Lid and Lacrimal Disorders

Question 1

Karatoconjunctivitis Sicca (KS)

Answer 1

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

Question 2

KS Findings

Answer 2

Conjunctival injection
Excessive tearing
Blepharitis
Often need optho referral

Question 3

KS Tx

Answer 3

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

Question 4

Dacrocystitis

Answer 4

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

Question 5

Dacrocystitis Causes

Answer 5

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

Question 6

Dacrocystitis Tx

Answer 6

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

Question 7

Dacrostenosis

Answer 7

Nasolacrimal duct obstruction

• Can occur anywhere in lacrimal drainage system
• Most common at membrane of Hanser

Question 8

Dacrostenosis is seen primarily in which population?

Answer 8

Newborns and infants

• Persistent tearing
• Acular discharge

Question 9

Dacrostenosis Tx

Answer 9

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

Question 10

Hordeolum (Stye)

Answer 10

A localized infection OR inflammation of the eyelid margin involving either:

• Hair follicles of eye lashes (external)
• Meibomian Glands (internal)

Question 11

Which bacteria is most often associated with a stye?

Answer 11

Staph Aureus in 90-95% of cases

Question 12

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

Answer 12

Blepharitis

Question 13

Chalazion

Answer 13

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

Question 14

Pertinent negatives for styes

Answer 14

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

Question 15

Stye Tx

Answer 15

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

Question 16

Should the patient squeeze the stye?

Answer 16

Really? No.

Question 17

Blepharitis

Answer 17

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

Question 18

Blepharitis Patho

Answer 18

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

Question 19

Blepharitis presentation

Answer 19

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

Question 20

Blepharitis Tx

Answer 20

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

Question 21

Blepharitis can be easily cured: T or F

Answer 21

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

Question 22

Ectropion

Answer 22

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.

Question 23

Causes of ectropion

Answer 23

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

Question 24

Entropion

Answer 24

Inversion of the eyelid toward the globe.

- muscle weakness, scarring, infections

Question 25

Entropion tx

Answer 25

Surgery, lubricants

Question 26

Pterygium

Answer 26

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

Question 27

Pinguecula

Answer 27

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

Question 28

Capillary Hemangomia

Answer 28

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

Question 29

Capillary Hemangomia Complications

Answer 29

- Amblyopia, astigmatism | - Superinfection, ulceration

Question 30

Capillary Hemangomia Tx

Answer 30

- Steroids, interferon - Radiation therapy - Surgical rescection

Question 31

Conjunctival Hemangomia

Answer 31

Red blood-filled growth on conjunctiva

Question 32

Conjunctival Hemangomia Tx

Answer 32

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

Question 33

Lacrimal Gland Tumors

Answer 33

- Enlargement of lacrimal fossa, no inflammatory signs

Question 34

Pleomorphic Adenoma

Answer 34

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

Question 35

Adenoid Cystic Carcinoma

Answer 35

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

Question 36

Basal Cell carcinoma (BCC)

Answer 36

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

Question 37

Squamous Cell carcinoma

Answer 37

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

Question 38

Meibomian Gland Carcinoma

Answer 38

``` 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 ```

Question 39

Melanoma

Answer 39

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

Question 40

Karposi Sarcoma

Answer 40

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

Question 41

Merkel Cell Carcinoma

Answer 41

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