2-Eyelids and anterior segment

Question 1

What are the best treatments for allergic conjunctivitis

Answer 1

cold compress, antihistamine drops, oral antihistamines

Question 2

What is blepharitis

Answer 2

chronic, intermittent inflammation of eyelids

Question 3

What are possible causes of blepharitis

Answer 3

anterior: infectious (S. Aureus) or seborrheic
posterior: meibomian gland dysfunction

Question 4

How does blepharitis present clinically

Answer 4

red eyes
gritty FB sensation
burning sensation
tearing 
crusty lashes
photophobia
\+/- blurry vision

Question 5

What will you see on blepharitis PE

Answer 5

diffuse conjunctival injection 
inflamed red eyelid margins 
Crusting or matting of lashes 
plugged glands 
collarettes

Question 6

How do you treat blepharitis

Answer 6

warm compress, lid massage/hygiene
topical Abx (erythromycin)
oral Abx

Question 7

What are the types of blepharitis

Answer 7

chalazion
hordeolum
stye

Question 8

What is periorbital cellulitis

Answer 8

infection of soft tissue around eye (more common)

does NOT extend into orbit or globe

Question 9

What causes periorbital cellulitis

Answer 9

external sources (blepharitis, insect bites, FB)
sometimes sinusitis

Question 10

How does periorbital cellulitis present

Answer 10

eye pain, swelling, and erythema

NO fever, vision change, pain with eye movement

Question 11

What is absent on PE for periorbital cellulitis

Answer 11

No proptosis

No ophthalmoplegia

Question 12

How should you work periorbital cellulitis up if you are unsure what it is

Answer 12

Treat like orbital cellulitis!

CBC, cultures, discharge culture, CT orbit/sinus

Question 13

How do you treat periorbital cellulitis

Answer 13

outpatient; empiric Abx (cover S. aureus, S. pneumo, MRSA

Suspected MRSA: oral Bactrim PLUS Amoxicillin and/or cefdinir, and/or cefpodoxime

Question 14

What is orbital cellulitis

Answer 14

infection of fat and muscle surrounding globe

does NOT involve globe

Question 15

What usually causes orbital cellulitis

Answer 15

extension of infection from paranasal sinuses (ethmoid)

Question 16

How does orbital cellulitis present

Answer 16

eye pain
eyelid swelling/erythema
*vision changes
*fever
*pain with eye movement

Question 17

What will you see on orbital cellulitis PE

Answer 17

proptosis
ophthalmoplegia
conjunctivitis
+/- discharge

Question 18

How do you work up orbital cellulitis

Answer 18

CBC
cultures
discharge cultures
CT orbit/sinuses

Question 19

How do you treat orbital cellulitis

Answer 19

hospitalize! consult ophtho
Immediate IV broad spectrum abx (vanco+ceftriaxone) until cultures come back
surgical drainage if abscess forms

Question 20

Why do you start IC abx in orbital cellulitis

Answer 20

to prevent optic nerve damage

prevent infection spread to cavernous sinus, meninges, and brain

Question 21

Where is the macula located in respect to the optic disc

Answer 21

macula is temporal to the optic disc

Question 22

What is conjunctivitis

Answer 22

inflammation of conjunctiva (white) most commonly due to viral infection
(can also be caused by bacteria, allergies, chemical)

Question 23

How do you transmit conjunctivitis

Answer 23

direct contact

Question 24

What is the most common cause of viral conjunctivitis

Answer 24

Adenovirus

Question 25

What are signs and symptoms of viral conjunctivitis

Answer 25

pharyngitis, fever, malaise, watery Dx, periauricular adenopathy

Question 26

How do you treat viral conjunctivitis

Answer 26

cold compress for discomfort

Question 27

What organisms commonly cause bacterial conjunctivitis

Answer 27

S. pneumo H. influenza Pseudomonas

Question 28

What are the signs and symptoms of bacterial conjunctivitis

Answer 28

copious discharge | eyes matted shut in morning

Question 29

How do you treat bacterial conjunctivitis

Answer 29

``` erythromycin ointment fluoroquinolone drops (-floxacin) ```

Question 30

How does allergic conjunctivitis present

Answer 30

bilaterally (seasonal) | itchy, conjunctival erythema and chemises (swelling)

Question 31

How do you treat allergic conjunctivitis

Answer 31

cold compress oral antihistamine drops

Question 32

What is Dacryocystitis

Answer 32

infection of lacrimal sac secondary to nasolacrimal duct obstruction more common in children

Question 33

How do you treat Dacryocystitis

Answer 33

``` aggressive abx (clindamycin, IV vanco) surgery (NLD probing) ```

Question 34

What is Entropion

Answer 34

inward turning of eyelids (especially lower lid) occurring with lid tissue degeneration that comes with AGE (can also be childhood facial structure)

Question 35

Why must you treat entropion with lubrication

Answer 35

to prevent lashes from rubbing surface of the eye

Question 36

What is Ectropion

Answer 36

outward turning of eyelids (lower) due to lid degeneration that comes with AGE

Question 37

How do you treat ectropion

Answer 37

surgery, if excess tearing or exposure keratitis occur

Question 38

What is a pingueculum

Answer 38

yellow, elevated nodule (usually on nasal side) common in 35+ y/o Rarely grow or require treatment

Question 39

What is a pterygium

Answer 39

fleshy, triangular growth of conjunctiva that can spread and compromise cornea and visual axis

Question 40

What causes pterygium

Answer 40

wind, sun, dust exposure

Question 41

How do you treat pterygium

Answer 41

artificial tears anti-inflammatory excision (if severe)