Lid and Lacrimal Disorders Flashcards Preview

Ophthalmology > Lid and Lacrimal Disorders > Flashcards

Flashcards in Lid and Lacrimal Disorders Deck (41):
1

Karatoconjunctivitis Sicca (KS)

1. Lacrimal gland dysfunction or destruction
2. Increased evaporation loss
- commonly caused by meibomian gland dysfxn
- structural abnormalities
- decreased blink fxn

2

KS Findings

Conjunctival injection
Excessive tearing
Blepharitis
Often need optho referral

3

KS Tx

Blepharitis: Eye hygiene
Avoidance if allergies
True KS:
1. Fake tears
2. Environmental strategies?
3. Topical cyclosporine (Restasis)

4

Dacrocystitis

An infection of the lacrimal sac and is often associated with a blocked duct.

5

Dacrocystitis Causes

Nose injury
Eye infxn/tumor
Nasal inflammation
Old Age
Blocked tear duct
Obstruction of nasolacrimal duct

6

Dacrocystitis Tx

Warm compress
Oral antibiotics (bactrim, clindamycin)
Careful follow up
If persistent, refer to optho

7

Dacrostenosis

Nasolacrimal duct obstruction
- Can occur anywhere in lacrimal drainage system
- Most common at membrane of Hanser

8

Dacrostenosis is seen primarily in which population?

Newborns and infants
- Persistent tearing
- Acular discharge

9

Dacrostenosis Tx

Massage 2-3 times/day
Probing(?) by an optho
**Don't get weird**

10

Hordeolum (Stye)

A localized infection OR inflammation of the eyelid margin involving either:
- Hair follicles of eye lashes (external)
- Meibomian Glands (internal)

11

Which bacteria is most often associated with a stye?

Staph Aureus in 90-95% of cases

12

Both internal and external styes can srise as a secondary complication to which other disease?

Blepharitis

13

Chalazion

AKA meibomian gland lipogranuloma
A PAINLESS mass arising from chronic granulation of a stye.
- If large enough can cause visual disturbance.
- generally disappear w/o tx in a few months, and certainly within 2 years

14

Pertinent negatives for styes

Absence of constitutional symptoms
Absence of periborbital involvement
Preauricular lymph nosed are NOT enlarged

15

Stye Tx

Generally self-limiting
Warm compresses
Abx if infection spreads beyond initial area
Consider eyelash removal to help with draining

16

Should the patient squeeze the stye?

Really? No.

17

Blepharitis

Inflammation involving structures of the lid margin and involves:
- erythema
- scaling
- crusting
Often associated with systemic conditions

18

Blepharitis Patho

Bacterial colonization of the eyelids
Direct invasion of tissues
Generally seen in ages 50 and older

19

Blepharitis presentation

- Burning, watering, crusting of lashes and medial canthus, scaling, erythematous eyelids.
- chronic course with intermittent exacerbations
- May be some conjunctival injection

20

Blepharitis Tx

Eyelid margin hygiene!
Application of heat
Antibiotic ointment (erythro)

21

Blepharitis can be easily cured: T or F

False, it is a chronic condition. educate the patients about this.

22

Ectropion

Eversion of the eyelid margin away from the globe.
Generally requires surgical repair
Eyedrops and ointments can be used to treat symptoms and protect eye.

23

Causes of ectropion

Aging, scarring, loss of tone, infxn, palsy of facial nerves

24

Entropion

Inversion of the eyelid toward the globe.
- muscle weakness, scarring, infections

25

Entropion tx

Surgery, lubricants

26

Pterygium

A corneal proliferative disease associated with UV exposure that arises form limbus and proliferates
- Can move to cornea
- Generally asymptomatic and zero consequence

27

Pinguecula

- Often associated with pterigium
- Appears as yellowish growth of scleral conjunctiva adjacent to limbus.
- Will not encroach onto cornea
- Generally asymptomatic

28

Capillary Hemangomia

Superficial tumor that develops strawberry appearance
1/3 diagnosed at birth
90% visible by 6 months

29

Capillary Hemangomia Complications

- Amblyopia, astigmatism
- Superinfection, ulceration

30

Capillary Hemangomia Tx

- Steroids, interferon
- Radiation therapy
- Surgical rescection

31

Conjunctival Hemangomia

Red blood-filled growth on conjunctiva

32

Conjunctival Hemangomia Tx

May not need tx
May cause amblyopia, strabismus
Almost all disappear by age 9
Laser can remove in some cases

33

Lacrimal Gland Tumors

- Enlargement of lacrimal fossa, no inflammatory signs

34

Pleomorphic Adenoma

Benign mixed Lacrimal tumor
20-50 years of age
Excision Tx
Painless globe displacement

35

Adenoid Cystic Carcinoma

Most common malignant lacrimal tumor.
Pain and numbness
50% mortality, requires agressive surgery

36

Basal Cell carcinoma (BCC)

Most common human malignancy
Usually effects elderly
Does not metastasize
90% of head or neck
90% of eyelid malignancies
Tx is excision

37

Squamous Cell carcinoma

Less common but more aggressive than BCC
Arise from solar damage
Most common of bottom eyelid
Tx: Excision, radiation

38

Meibomian Gland Carcinoma

AKA sebaceous cell carcinoma
Lethal eyelid malignancy
Error and delay in dx is common
Commonly occur in upper eyelid
50% mortality
Tx: Excision and radiation

39

Melanoma

Very aggressive, rapid spread.
Affects choroid, conjunctiva, ciliary body, eyelid.
Tx: excision and possibly radiation

40

Karposi Sarcoma

- Malignant, vascular tumor that occurs mainly is AIDS patients.
- Usually associated with advanced disease
Tx: chemo, radiation

41

Merkel Cell Carcinoma

Rare, agressive malignancy
Metastasizes early to lymph nodes
Intact overlying skin
Most common on upper eyelid
treatable if caught early
Tx: excision, radiation, chemo