues behind orbital septum.
33
Q

Risk factors for orbital cellulitis.

A
  • Trauma
  • Sinus disease – ethmoidal sinus infection spreads to eye
  • Strep/ staph infection – can spread from resp tract.
  • Dacrocystisis, dental abscess.
  • peri-orbital cellulits
34
Q

How does orbital cellulitis present?

A
  • Pain on eye movement, reduced eye movements, diplopia.
  • Changes in vision.
  • Proptosis.
  • Fever and malaise.
  • Chemosis.
35
Q

Diagnosis and Ix for oribital cellulitis.

A
  • Blood tests: FBC, CRP to screen for raised inflammatory markers
  • Swabs sent for microscopy, culture and sensitivity
  • CT orbit is the gold standard investigation to distinguish orbital cellulitis from preseptal cellulitis
36
Q

Mx of orbital cellulitis?

A

MEDICAL EMERGENCY
- IV Abx
- surgical drainage if abcess forms.

Opthalmology (6 decks)

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