Eyelids & Anterior Segment

Question 1

3 most important things to check when doing an eye exam?

Answer 1

Vision
pupils
tonometry

Question 2

What is Blepharitis?

Answer 2

chronic condition

inflammation of the eyelids w/ intermittent exacerbations

Question 3

Anterior blepharitis is caused by? (2)

Answer 3

infectious (S. aureus)
or
seborrheic component

Question 4

Posterior blepharitis is caused by?

Answer 4

meibomian gland dysfunction

Question 5

Clinical presentation of Blepharitis?

Answer 5

red eyes
gritty/foreign body sensation
burning
excessive tearing
crustiness in lashes
light sensitivity
\+/- blurry vision

Question 6

What might you see in a PE in a pt with Blepharitis?

Answer 6

diffuse conjunctival injection
eyelid magins=inflamed and red
crusting or matting of lashes
plugged glands w/ magnification
Collarettes (flakes on eyelashes)`

Question 7

Tx of Blepharitis

Answer 7

warm compress
lid massage
lid hygiene
topical abx (erythromycin ointment)
oral abx in severe cases

Question 8

describe Chalazion vs Hordeolum

Answer 8

Chalazion- painless, rubbery, nodular

Hordeolum- painful, infected, purulent

Question 9

Does periorbital cellulitis extend into the orbit?

Answer 9

No!

it is an infection of soft tissue AROUND the eye

Question 10

What types of tissue does orbital cellulitis involve?

Answer 10

the fat and muscle tissue surrounding the globe

Question 11

Do either periorbital or orbital cellulitis involve the globe?

Answer 11

NAHHH

Question 12

Is periorbital or orbital cellulitis more common? Who gets it the most?

Answer 12

periorbital

childrens

Question 13

What causes periorbital cellulitis?

Answer 13

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

Question 14

Most common cause of orbital cellulitis?

Answer 14

An extension of infection from the paranasal sinuses (ethmoid sinuses)

Question 15

What might you see on clinical presentation of a patient with periorbital cellulitis?

Answer 15

Eye pain
eyelide swelling/erythema
(No vision change, fever, or pain with eye movement)

Question 16

What might you see on clinical presentation of a patient with orbital cellulitis?

Answer 16

eye pain
eyelid swelling/erythema
vision changes (possible diplopia)
fever
pain with eye movement

Question 17

What might you see on PE of a patient with orbital cellulitis that you would not see in pt with periorbital cellulitis?

Answer 17

Proptosis
Ophthalmoplegia (paralysis of the muscles within or surrounding the eye)

You would also see:
conjunctivitis
+/- discharge

Question 18

If in doubt if periorbital vs orbital cellulitis what should you treat it as?

Answer 18

ORBITAL!

Question 19

Tx of periorbital cellulitis (outpt or hospital)

Answer 19

outpatient

Question 20

What pathogens do you need to cover with empiric tx of periorbital cellulitis?

Answer 20

S. aureus
S. pneumoniae
MRSA

Question 21

Abx for periorbital cellulitis for non MRSA? MRSA?

Answer 21

Non MRSA:
oral clindamycin or amocicillin-clavulanic acid

MRSA:
oral trimethoprim-sulfamethoxazole (Bactrim)
PLUS either:
Amoxicillin, Amoxicillin-Clavulanic acid, Cefdinir, Cefpodoxime

Question 22

Tx of orbital cellulitis:
outpatient vs inpatient?
Abx?

Answer 22

Hospitalization w/ ophthalmologist consult

start IV abx immediately
(broad spectrum- vancomycin + ceftriaxone)

Surgical drainage is abscess formation

Question 23

What is the most common eye disease?

Answer 23

Conjunctivitis

Question 24

what is conjunctivitis? What is it caused by?

Answer 24

inflammation of the white of the eye

Viral infection is most common (others= bacterial, allergies, chemical)

Question 25

How is conjunctivitis spread?

Answer 25

Direct contact

Question 26

Most common cause of viral conjunctivitis?

Answer 26

Adenovirus

Question 27

Usual symptoms of viral conjunctivitis?

Answer 27

``` bilateral pharyngitis fever malaise watery discharge preauricular adenopathy ```

Question 28

How do you treat viral conjunctivitis?

Answer 28

Give cold compress for discomfort | It's viral- obvi NOT with abx

Question 29

Most common cause organisms in bacterial conjunctivitis? (3)

Answer 29

S. pneumoniae H. influenzae Pseudomonas

Question 30

Characteristic findings in bacterial conjunctivitis

Answer 30

unilateral Copious dischage "eye matted shut" in the morning

Question 31

Tx for bacterial conjunctivitis

Answer 31

Abx eye drops or ointment - Erythromycin ointment - Fluoroquinolone drops

Question 32

Is allergic conjunctivitis usually unilateral or bilateral?

Answer 32

Bilateral

Question 33

Characteristics of Allergic conjunctivitis

Answer 33

chronic (seasonal) itchiness conjunctival injection swelling (chemosis)

Question 34

Tx of allergic conjunctivitis

Answer 34

cold compress oral antihistamines drops

Question 35

What do you want to educate your patient about in regards to conjunctivitis?

Answer 35

handwashing no sharing eye drops throw away eye makeup

Question 36

What is dacryocystitis and who is it more common in?

Answer 36

infection in the lacrimal sac, usually 2/2 a nasolacrimal duct obstruction children

Question 37

Tx of Dacrocystitis

Answer 37

``` agressive abx (clindamycin, IV vancomycin) may require surgery ```

Question 38

What is entropion vs ectropion?

Answer 38

Entropion- inward turning of eyelids (especially lower lid) Ectropion- outward turning of the eyelids (especially the lower lid)

Question 39

Cause of entropion vs ectropion

Answer 39

Entropion- may occur w/ age as result of degeneration of lid tissue, or due to childhood facial structure ectropion- may occur w/ age as result of degeneration of tissue

Question 40

How do you treat entropion?

Answer 40

lubrication | because damage may occur w/ rubbing of lashes on eye

Question 41

How do you treat ectropion?

Answer 41

May require surgery of excessive tearing or exposure keratitis

Question 42

Describe a pingueculum (shape, color, nasal or temporal side)

Answer 42

yellow elevated nodule mostly on the nasal side

Question 43

What age are pingueculums most common and what is the treatment?

Answer 43

over age 35 trick question: they rarely grow, don't require treatment

Question 44

Describe pterygiums (color, shape, complications)

Answer 44

fleshy triangular growth of the conjunctiva that typically spreads and may threaten cornea and visual axis

Question 45

What are pterygiums caused by?

Answer 45

associated with wind, sun, dust exposure

Question 46

Tx of pterygium

Answer 46

artificial tears, anti-inflammatories may be helpful

Question 47

pingueculum vs pterygium, which one is serious?!

Answer 47

Pterygium!!