Disorders of the Lids & Lashes

Question 1

A pt comes in with an itchy, watery eye saying it feels like there’s something in his eye. On exam the pt’s eye is bloodshot, inflamed, has flaky scales on his lashes, and pressing on his meibomian glands produces a thick, cloudy secretion. What is the most likely diagnosis?

Answer 1

Blepharitis

Question 2

Tx for belpharitis

Answer 2

Warm compress
Improve eyelid hygiene
Topical Abx on lid margins
Oral Abx. for recurrence

Question 3

Common causes of blepharitis

Answer 3

Staph
Seborrheic
Meibomian gland dysfunction

Question 4

A pt comes in complaining of a small, tender red bumb on her eyelid that appeared overnight. What is her most likely diagnosis?

Answer 4

Stye (Hordeolum)

Question 5

Common causes of styes (hordeolums)?

Answer 5

Staph infection of the sebaceous gland

Question 6

Tx for stye (hordeolum)?

Answer 6

Warm compress
Topical Abx drops
I&D (if Abx fails)

Question 7

What do you have to make sure you prevent in a pt with a hordeolum?

Answer 7

Orbital cellulitis

Question 8

A pt comes in with a firm, visible, grayish nodule on his eyelid. He claims it isn’t tender to the touch. What is the most likely cause?

Answer 8

Pt has a chalazion

Chronic inflammation of the meibomian gland

Question 9

An African-American pt comes in with a chalazion, what are the best treatment options for him?

Answer 9

Warm compress (early)
Surgical removal (late)
NOT triamcinolone injection

Question 10

A pt comes in with mildly painful inflammation of the eyelid, gold fibrous scales on the lashes, and complains of irritation, burning, excessive tearing, blurry vision, and sensitivity to light. You notice a vesicular eruption on the lid margin. What is the most likely cause for her symptoms?

Answer 10

Herpes simplex of the eyelid, most likely due to HSV 1 (but could be HSV 2)

Question 11

How do you treat herpes simplex of the eyelid?

Answer 11

Viral culture (if needed)
Encourage good hygiene (prevent secondary infection)
Topical polysporin, trifluridine drops
Follow up with ophthalmologist

Question 12

A pt comes in with a chief complaint of excessive tearing. What if the most likely cause?

Answer 12

Blocked nasolacrimal duct

Question 13

What do you do for a pt with nasolacrimal duct obstruction?

Answer 13

Refer for an eye doctor for:
Irrigation/probing of the duct
Surgery

Question 14

A pt comes in complaining of a painful, excessive tearing accompanied by pus coming out of the tear duct. What is their diagnosis, and what is the underlying cause?

Answer 14

Dacryocystitis from nasolacrimal duct obstruction

Question 15

How do you treat dacryocystitis?

Answer 15

Oral, broad-spectrum Abx

I&D if abscessed

Question 16

A pt comes in with a painful, swollen lid. You notice it is tender, red, and slight inferonasal globe displacement. What is the diagnosis?

Answer 16

Dacryoadenitis

Question 17

What are the common causes of dacryoadenitis?

Answer 17

Idiopathic
Sjogren’s disease
Vasculitis or systemic disease
Infection

Question 18

How do you treat dacryoadenitis?

Answer 18

Idiopathic - oral steroids
Bacterial - broad spectrum Abx
Treat underlying condition

Question 19

Your pt comes in with an irritated, burning eye that feels like there’s something in it. You notice visible space between the globe and the lid. What is the diagnosis?

Answer 19

Ectropion (Out-turned eyelid)

Question 20

What are the causes of ectropion?

Answer 20

Involutational (aging)
Paralytic (CN VII palsy)
Scarring of lower lid
Mass on lower lid/cheek

Question 21

A pt has an in-turned lid margin accompanied by irritation, burning, and FB sensation. What is the treatment?

Answer 21

Surgical correction

pt has entropion

Question 22

What are the causes of entropion?

Answer 22

Involutional (aging)

Scarring (from chemical burn)

Question 23

A pt comes in worried about her right eyelid which appears “droopy”. Her upper visual field is slightly obstructed. What is the most likely problem?

Answer 23

Ptosis

Question 24

What causes ptosis?

Answer 24

Congenital
Horner’s syndrome
CN III palsy

Question 25

Which cranial nerve is affected in ptosis?

Answer 25

CN III

Question 26

A pt comes in with ptosis. What are her treatment options?

Answer 26

``` Treat the underlying condition Surgical correction (congenital) ```

Question 27

A pt comes in worried about a yellow deposit he noticed on his upper eyelid. He claims it doesn't hurt or impair his vision. What treatment do you recommend? What does this pt have?

Answer 27

Surgical excision for cosmetic purposes, otherwise it's asymptomatic. The pt has Xanthelasma

Question 28

What are causes of an eyelid twitch?

Answer 28

Conjunctiva irritation Stress Caffeine/stimulants MS (rare)

Question 29

A pt comes in with a red, swollen upper eyelid. It is warm to the touch and tender. The pt has a low-grade fever, a bulging globe (proptosis), and a sluggish pupillary reflex in the affected eye. What is the most likely diagnosis?

Answer 29

Orbital cellulitis

Question 30

What are the precursors to look for in a pt that you suspect might have orbital cellulitis?

Answer 30

Upper respiratory infection Sinusitis Preseptal cellulitis

Question 31

What are the causes of orbital cellulitis?

Answer 31

Strep, staph, mixed flora Lid trauma Superficial lid/conjunctiva infection Surgical contamination

Question 32

How do you treat a pt with orbital cellulitis?

Answer 32

Broad-spectrum systemic (IV) Abx PENICILLIN Surgical drainage if abscessed Sinus drainage

Question 33

How does thyroid eye disease manifest?

Answer 33

``` Exophthalmos Proptosis Lid retraction Lid lag Ocular cranial nerve dysfunction ```

Question 34

A pt comes in with irritation, tearing, burning, and FB sensation that have gotten worse over the past week. On exam you notice proptosis, lid lag, conjunctival edema and dilated blood vessels in the conjunctiva. What is the most likely diagnosis?

Answer 34

Mild thyroid eye disease

Question 35

A pt with Grave's disease comes in with double vision, achiness, and blurred vision. What is the diagnosis?

Answer 35

Moderate thyroid eye disease

Question 36

Visual loss, pain, and corneal ulceration are sympmtoms of what?

Answer 36

Severe thyroid eye disease

Question 37

How do you test to confirm a Dx of thyroid eye disease?

Answer 37

Full thyroid testing | Monitor thyroid function

Question 38

How do you treat moderate thyroid eye disease?

Answer 38

Oral prednisone Orbital decompression surgery Eye muscle surgery

Question 39

What is the best treatment option for mild thyroid eye disease?

Answer 39

Artificial tears