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CMT > Eyelid Disorders > Flashcards

Eyelid Disorders Flashcards

1
Q

Pterygium

risk factors

A
  • increased UV light exposure in sunny climates
  • sand, wind, dust exposure
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2
Q

Pterygium

clinical presentation

4 components

A
  • elevated, superficial fleshy, triangular-shaped growing mass
  • starts medially & extends laterally
  • irritation, erythema, foreign body sensation
  • can impair vision
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3
Q

Pterygium

management

3 components

A
  • observation
  • artificial tears
  • surgical removal once vision is impaired
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4
Q

Pterygium

what can occur with recurrent pterygium

A

can cause sx more quickly resulting in more surgery and increased scarring

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5
Q

Pinguecula

risk factors

2

A
  1. eye irritation (dry, windy, sunny conditions)
  2. ocular trauma
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6
Q

Pinguecula

clinical manifestations

4 components

A
  • yellow
  • slightly elevated nodule
  • found on nasal side of sclera
  • does not grow onto cornea
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7
Q

Pinguecula

management

2

A
  • no tx necessary
  • cosmetic: resection
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8
Q

Hordeolum

most common bacteria

A

s. aureus

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9
Q

Hordeolum

pathophys of internal infection

A

inflammation or infection of a meibomian gland found deep from the palpebral margin under the eyelid

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10
Q

Hordeolum

pathophys of external infection

A

infection of an eyelash follicle or sebaceous gland near the lid margin w/ production of pus in the gland of Moll or Zeis

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11
Q

Hordeolum

clinical manifestations

5

A
  • localizaed erythema
  • painful
  • warm
  • tender
  • nodular/pustule on the eyelid
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12
Q

Hordeolum

management

A
  • warm compress
  • may need I&D or abx ointment
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13
Q

Hordeolum

which abx ointment to use

A

erythromycin or bacitracin

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14
Q

Chalazion

pathophys

A

obstruction of Zeis or Meibomian glans

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15
Q

Chalazion

clinical manifestations

3

A
  • non-tender (PAINLESS)
  • localized edema
  • conjunctival nodule
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16
Q

Chalazion

management

2 components

A
  • eyelid hygiene
  • warm compress
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17
Q

Chalazion

what to do if refractory?

A
  • refer to ophthalmology
  • glucocorticoid infection or I&D
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18
Q

Chalazion vs Hordeolum

A

Chalazion is larger, firmer, slower growing, less painful than hordeolum

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19
Q

Ectropian

risk factors

4

A
  • elderly
  • CN 7 palsy
  • congential
  • infectious
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20
Q

Ectropian

pathophys

A

relaxation of orbicularis oculi muscle

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21
Q

Ectropian

PE findings

A

eyelid/lashes are everted (turned outward)

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22
Q

Ectropian

clinical findings

5

A
  • irritation
  • ocular dryness
  • tearing
  • sagging of eyelid
  • increased sensitivity
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23
Q

Ectropian

management

3

A
  • lubricating eyedrops
  • moisture shield
  • surgical correction
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24
Q

Entropion

risk factors

A

elderly

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25
Q

Entropion

pathophys

A

spasm of the orbicularis oculi muscle

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26
Q

Entropion

PE findings

A

eyelid and lashes are inverted (turned inward)

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27
Q

Entropion

clinical presentation

4 components

A
  • erythema
  • tearing
  • increased sensitivity
  • corneal abrasion/ulceration
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28
Q

Entropion

management

A
  • lubricating eyedrops
  • moisture shield
  • surgical correction
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29
Q

Blepharitis

risk factors

4

A
  • down syndrome
  • atopic dermatitis
  • rosacea
  • seborrheic dermatitis
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30
Q

Blepharitis

pathophys of anterior

A
  • commonly infectious/viral in naure (s. aureus or s. epidermis)
  • can also be seborrheic
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31
Q

Blepharitis

pathophys of posterior

A

meibomian gland dysfunction

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32
Q

Blepharitis

clinical manifestations

6

A
  • burning
  • erythema
  • crusting/scaling
  • red rimming of the eyelid
  • gritty sensation
  • flaking on the lashes/lid margins
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33
Q

Blepharitis

potential PE finding

A

+/- entropion or ectropion

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34
Q

Blepharitis

management

A
  • eyelid hygiene (warm compress, scrub, massage, artificial tears)
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35
Q

Blepharitis

what to use if severe or refractory

2

A
  • abx (erythromycin, azithromycin, ofloxacin)
  • topical glucocorticoid
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36
Q

Dacrocystitis

common etiologies

4

A
  • s. epidermis
  • s. aureus
  • GABHS
  • pseudomonas
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37
Q

Dacrocystitis

risk factors

2

A
  • sjorgen syndrome
  • thyroid disease
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38
Q

Dacrocystitis

pathophys

A

obstruction of the nasolacrimal duct

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39
Q

Dacrocystitis

clinical manifestations of acute disease

6

A
  • tenderness/pain
  • tearing
  • erythema
  • edema
  • warm to touch (medial canthal side/lower lid area)
  • +/- purulent discharge
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40
Q

Dacrocystitis

clinical manifestation of chronic

1 additional

A

mucopurulent drainage from puncta

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41
Q

Dacrocystitis

management acute

A

abx PO (clindamycin) + warm compress

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42
Q

Dacrocystitis

management of chronic

A

dacrocystorhinostomy

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43
Q

Viral Conjunctivitis

most common in who

A

children

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44
Q

Viral Conjunctivitis

mode of transmission

A

direct contact

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45
Q

Viral Conjunctivitis

common source

A

swimming pools

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46
Q

Viral Conjunctivitis

clinical manifestations

5

A
  • bilateral
  • foreign body sensation/gritty
  • ocular erythema
  • tearing/watery discharge
  • itching
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47
Q

Viral Conjunctivitis

how is vision?

A

unimpacted

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48
Q

Viral Conjunctivitis

PE findings

A
  • ipsilateral pre-auricular lymphadenopathy (enlarged/tender)
  • copious watery tearing
  • tarsal conjunctiva may be follicular/bumpy
49
Q

Viral Conjunctivitis

management

3

A
  • warm/cool compress
  • artificial tears
  • anti-histamines (olopatadine)
50
Q

Bacterial Conjunctivitis

causative agents

adults, general, contact use

A
  • adults: s. aureus
  • general: s. pneumonia, h. influenzae, m. catarrhalis
  • contacts: pseudomonas
51
Q

Bacterial Conjunctivitis

clinical manifestations

4 components

A
  • painless
  • mucopurulent discharge/crusting
  • conjunctival erythema
  • “eyelids crusted shut in AM”
52
Q

Bacterial Conjunctivitis

associated vision changes

A

none

53
Q

Bacterial Conjunctivitis

managment

A

topical abx
* erythromycin
* trimethoprim-polymixin B
* ofloxacin

54
Q

Bacterial Conjunctivitis

management if contact user

A

ciprofloxacin or ofloxacin

55
Q

Allergic Conjunctivitis

pathophys

A

type I (IgE) mediated rxn causing local mast cell degranulation and histamine release

56
Q

Allergic Conjunctivitis

clinical manifestations

4

A
  • conjunctival erythema
  • watery discharge
  • marked pruritis
  • other allergy sx (nasal congestion, sneezing)
57
Q

Allergic Conjunctivitis

associated vision changes

A

none

58
Q

Allergic Conjunctivitis

PE Findings

3

A
  • cobblestone mucosa
  • watery stringy discharge
  • conjunctival edema
59
Q

Allergic Conjunctivitis

management

A
  • supportive measures
  • topical anti-histamine (olopatadine, pherniramine-naphazoline)
60
Q

Gonococcal Conjunctivitis

complications

2

A
  • meningitis
  • blindness
61
Q

Gonococcal Conjunctivitis

when is this typically spread

A

during delivery, sx appear 2-5d later

62
Q

Gonococcal Conjunctivitis

dx

A

PCR or gram stain

63
Q

Gonococcal Conjunctivitis

clinical manifestations

6

A
  • conjunctival injection
  • chemosis
  • eyelid edema
  • mucopurulent discharge
  • globe tenderness
  • pre-auricular lymphadenopathy
64
Q

Gonococcal Conjunctivitis

preventive management

A

erythromycin ophthalmic ointment

65
Q

Gonococcal Conjunctivitis

sx management

A
  • IM ceftriaxone
  • IM cefotaxime
66
Q

Chlamydial Conjunctivitis

leading cause of?

A

blindness of infectious origin

67
Q

Chlamydial Conjunctivitis

incubation period

A

2-19 days

68
Q

Chlamydial Conjunctivitis

associated w/

A

concurrent genital infection

69
Q

Chlamydial Conjunctivitis

dx

A

PCR or gram stain

70
Q

Chlamydial Conjunctivitis

clinical manifestations

6

A
  • unilateral
  • mucopurulent discharge
  • hyperemic tarsal conjunctiva
  • marked tarsal follicular response
  • pre-auricular lymphadenopathy
  • +/- superior corneal opacity/vascularization
71
Q

Chlamydial Conjunctivitis

management

A

abx PO (azithromycin or doxy)

72
Q

Chlamydial Conjunctivitis

prevention

A

treat all partners of pts with this

73
Q

Keratoconjunctivitis Sicca

risk factors

8

A
  • female gender
  • increasing age
  • DM
  • Sjogrens
  • Parkinsons
  • hormonal changes
  • Vitamin A deficiency
  • contact lens use
74
Q

Keratoconjunctivitis Sicca

pathophys

A
  • decreased tear production
  • abnormal meibomian gland pathophys
75
Q

Keratoconjunctivitis Sicca

clinical manifestations

7

A
  • dryness
  • irritation
  • bilat conjunctival infection
  • foreign body sensation
  • paradoxical excessive tearing
  • photophobia
  • blurred vision
76
Q

Keratoconjunctivitis Sicca

PE findings

4

A
  • corneal scarring
  • ec/en tropian
  • blephritis
  • reduced blink rate
77
Q

Keratoconjunctivitis Sicca

management

2 components

A
  • artificial tears, gels, ointments
  • ophthalmology referral
78
Q

Orbital/Septal Cellulitis

typically secondary to?

A

sinus infection (ethmoid sinusitis)

79
Q

Orbital/Septal Cellulitis

most common in?

A

children

80
Q

Orbital/Septal Cellulitis

most common etiologies

A
  • s. aureus
  • streptococci
  • GABHS
  • h. influenzae
81
Q

Orbital/Septal Cellulitis

dx

A

CT head or clinical

82
Q

Orbital/Septal Cellulitis

clinical manifestations

5

A
  • ocular pain (esp w/ EOM)
  • ophthalmoplegia (EOM weakness)
  • diplopia
  • proptosis (protrusion of eye)
  • +/- visual changes
83
Q

Orbital/Septal Cellulitis

management

4 components

A
  • hosp admission
  • IV abx (vanco followed by ceftriaxone, ampicillin-sulbactam, piperacillin-tazobactam)
  • drainage
  • ENT referral
84
Q

Preseptal/Periorbital Cellulitis

where is infection located

A
  • anterior to the orbital septum
85
Q

Preseptal/Periorbital Cellulitis

commonly due to?

A

sinusitis or contagious infection of the soft tissues of the eyelid/face

86
Q

Preseptal/Periorbital Cellulitis

what should we think of with these?

PPP?

A

insect bites

87
Q

Preseptal/Periorbital Cellulitis

common pathogens?

A
  • s. aureus (MRSA)
  • streptococci
  • anaerobes
88
Q

Preseptal/Periorbital Cellulitis

dx

A

clinical & if uncertain then order CT

89
Q

Preseptal/Periorbital Cellulitis

clinical manifestations

5 components

A
  • unlateral
  • ocular pain
  • eyelid erythema
  • edema
  • no pain w/ movement/limitation w/ movement
90
Q

Preseptal/Periorbital Cellulitis

management

2 components

A
  • abx: TMP-SMZ, clindamycin
  • if younger than 1 y/o, inpatient tx
91
Q

Bacterial Keratitis

causative agents

general, w/ contacts

A
  • general: s. aureus, streptococci
  • contacts: pseudomonas aeruginosa
92
Q

Bacterial Keratitis

risk factors

4 components

A
  • improper contact lens wear
  • dry ocular surface
  • topical corticosteroid use
  • immunosuppression
93
Q

Bacterial Keratitis

clinical manifestations

7

A
  • unilateral
  • ocular pain
  • photophobia
  • redness
  • vision changes
  • foreign body sensation
  • cannot keep affected eye open
94
Q

Bacterial Keratitis

PE findings

4

A
  • conjunctival erythema
  • ciliary injection
  • hazy cornea
  • hypopyon
95
Q

Bacterial Keratitis

findings w/ slit lamp

A

increased fluorescein uptake

96
Q

Bacterial Keratitis

management

A
  • ophthalmology referral for corneal culture
  • topical fluoroquinolone (moxifloxacin)
97
Q

Bacterial Keratitis

what to absolutely avoid!

A

DO NOT PATCH EYE

98
Q

HSV Keratitis

pathophys

A

corneal infection and inflammation due to reactivation of HSV in the trigeminal ganglion

99
Q

HSV Keratitis

dx

A
  • fluorescein staining (Slit lamp)
100
Q

HSV Keratitis

slit lamp findings

A

dendritic corneal ulceration

101
Q

HSV Keratitis

clinical manifestations

8

A
  • acute onset
  • unilateral
  • ocular pain
  • photophobia
  • conjunctival erythema
  • blurred vision
  • ciliary flush (limbic injection)
  • pre-auricular lymphadenopathy
102
Q

HSV Keratitis

management

A
  • topical: acyclovir
  • PO: valacyclovir
103
Q

Herpes Zoster Keratitis

pathophys

A

after initial zoster infection, it becomes latent in the dorsal root ganglia or trigeminal ganglia where it can reactivate

104
Q

Herpes Zoster Keratitis

dx

A
  • clinical + fluoroscein staining
  • PCR PRN
105
Q

Herpes Zoster Keratitis

prodrome sx

4

A
  • HA
  • malaise
  • fever
  • unilateral pain
106
Q

Herpes Zoster Keratitis

describe rash

4 components

A
  • group vesicles
  • erythematous base
  • Hutchinson’s Sign (rash on nose)
  • ocular involvement (hyperemic conjunctivitis, uveitis, episcleritis)
107
Q

Herpes Zoster Keratitis

describe slit lamp findings

A

dendritic uptake of fluoroscein

108
Q

Herpes Zoster Keratitis

management

A
  • urgent ophthalmology referral
  • analgesics for pain
  • atropine
  • PO anti-viral
109
Q

Fungal Keratitis

common causative agents

A
  • fusarium
  • aspergillus
  • candida
110
Q

Fungal Keratitis

pathophys

A
  • fungal infection of cornea
  • occurs after eye injury
111
Q

Fungal Keratitis

risk factors

3

A
  • eye injury w/ veg active matter
  • corticosteroid use
  • contact lens use
112
Q

Fungal Keratitis

dx

A

clinical, +/- corneal biopsy

113
Q

Fungal Keratitis

clinical manifestation

A
  • blurry vision
  • sudden ocular pain
  • photosensitivity
  • eye erythema
  • tearing
  • blepharospasm
114
Q

Fungal Keratitis

management

3

A
  • ophthalmology referral
  • antifungal PO (natamycin, voriconazole)
  • +/- corneal transplant
115
Q

Acanthamoeba Keratitis

pathophys

A

rare corneal infection w/ acanthamoeba species

116
Q

Acanthamoeba Keratitis

diagnosis

A

corneal biopsy or PCR

117
Q

Acanthamoeba Keratitis

clinical manifestations

8

A
  • unilateral
  • pain out of proportion to clinical findings
  • decreased vision
  • ocular erythema
  • foreign body sensation
  • photophobia
  • tearing
  • mucopurulent discharge
118
Q

Acanthamoeba Keratitis

slit lamp findings

A
  • radial or ring-like infiltrate
  • perineural infiltrates
119
Q

Acanthamoeba Keratitis

management

A
  • ophthalmology referral
  • biguanide + diamidine
  • miltefosine

CMT (72 decks)

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