Infection of Eyelids

Question 1

Molluscum Contagiosum

-What kind of infection? What layer of skin?

Answer 1

Viral of the epidermis

Virus is the pox virus. Transited through skin to skin contact or contact with fomites, which are contagious with touch.

Question 2

Molluscum Contagiosum

Demographics and laterality

Answer 2

Infant and children
If seen in adults, consider immunosuppression
Can be unilateral or bilateral

Question 3

Molluscum Contagiosum

Symptoms and signs

Answer 3

Symptoms- Bumbs on skin. Can be on hands, arm, face. Mild itchy.

Signs- Skin papule (Dome shape bump) 
No red rash 
Single or multiple lesions 
Flesh colored or pearly white 
1-2 mm in size 
Central umbilication due to central keratin plug 

*Immunocomp patients may have larger (5mm) and more lesions.

Question 4

Molluscum Contagiosum

Management

Answer 4

Self limiting within 6-12 months.

If it does not resolve or accompanied by conjunctivitis, curettage the eyelid lesions (scrape away under anesthesia)

Question 5

Papule

Answer 5

Bump, palpable and circumscribed. Elevated. Less than 5mm in diameter. May be pigmented, erythematous, or flesh toned
Ex: mole
Seen in molluscum contagiosum

Question 6

Impetigo

-What kind of infection and what layer of the skin

Answer 6

Bacterial infection of the epidermis

Usually staph aureus or strep progenies (Gram +)

Question 7

Impetigo

Demographics and laterality

Answer 7

Usually infants and children

Unilateral or bilateral

Question 8

Impetigo

Symptoms and signs

Answer 8

Symptoms- Red, itchy, skin rash. Can be painful.
Signs- Skin macules (Flat lesion), erythematous, macules evolve rapidly into thin walled blisters that can rupture into a honey colored crust.

Question 9

Impetigo

Management

Answer 9

Topical Antibiotic + oral (Especially if bullies impetigo bc more likely to scar)
Discuss hand washing, avoid touching eyes, wash towels and stay home from school since highly contagious.

Question 10

Impetigo

Most commonly affects which area

Answer 10

Arms, legs, around nose and mouth.

Question 11

Most common bacterial skin infection in children

Answer 11

Impetigo

Question 12

Macule

Answer 12

A spot, circumscribed up to 1 cm. Not palpable, not elevated above or depressed below skin surface.

Can be hypo, hyper or red.
Ex: Freckles, cafe au lait spots.

Seen In impetigo

Question 13

Preseptal Cellulitis

-What kind of infection and where is it located.

Answer 13

Infection of the subcutaneous tissue anterior to the orbital septum.

Could be due to:
skin trauma with subsequent bacterial infection.
Extension from adjacent infection- hordeolum, dacryoadenitis, dacryocystitis, sinusitis, conjunctivitis.
Most commonly staph aureus, streptococcus, influenzas.
Less commonly herpes simplex or zoster

Question 14

Preseptal Cellulitis

Demographics and laterality

Answer 14

No predilection

Unilateral

Question 15

Preseptal Cellulitis

Symptoms and signs

Answer 15

Symptoms- Eyelid swelling, red and tender

Signs- Eyelid edema, erythema with tenderness/pain or eyelid palpation. Low grade fever

Question 16

Preseptal Cellulitis complications

Answer 16

could lead to orbital cellulitis

Question 17

Preseptal Cellulitis management

Answer 17

Oral antibiotic.

If no improvement or worse after 24 hours, refer out for IV antibiotics.

Question 18

Preseptal Cellulitis difference from orbital

Answer 18

Orbital has proptosis, restricted EOM and pain with eye movement, high grade fever

Question 19

Hordeolum

• What kind of infection
• Location

Answer 19

Acute bacterial infection of the eyelids sebaceous glands with retention of oils and inflammatory debris. Usually staph aureus.

External- Zeis glands. Mounted point externally. Eyelash at apex.
Internal- Meibomian glands. Mounted point through palpebral conj. Must flip lids.

Question 20

Hordeolum

Demographics and laterality

Answer 20

No predilection, unilateral

Question 21

Hordeolum

Symptoms and sings

Answer 21

Symptoms- Eyelid swelling, focal but may be diffuse if preseptal cellulitis is present. Pain.

Signs of external: Visible, palpable nodule pointing anterior through skin. Red. Eyelash might be at apex.

Signs of internal: Visible or palpable nodule pointing posterior through palpebral conj. Red.

Signs of both: preseptal cellulitis commonly present

Question 22

Hordeolum Compliations

Answer 22

Orbital cellulitis

Could evolve into chalazion

Question 23

Hordeolum

Management

Answer 23

Antibiotic- topical for external. Oral for internal. BID x 10-14 days. Cephalexin, augmenting, bactrim.

Warm compress with massage to express the contents of the hordeolum. BID for 10 mins. Start 3 days after antibiotic.

Lid hygiene

Lash epilation if lash is within the lesion. May allow it to drain.