Eyes (chalazion, hordeolum, conjunctivitis, subconjunctival hemorrhage, corneal abrasion) Flashcards
Eyes
Chalazion vs hordeolum/stye
What is it
Age
Pathogen
What is it:
Chalazion: chronic inflammation of meibomian gland
Hordeolum: infection of meibomian gland or eyelash follicle (eyelid folliculitis!)
Age:
Chalazion: 30-50’s
Hordeolum: children/teens
Pathogen:
Chalazion: none
Hordeolum: staph aureus
Eyes
patho, risk factors & S/S for hordeolum (stye)
Risk factors:
recurrent blepharitis, seborrheic dermatitis, rosacea, diabetes, hyperlipidemia
Patho:
infection/abscess
S/S:
red, painful/tender lump
Eyes
patho, risk factors & S/S for chalazion
Risk factors:
increased androgen/sebaceous gland secretion
Patho:
Localized inflammation/abscess (sterile) from occlusion of gland ducts
S/S:
non-tender, rubbery nodule (no redness)
Eyes
S/S preseptal cellulitis vs orbital cellulitis
preseptal/periorbital cellulitis:
eye pain/tenderness, periorbital redness & swelling
orbital cellulitis:
above +
pain w/ EOM
can also have chemosis, fever, dipoplia, vision loss, EOM palsy…
Afferent pupillary defect (swinging light test) = impending visual loss!!
Eyes
What is blepharitis?
Inflamed flaky greasy eyelid margin… no nodule/abscess/localized inflammation
fun fact: linked w/ oral retinoid use!
Eyes
Tx & follow-up for chalazion
Warm, moist compress QID
If large and infected, f/u in 1 week… if does not resolve refer to opth (I&D)
Eyes
Tx & follow-up for hordeolum (stye)
warm compress QID
treat underlying condition
hygiene (wash hands before touching eyes, change eye make-up Q6 weeks etc)
F/U in 48 hours
Refer to ophtho if not responding to warm compresses within 1-2 weeks
Refer to ER if cellulitis
Eyes
Corneal abrasion
What is it
Age
Sex
defect in corneal epithelium
20-29
M>F
Eyes
Corneal abrasion red flags
penetrating trauma (metal!!!) large nonreactive/irregular pupil hyphema hypopyon visual disturbance ciliary flush with ring-like appearance around iris (iritis!)
Eyes
Hx for corneal abrasion
- visual changes (blurred, diplopia, field of vision)
- mechanism of injury
- work? Sports? Hobbies?
- eye protection
- degree of pain, headache, photophobia, redness, itching
- contact lens use: sleeping in contacts? Poor hygiene?
- timing: recurrent corneal erosions will wake up middle of the night with pain or have pain first this in AM when trying to open eyes
- Td immunization
Eyes
Exam for corneal abrasion
- visual acuity (before floresceine/tetracaine)** if abnormal ?? penetrating trauma
- penlight exam (swinging)
- corneal surface (look for shadow on surface of iris)
- fundoscopy (confirm red reflex)
- always evert eyelid to look for FB
Eyes
Pertinent positive and negative findings for corneal abrasion
normal anterior chamber contour round small reactive pupil mild conjunctival injection or ciliary flush no discharge FB sensation sudden onset eye pain no infiltrate/corneal opacity no hyphema or hypopyon
Eyes
ddx for corneal abrasion
- acute angle glaucoma
- HSV infection (will have ↓ corneal sensation)
- recurrent corneal ulceration
- ulcerative keratitis
Eyes
Tx and f/u for corneal abrasion
Foreign body removal:
- irrigation after instilling topical anesthetic
- try to remove with swab
- if unable to remove, will need to refer to ophtho to remove FB within 24 hours
- in meantime do topical antibiotic ointment QID and no patch
Patching NOT needed for uncomplicated small abrasions, contraindicated with recent contact lens wear
Deep abrasions will need patch to prevent lid motion for 24-48 hours
No contact lens until healed
Topical abx
F/U in 24 hours àcornea usually heals overnight within 24-48 hours àcontinue rx ointment for 4+ days to help with healing
Eyes
referral for corneal abrasion
if large/central lesions, corneal opacity or ulceration, hypopyon, hyphema, irregular pupil or deep/penetrating wounds or open globe
Refer ophtho if still symptomatic in 48 hours
