Lecture 7- Eyelids Part 2 Flashcards Preview

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Flashcards in Lecture 7- Eyelids Part 2 Deck (38)
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1

Most common form of blepharitis

squamous - non purulent - with increased marginal hyperemia and telangectasia- squamous types have a hypersensitivity component - pollutants, makeup, soaps etc

2

Most common bacteria in and around the eyes

Stachylococcus - gram + noncapsulated spheroidal bacteria - always on lid margin

3

Most common strains associated with eye conditions - strains of the most common bacteria on lids

Staph. Aureus and Staph. Epidermidis

4

Staph is the leading cause of marginal infiltrative keratitis, BUT what bacteria are more aggressive, more frequent proliferation, and cause more inflammatory reaction?

Streptococcus - and other gram positive bacterium

5

Toxin produced by staphylococcus aureus that causes a dermonecrosis, irritates occular surface - stimulating immune- inflammatory response

Alpha- Toxin

6

hyperacute forms of blepharitis with heavy discharge and preseptal cellulitis (for example) are caused by which bacteria

Streptococcus - G+, and some G-

7

condition caused by infection of eyelid margin- lash follicles and MG's, become edematous and erythematous-greasy scales, lashes become crusted with dried serous fluid, typically caused by s. Aureus/epidermidis, or HSV/VZV, rapid onset/short duration, prevalent in warmer climates, affects middle aged females, related hordeolum/chalzion/SPK, cause preseptal cellulitis

Acute Marginal Blepharitis

8

condition involving poor hygeine and yellow pustules and gold crusts, could be mistaken for Acute Marginal Blepharitis, so you need to look for vesicles on the skin.

Impetigo

9

How to treat Acute Marginal Blepharitis
what happens if you remove the crusts?

lid hygiene 2-8 weeks BID to QID- hot compress, lid scrubs, baby shampoo diluted w water, Tea tree oil or cetaphil, Blephex, artifical tears for dry eye, antibiotics

10

What antibiotics should be employed for treatment of Actute Marginal Blepharitis?

Ointments - Bacitracin and EEM - staph Aureus/epidermidis
Lid scrubs with Gentamycin and tobramycin - aminoglycosides
Sulfonamides but 70% of staph not affected
Broad spectrum- Azythromycin - not as effective, no effect on MRSA
Trimethoprim.polyminB are effective
AB/steroid combo like genta/dexa, Tobradex, zylet,

11

AB with dual action anti-inflammatory, with Durasite vehicle, 1 drop bid x 2 days, then 1 drop 2-4 weeks, use for bacterial conjunctivitis

Azasite - topical medication for Acute Marginal Blepharitis

12

If a patient used Azasite for 4 week and is not seeing any improvement, start systemic antibiotics for MRSA and other infections. Which ABs could be used?

Doxycycline - 100 mg bid for 7-10 days (other strengths and duration for other conditions)
EES - 400 mg 4/day for 1-4 weeks
NO TETRACYCLINE OR DOXCICLINE in pregnant/nursing or kids under 8, Erythromycin 200 mg BID can be used instead

13

T or F: meibomian glands become clogged in posterior blepharitis only if there is rosacea present?

FALSE : Meibomian glands get clogged in posterior blepharitis, whether rosacea is present or not!

14

Condition marked by posterior lid margin redness, often seen in patients with MGD, indicated by crusting on anterior lashes, can lead to chrnoc conjunctivitis, madarosis, and tylosis- thickened lid margin, Treated with hygiene and ABs

Mixed Blepharitis- "mixed" often indicated by crusting on anterior lashes, Blepharitis MIXED with MGD

15

What is the difference between and External and Internal Hordeolum in terms of location and appearance, and which more often causes preseptal cellulitis

External Hordeolum: Zeis and Moll glands, with Head

Internal Hordeolum: Meibomian glands, no Head, more often preseptal cellulitis

16

Type of hordeolum more common in children and young adults, due to acute staph infection of Zeiss or Moll glands, lash at apex, associated with staph blepharitis- change makeup/mascara every 3 months, poor diet, fatigue, stress, can lead to preseptal cellulitis, how is it treated?
1. Name
2. normal course- how to hasten progression
3. How to prevent further infection of area
4. Tx if severe inflammation
5. How to further assist drainage
6. What if lesion is resistant to topical ABs
7. what if infection or PAN lymphadenopathy
8. if condition is recurrent? - pharmacological
9. If condition is recurrent? - test

1. External Hordeolum
2. Self limiting - 5-7 days - hot compress to hasten drainage/pointing
3. Topical antibiotics to prevent infection of surrounding follicles - Bacitracin, Erythromycin
4. Topical steroid if severe inflammation
5. Epilate 1 or 2 of involved lashes to create drainage
6. If lesion is resistant, incision with blade, topical AB - tobramycin or bacitracin/polymycin B
7. systemic antibiotics if infection elsewhere or + PAN lymphadenopathy - EEM, Doxy, Diclo, Tetra, Amox - TID - best for kids but tastes bad
8. If recurrence - Tetracycline or Doxycycline for several months
9. Obtain lid culture for recurrent hordeolum to institute specific AB

17

Localized staphylococcal infection of the meibomian gland, can be from blockage, found in upper tarsus usually, diffuse swelling, preseptal cellulitis greater risk, recurrence associated with IgM deficiency and abnormal triglycerides
1. name
2. treatment if mild
3. tx if moderate
4. if mild PCN allergy
5. if True PCN allergy
6. Second line therapy
7. are VA affected
8. Most common eyelid lesion acquired by what population
9. Follow up how often
10. if cases are resistant to ABs
11. What is needed if recurrent or unusual - test
12. What if cellulitis develops

1. Internal Hordeolum
2. mild- hot compresses several times a day
3. moderate - oral AB - doxycycline 100mg, dicloxacillin 250
4. for mild PCN allergy, 1 or 2 en cephalosporin like cephalexin or cefuroxime
5. true PCN allergy - lovofloxacin
6. second line therapy - oral EEM, TTC, or Amox for 10 days
7. VA usually not affected unless causing distortion of cornea
8. most common eyelid lesions acquired in children
9.follow up every week until resolved
10. incision and drainage, injection of steroid - triamcinolone, lidocaine with epinephrine to open vessels for faster action,
11. Biopsy
12. IV antibiotics referral

18

What is the most common misdiagnosis of a hordeolum?

Chalazion - which is NOT painful, but Hordeolum are

19

Why should HIV be considered in young pt with atypical hordeolum?

Occult HIV because Kaposi sarcoma can mimic a hordeolum

20

*Why do recurrent lesions with madarosis require a biopsy?*

Need to rule out Sebaceous Cell Carcinoma

21

Uncommon superficial skin infection by staph or strep, typically if skin barrier is broken, contagious if fluid that oozes from blisters touches an open area on skin. MRSA is becoming a common cause. most common in children in unhealthy living conditions. in adults, may follow other skin disorders or URTI, only involves top layer of skin, yellow fluid, pus filled blisters that leave a raw base, + lymphadenopathy in adjacent nodes
1. Disease
2. how to treat/ hygiene
3. pharm tx
4. tx for mild infection
5. if caused by S pyogenes
6. severe cases tx
7. tx for severe localized cases, causes skin photosensitivity not for kids under 8
8. complications
9. Prevention

1. Impetigo
2. no sharing towels, clothes, razors, personal care products, wash hands with clean washcloth, wash skin with AB soap several times per day
3. Hydrogen peroxide 1% cream 2/3x per day for 3 weeks
4. mild - Bactroban or mupirocin 2/3/day for 7 days, Fusidic Acid in europe but not in USA
5. caused by S. pyogenes - Retapamulin (altabax)
6. oral antibiotics - Clindamycin/Gentamycin
7. Tetracycline
8. scar, spread, post infection glomerulonefritis
9. good hygiene, clean minor cuts and scrapes well with soap and clean water

22

Holy Fire: Uncommon acute subcutaneous cellulitis by S aureus or strep pyogenes through minor skin trauma or pharyngitis. Well demarcated erythematous subcutaneous plaque, involved upper dermis and extends into superficial cutaneous lymphatics, primary lid involvement, fever, malaise, pruritis, burning, swelling, tender.
1. Name
2. risk factors
3. treatment- for condition, fever, ulceration, severe infection
4.if severe, tx, if allergic to PCN

1. Erysipela
2. 60-80 y/o, immunocomrpomised-DM, lymphatic drainage problems - after surgery, homeless
3. ABs usually, hydration and cold compress for fever, saline wet dressings for ulcerated or necrotic lesions, debridement if severe infections
4. hospitalize, oral phenoxymethylpenicillin (abbocillin), EEM if allergic to PCN

23

Skin disease by flesh eating bacteria: S pyogenes or S aureus, usually extremities, trunk, perineum, post op sites, LETHAL if not treated. redness and edema with large bullae (bubble) and black skin, gangrene or underlying thrombosis, can cause ophthalmic artery occlusion, lagophthalmos, disfigurement
1. Condition
2. Treatment

1. Necrotizing Fasciitis
2. IV benzylpenicillin and debridement of necrotic tissue/ reconstructive sx

24

Acute viral infection by human specific double-stranded DNA poxvirus, typically affects healthy children between 2 and 4 y/o -MCV1, also immunocompromised adults or STD - MCV2, chinstrap in HIV, transmission with contact with infected people, most prevalent in tropics, painless, can be itchy
1. name
2. histology - structures and cellular inclusions affect
3. What if lesions on lid margin shed the virus
4. Management
5. tx for immunocompromised patients
6. Differential Dx

1. Molluscum Contagiosum
2. Henderson patterson bodies - large round structures with virons and eosinophil/basophils- waxy, smooth domes, cellular inclusions - produce hyperplasia that causes epithelium to slough off and form central cavity
3. secondary ipsilateral chronic follicular conjunctivitis
4. self limited, resolves in 6-18 months, but tx recommended for itching and cosmetics and autoinocculation prevention - Cauterize, shave, laser, cryo
5. topical autoimmunomodulatory agents like Aldara or Zyclara - Imiquimod - off label, or Zymaderm, tea tree oil, apple cider vinegar?
6. Verruca vulgaris, squamous cell carcinoma, basal cell carcinoma

25

Virus called varicela - chickenpox in children and shingles - culebrilla in adults, caused by Varicella zoster virus, infecting the dorsal root ganglion - first Div of trigeminal nerve - unilateral. Typically affects elderly. If it affects the nasociliary branch of trigemnial nerve - there is a vesicle at the tip of the nose - Hutchinson sign - 60% risk of ocular involvement, 40% risk without hutchinson
1. Name
2. How to diagnose
3. signs
4. rash progression
5. Cause of chronic pain
6. DDX
7. eye parts involved
8. systemic evaluation
9. General Tx
10. pharm for adults under 72 hrs of onset
11. Pharm for adults over 60, not immuno, not DM, no TB
12. Anti ulcer therapy for HZV
13. children tx
14. what frequently appears during acute phase
15. tx that interferes with pain signals in post herpetic neuralgia, but not used around the eyes
16. how is it spread, who is susceptible, how is it prevented
17. follow up

1. Herpes Zoster Ophthalmicus
2. tingling sensation of the scalp, prodromal itch around the eye, Hx of shingles
3. unilateral lesions up to midline, lymphadenopathy, erythema spread from forehead to eyelid, fluid filled maculopapular rash with erythematous base, edema can spread to other side
4. Vesicles, pustular lesions, crusted lesions, resolution
5. Post-Herpetic Neuralgia
6. HSV, bacteria, dermatosis, neoplasm
7. cornea, retina, uvea
8. under 40 - rule out immunocomp, 40-60- refer if immuno, over 60 - steroid work up - immuno pts do not receive steroids
9. Oral Acyclovir, Vitamin B12, analgesic - narco or non narco, topical ABs prophylaxis,
10. acyclovir 800 mg, famciclovir 500 mg, Valcyclovir 1000 mg
11. Prednisolone 60 mg 3 days, 40 mg 3 days, 20 mg 4 daysto minimize post herpetic neuralgia, AB for lesions
12. Antiacid, H2 blocker - Cimetidine for ulcer and neuralgia
13. same as adults, unless systemic spread
14. depression - antidepressant may be used
15. Capsaicin
16. inhalation, children/adults who havent had chickenpox, Zostavax vaccine
17. every 1-7 days if occular involvement, 1-2 weeks if not. resolves after 3-6 months

26

most common virus in humans, Type 1 is oral, Type 2 is genital, causes secondary blepharoconjunctivitis, transmitted by saliva or contact with vesicles, incubation takes 1 week. 25% have recurrence, must be differentiated from impetigo, vesicles along the base of the eyelashes, pinhead size, with erythematous base, generally resolves without scarring1. Disease2. Symptom3. what needs ruled out4. form without vesicles, erosion at gray line, area tender and swollen, more prevalent5. Treatment for eyelids only6. Treatment for skin lesion

1. Herpes Simplex Virus2. Herpes Simplex Blepharitis3. Genital history of HSV to rule out Type 24. Erosive Ulcerative form5. topical antivirals can be used to prevent cornea infection, Trifluridine or Ganciclovir, F/U 3-5 days6. warm saline solution compresses, aluminum sulfate to dry, cetaphil to clean, calamine for itch

27

Crab louse found mostly in pubic hair but can infest facial hair, transferred to eye by sexual contact or bedding, towels, translucent eggs, dark colored lids due to fecal matting of lids. 1. organism responsible2. How to treat scalp and body, remove crabs, lashes with eggs, other tx

1. Phthiriasis Palpebrarum2. 1% lindane gamma benzene hexachloride "Rid" pediculicide OTC, wash bedding, check family, epilate lashes with eggs, physostigmine, yellow murcuric oxide, fluorescein.

28

crab louse found mostly in pubic hair but can infest facial hair, transferred to eye by sexual contact or bedding, towels, translucent eggs, dark colored lids due to fecal matting of lids. 1. organism responsible2. How to treat scalp and body

1. Phthiriasis Palpebrarum2. 1% lindane gamma benzene hexachloride3.

29

Anterior Chronic Inflammation of lid margin as part of a dermatologic condition that extends into scalp, face, eyebrow, appears as greasy scales above eyelid and at eyebrow area, runs a long course, common presentation as dandruff, frequently associated with seborrheic MGD - no expression. 1. name2. management- for dandruff, MGD, infection, Associated KCS

1. Seborrheic Blepharitis - Chronic Anterior Blepharitis 2. baby shampoo, lid scrubs, consider superinfection - Bacitracin or Erythromycin, artificial tears,

30

Anterior Chronic Inflammation as part of a dermatologic condition that extends into scalp, face, eyebrow, appears as greasy scales above eyelid and at eyebrow area, runs a long course, common presentation as dandruff, frequently associated with seborrheic MGD - no expression. 1. name2. management- for dandruff, MGD, infection, Associated KCS

1. Seborrheic Blepharitis - Chronic Anterior Blepharitis 2. baby shampoo, lid scrubs, consider superinfection - Bacitracin or Erythromycin, artificial tears,