Causal Conditions Flashcards
What is blepharitis?
Types
Presentation
Complications
Tx
Inflammation of the lid margins
2 types:staph aureus ~ crust around the eyelashes OR seborrheic ~ greasy & dandruff lesions at base eyelids
Features: crusting, itching, tearing, foreign body sensation, lid margins red & thickened
Complications: hordeola recurrent, conjunctivitis, corneal ulceration, keratitis
Tx: warm compresses, lid massage, lid washing, artificial tears
What is a hordeolum?
Stye - acute inflammation of the eyelid gland
Types: meibomian ~ internal gland, Moll ~ external gland (commonly), Zeis ~ modified sweat gland
Usually cause staph A.
Localize to lid margin after a couple days
Painful, red, swollen
Tx: warm compresses, massags, should resolve 1-2 weeks
What is a chalazion?
Granulomatous inflammation of a meibomian gland
Preceded by hordeolum of meibomian gland (internal)
Red, pain, edematous, but over time becomes small, non painful, never localizes to lid margin
DDX: BCC, sebaceous adenoma, meibomian carcinoma
Tx: warm compresses ~ no resolution in 1 mon ~ removes
Continues to re-occur, re-examined for malignancy
what is a foreign body?
Foreign body on or in the cornea
Presents red eye, pain, tearing, foreign body sensation, photophobia
Complications: ulcer, infection, secondary iritis, rust ring in visual field
Dx: slit lamp, magnification, fluorescen stain
Tx: drummel to remove it under microscope or refer to optho
What is preseptal cellullitis?
Inflammation of the structures anterior to orbital septum
Usually from trauma, infection ~ bite, sinus, chalazion, conjunctivitis
Can progress to orbital cellulitis
Present: lid edema, no ∆ vision & mobility of eyes & no pain with eye movement
Tx: amoxi-clav ~ if severe or <1 yo = tx orbital cellulitis
What is orbital cellulitis?
Inflammation of the structures POSTERIOR to orbital septum
EMERGENCY
Present: lid edema, erythema of conjunctiva, diplopia/vision ∆, pain eye movement, decreased eye movement, fever, proptosis, chemosis
Causes: preseptal cellulitis, sinus infection (ethmoid), trauma, tooth infection
Complications: optic nerve inflammation, brain abscess with visio loss, meningitis
Tx: ceftriaxone + vanco IV, 2x blood cultures
Conjunctivitis
Bacterial ~ purulent discharge, staph, strep or chlamydia,
Viral ~ serous discharge, HSV, herpes zoster, CMV, adenovirus ~ self limiting ~ pink eye
Allergic ~ irritant ~ smoking, fumes, ~ asthma, rhinitis, sinus pressure,
Present: chemosis ~ bacterial, itchy ~ allergic, redness wtih scleral sparring (peri-limbic sparring), discharge, crust forming eyelids in morning, no changes to vision, no eye pain
Tx: viral ~ warm compresses, bacterial ~ topical antibiotics, chlamydia ~ oral azithromycin/doxcycline, allergic ~ antihistamines
Subconjunctival Hemorrhage
Blood beneath conjunctiva
Otherwise asx
No pain, no nothing
If 360 involvement ~ consider globe rupture
Should resolve 2-3 weeks
Causes: idiopathic, valsava, trauma, HTN, anticoagulation, bleeding disorders
Episcleritis
Inflammation of episclera (bw conjunctiva & sclera), idiopathic, self-limiting
Hyperemia isolated to a specific area (bulbar conjunctiva) ~ conjunctivities generalized hyperemia
No discharge, no lacrimation
No pain & no photophobia~ different than scleritis
Tx: self-limiting
Scleritis
Inflammation sclera & episclera
CAN THREATEN VISION
Present: severe eye pain (affects sleep & appetite), lacrimation, hyperemia (blue-purple), sparring palpebral conjunctiva
Common in women & connective tissue disorders (SLE, RA)
Tx: corticosteroids & tapering
Px: 18% lose visual acuity in 1 years, ?30% lose in first 3 years
Complications : perforation of eye & lose eye
Pinguecula
Hyaline & elastic tissue deposition on nasal or temporal limbus sparring cornea
Benign
Causes: wind & sun exposure, aging
Can get it removed ~ cosmetically
Irritative sx: lubricating drops
Pterygium
Fibrovascular, triangular wing like thing extends onto cornea
May induce astigmatism, decrease vision
Removed ~ affecting vision, chronic inflammed, cosmetically
Irritative sx: tx lubricating drops
Herpes Zoster Opthalmicus
Herpes zoster, involved 1 branch TG nerve
Covers eyelid, vesicular rash
Pain, photophobia, red eye, tearing
Antiviral immediately
Complications: keratitis, perforation, ulceration, scarring
Keratitis
Inflammation cornea
Usually from HSV ~ may lay dormant in dorsal n.root until activated again
Dendritic lesion on cornea seen with fluorescein stain
Pain, red eye, tearing, decreased vision, foreign body sensation
Complications: scarring, secondary iritis, secondary glaucoma
Tx: antivirals (trifluridine - topical) or acyclovir (oral)
Why would we not prescribe steroids for ocular disorders?
Increase IOP, impair corneal healing, exacerbate herpetic keratitis
