Eye Disorders

Question 1

Ectropion (eyelid turned inward)
-Relaxation of which muscle?
-Risk Factors
-Symptoms
-Treatment

Answer 1

-Relaxation of orbicularis oculi
-RF: Elderly, cranial nerve 7 palsy, infectious, congenital
-Irritation, dryness, tearing, sagging eyelid
-Artificial tears, surgery if needed

Question 2

Entropion (eyelid turned outward)
-Spasm of which muscle?
-Symptoms

Answer 2

-Spasm of orbicularis oculi
-Corneal abrasion, erythema, tearing, irritation

Question 3

Dacryocystitis
-Infection of lacrimal sac due to obstruction of ________
-MC etiologies
-Symptoms of acute vs chronic
-Management of acute
-Management of chronic

Answer 3

-Nasolacrimal duct is obstructed
-Staph Epidermis, Staph Aureus, GABHS, Pseudomonas
-Acute: tearing, infection signs (tenderness, erythema, warmth to medial cantonal (nasal) side of lower lid area. Purulent discharge +/-.
-Chronic: mucopurulent drainage without signs of infection

-Management
–Acute: warm compresses + ABX (Clinda, Vanco + Ceftriaxone)
–Chronic: Dacryocystorhinostomy

Question 4

Blepharitis (inflammation of eyelid margin)
-Risk Factors
-Types (Posterior vs Anterior)
-Symptoms
-Management

Answer 4

-RF: Down Syndrome, Rosacea, seborrheic dermatitis
-Posterior: MGD (MC Type)
-Anterior: Infectious (Staph A) or Seborrheic
-Symptoms: crusting, scaling, red rim eyelid, flaking
-Mgmt: Eyelid hygiene is mainstay. Severe (topical E-mycin or Azithromycin)

Question 5

Hordeolum (Stye)
-MCC
-Symptoms
-Management

Answer 5

-MCC is Staph Aureus
-Erythematous, painful, warm, nodule or pustule on the eyelid
-Management
–Warm compresses are mainstay
–Incision and drainage if no drainage after 48 hours
–Topical E-mycin or Bacitracin if needed

Question 6

Chalazion
-Painless indurated granuloma of the internal Meibomian sebaceous gland
-Due to obstruction of Zeis or Meibomian gland
-Symptoms
-Management

Answer 6

-Symptoms: non-tender, localized eyelid swelling
-Management
–Eyelid hygiene and warm compresses
–Oph. referral for incision and curettage may be needed

Question 7

Pinguecula
-Describe it
-Risk Factors
-Management

Answer 7

-Yellow, slightly elevated nodule on nasal side of sclera
-RF: Dry, windy, sunny conditions
-No treatment needed

Question 8

Pterygium
-Describe it
-Risk Factors
-Management

Answer 8

-Elevated, fleshy triangular-shaped growing fibrovacular mass that starts medially (nasal side of eye) and extends laterally
-RF: UV exposure in sunny climates, sand/wind/dust exposure
-Observation for most as treatment

Question 9

Globe Rupture
-Ophthalmic emergency
-Symptoms
-Positive _____ Test
-Other Exam Findings
-Management

Answer 9

-Diplopia, reduced VA
-Enophthalmos, exophthalmos, 360’ bulbar conj heme
-Positive Seidel’s Test: parting of fluoro dye by clear stream of aqueous humor from AC
-Exam: Obscured red-reflex, teardrop/irregular pupil shape, hyphen (blood in AC)

-Mgmt: Rigid eye shield, leave impaled objects alone, emergent consult, avoid pressure on the eye