The external eye

Question 1

Styes definition and subtypes (3)

Answer 1

inflammatory lid swelling

hordeolum externum/internum

Question 2

Features of hordeolum externum and Rx (5)

Answer 2

infection/abscess of lash follicle
by staph
involve glands of moll (sweat) and zeis (sebacious)

Rx:

• warm compresses+analgesia 1st line
• topical fusidic acid.

Question 3

Features of hordeolum internum (3)

Answer 3

less common
involve meibomian glands
can cause decreased vision through lens flattening

Question 4

Features, DDx and Rx of chalazion/meibomian cyst (5)

Answer 4

blockage of meibomian glands w/o infection

differ from styes:

• painless
• larger
• harder

should resolve spontaneously w. warm compresses, review in 1mo.

Question 5

Features and causes of blepharitis (4)

Answer 5

inflammation of eyelid

causes:

• acne rosacea
• staph
• seborrhoeic dermatitis

Question 6

Mx of blepharitis (6)

Answer 6

1st use warm compresses and clean crusts of lashes

drugs:

• tears naturale
• topical fusidic acid
• topical steroids
• oral doxycycline
• in children consider erythromycin

Question 7

Features of pinguecula (6)

Answer 7

degenerative, vascular, yellow-grey nodule on corneal surface
characteristic of Gaucher’s
typically affects adult males
common in darker skinned/haired people; sun-damage
can become inflamed>pingueculitis
can invade cornea>pterygium (appears fleshy)

Question 8

Mx of pinguecula (2)

Answer 8

pingueculitis>topical steroids

pterygium>surgery

Question 9

Entropion features and Rx (5)

Answer 9

when (usually lower) lid curls in
due to degeneration of facial attachments and muscles
Rx:
-tape lid to cheek
-botox
-surgery

Question 10

Ectropion features (3)

Answer 10

lower lid turns out
>irritation, watering +/- exposure keratitis
assoc. w. old age; facial palsy

Question 11

Features and causes of lagopthalmos (4)

Answer 11

difficulty closing lid
can>keratitis and corneal ulcers
causes:
-exopthalmos
-mechanical difficulty

Question 12

Mx of lagopthalmos (2)

Answer 12

lubricate w. liquid paraffin

if corneal ulcers develop>temporary tarsorrhaphy.

Question 13

Dendritic ulcer symptoms Ix and Mx (4)

Answer 13

photophobia and watering
stain lesion w. fluorescin eyedrops 
Mx:
-topical aciclovir
-if topical steroids are used w/o aciclovir cover, corneal invasion and scarring can occur risking blindness.

Question 14

Benign lid tumours (3)

Answer 14

skin papillomas
seborrhaic keratosis
naevi

Question 15

Malignant lid tumours (5)

Answer 15

BCC 
sebaceous gland carcinomas
malignant melanoma
KS
merkel cell ca. (rapidly growing purple nodule in elderly pt.)