OPTM 6076: Anterior Seg. Disease (Lumps and Bumps, Common Medications, Disorders of the Eyelids)

What is the definition of benign?

abnormal growth of cells that lack the ability to invade neighboring tissues or metastasize

What is the definition of malignant

cancerous cells that invade and destroy body tissue; fast and uncontrolled growth due to genetic mutation

What are different features of malignant lumps or bumps?

1. irregular boders/ pigmentary changes

2. vascularization/ telangiectasia

3. ulceration and bleeding

4. alteration of normal architecture

5. Loss of cilia

What is the definition of metastatic?

Cancerous cells that spread from a primary site to tissues not directly adjacent to the primary site

How do metastatic cells spread in the body?

1. bloodstream

2. lymph system

What is the definition of paraneoplastic syndrome?

disease or symptom that is a consequence of cancer in the body, but is not due to the local presence of cancer cells

What kind of tissue is the epidermis composed of in the skin?

stratified squamous epithelium

A 75 YO patient walks in with a slightly darker than his skin color growth on his eyelid. You ask them if it has gotten bigger since he noticed it and he mentioned it has slowly done so. What is the diagnosis and and is this condition a danger to the person's immediate health? How should they manage this condition?

Diagnosis: Squamous papilloma

danger to health: benign hyperplasia of squamous epithelium

Management: Observation, surgical excision for aesthetics

A 70 year old patient comes in presenting with multiple lesions of a darker color around his eyelids. When doing a history, he claims to garden in the hot sun everyday for exercise . What is the diagnosis and how would you manage this?

Diagnosis: Seborrheic Keratosis

Management: Refer for colonoscopy because you see multiple lesions in 2 weeks

An 18 YO Female patient comes in with debris and flakes on her lashes. You take a closer look and see a white elevated lesion on her eyelid. As you do a thorough history with her, you find out that she has a weaker immune system than most. What is the diagnosis and how woud you manage her?

Diagnosis: Verruca Vulgaris

management: Let it go away on its own

A 3 year old male patient comes in with multiple flesh colored lesions with a central impression on both eyelids. They have not experienced any symptoms . What is the diagnosis and management. Should the patient be worried about recurrence?

diagnosis: Molluscum contagiosum

Management: get it excised, cryotherapy, laser

recurrence rate: Very rare after complete resolution

What virus can cause verruca Vulgaris?

human papilloma virus type 6 or 11

We have a 20 yeard old male patient who comes in with rashes all over their face and a lid tingling sensation that happened 18 hours ago and has continued to the exam. What is the diagnosis and how would you manage this condition. If you wanted to get rid of it quicker, how could you help the patient?

Diagnosis: Herpes Simplex Dermatitis

Management: Self limiting

Management accelerated: Acyclovir 400mg 5x/day x 7-10 days

A 75 year old female patient complains of a burning and pain along one side of her body which was followed by an outbreak of pustular rashes only along that same side of her body. What is the diagnosis and how do you know when the condition has reached a chronic phase? What is the management for this?

Diagnosis: Herpes zoster dermatitis

How do you know chronic phase: post-herpetic neuralgia; pain following herpetic outbreak

management: Acyclovir 800mg 5x/day x 10 days (double simplex dose)

management 2: Topical antibiotic - erythromycin or bacitracin ung BID for 1-2 weeks

A 45 year old caucasian male patient complains of a single lesion that looks elevated with a central crater that has gotten a lot bigger after 2 months. The patient enjoys surfing alot and always gets that vitamin D from the sunlight. What is the diagnosis and if multiple lesions are found, what is the possible systemic condition that this can be associated with. How would you manage this condition?

Diagnosis: Keratoacanthoma

Multiple lesions: colon cancer

managment: complete removal via surgical excision

A 62 year old caucasian male patient complains of pink colored lesions that look to be about 1-10 mm in diameter. Some of these lesions have become ulcerated and are painful. When asked his previous occupation was playing golf. What is the diagnosis and management for this condition.

Diagnosis: Actinic Keratosis

Management: biopsy

A 63 year old caucasian female complains about a lesion located at her lower eyelid thats been irritating her and bleeding for quite some time now. She said she has been noticing red in her eye for the past 6 months. What is the diagnosis and management plan?

diagnosis: squamous cell carcinoma

management: radiotherapy, cryotherapy, photodynamic therapy

A 75 year old female caucasian patient compains of a lesion at their medial canthus that is painless. You observe that its pearly, waxy and has telangiectatic borders with a central ulceration . What is the diagnosis, and what are the chances this could recur?

DIagnosis: Basal cell carcinoma

recur: 40% of patients with one lesion will develop another within 5 years, 15-30% that have it at the medial canthus will have greatest risk of recurrence

A 14 year old male is concerned about a dark spot that he realized recently at his eyelid margin. What is the diagnosis and is it dangerous?

Diagnosis: Melanocytic nevus

Danger: benign

A 30 year old asian male patient comes in with a flat grayish lesion along his face that he has had since he was born. He wanted to make sure it wasn't cancerous. What is the diagnosis and is this cancerous or benign. What disease does Relative peripheral refraction screen for that is correlated with this condition?

Diagnosis: Oculodermal melanocytosis

Benign

RPR screen: syphillis

A 55 year old african american female patient complains of a flat, irregular and tannish brownish lesion that has gotten bigger over a few years. What is the diagnosis and is there a danger of malignancy?

Diagnosis: Lentigo Maligna

Malignancy: pre-malignant (common)

A 42 year old caucasian male patient complains of a thin brown lesion at his eyelid margin. The lashes that used to be there for his lower lashes are gone. He is wondering if it is cancerous and what the diagnosis is.

Diagnosis: Primary Malignant Melanoma

98% survival rate at 5 years if thin lesion (

What does ABCD screening for melanoma stand for?

A: Asymmetry

B: border (indistinct)

C: Color (not a normal color)

D: diameter( how big)

E: elevation ( elevated)

A 70 year old caucasian female patient complains of lid swelling on and off for years with a loss of lashes. She has tried lipiflow with minimal success and you boserve that their is a whitening of her upper eye lashes. What is the diagnosis and management?

Diagnosis: Sebaceous gland carcinoma

Management: wide surgical excision

A 33 year old female patient with hyperlipidemia comes in with a complaint of multiple flat yellow lesions that are around her eyelids on both eyelids. What is the diagnosis and management?

Diagnosis: eyelid xanthelasma

Management: observation, surgical excision for cosmetic concerns

A sebaceous cyst normally occurs in what glands?

Glands of Zeis

What is the management of a sebaceous cyst?

hot compresses

A patient comes in with a clear cystic translucent lesion near the eyelid margin. THey claim to run alot but never wipe their sweat away. What is the diagnosis and management?

Diagnosis: Sudiferous Cyst

Management: observation or drainage

Eyelid Syringoma are benign proliferations of what glands?

Eccrine sweat glands

Which condition of the eyelid is correlated with causing an S-shaped curve of the upper eyelid and feels like a "bag of worms" upon palpation?

Neurofibroma

A patient comes in with these diagnostic criterias:

1. 6+ cafe au lait macules

2. 2+ neurofibromas or one plexiform neurofibroma

3. optic nerve glioma

4. 2+ Lisch nodules

What is the condition?

Neurofibromatosis Type I

A 1 year old female infant patient has what looks to be a strawberry like mark on her face. When applying pressure on the lesion, it blanches and swells up when the infant is crying. What is the diagnosis and management?

Diagnosis: Capillary Hemangioma

Management: careful assessment of VA and refraction; topical beta blockers (timolol): first line of therapy for superficial lesions

If a patient with capillary hemangioma has a deeper lesion, what is the management?

oral propanalol

If a patient with capillary hemangioma has amblyogenic potential, what is the proper management?

intralesional steroid injection

If a patient has a port wine stain with upper eyelid involvement, what is the condition called and what condition does it have an indication for? What is management?

Nevus Flammus

indication: glaucoma development

management: laser decreases skin decoloration

Nevus Flammeus is associated with what syndrome ?

Sturge Weber Syndrome

A 32 year old male patient comes in with a brown eyelid lesion that had begun in his lower extremeties and slowly made its way up his body. After a thorough history, it is found out that the patient also has AIDs. What is the diagnosis and management pla for this condition.

Diagnosis: Kaposi Sarcoma

Management: chemotherapy for extensive lesions; radiotherapy for small local lesions

A 75 year old female patient complains of a lesion that appears red and dark near the upper eyelid. Patient history reveals that hte patient also has systemic lymphoma. What is the diagnosis and management.

Diagnosis: Eyelid Lymphoma

Management: Local: radiotherapy; Systemic: chemotherapy

A 25 year old male patient comes in and gets a refraction done. He seems to have some astigmatism he did not have the previous exam. On closer examination on slit lamp, you see a yellow-white limbal mass in the infratemporal portion of the limbus. What is the diagnosis and management

Diagnosis: Conjunctival Dermoid

Management: surgical removal due to new astigmatism

What condition do you usually find tied to a patient that has a conjunctival dermoid? What exactly does it entail?

Goldenhar Syndrome: underdevelopment of the bones normally on one side of the face, can also be mental handicap

A 20 year old patient comes in presenting with dark pink fleshy mass growing on their conjunctiva. A quick history reveals that he got hit in the eye with a baseball and then a few weeks later is when the mass started to grow. What is the diagnosis for this condition and what is the management?

Diagnosis: Pyogenic Granuloma

management: Topical steroids, excision

What is the most common conjunctival melanocytic lesion?

conjunctival nevus

A 31 year old male african american patient comes in and you find a concentrated pigmented ring around the limbus of both eyes. What is the diagnosis and is it dangerous to his health?

Diagnosis: Racial Melanosis

Danger to health: benign

A patient comes in with a fleshy lesion near the limbus which seems to have vascularization surrounding it. What is the diagnosis and management for this condition?

Diagnosis: intraepithelial Neoplasia

management: excision

A 40 year old caucasian male patient is concerned due to a recent growth of a brown patch on the white of his eye. This patch of color was never there before and you see that none of it has entered his cornea. WHat is the diagnosis and management. If you are suspicious of it becoming something more, what could it possibly metastasize into?

Diagnosis: Primary acquired melanosis

management: excision biopsy; if suspicious - excision, mitomycin C; long term follow up

metastasize: malignant melanoma

What percentage of conjunctival malignant melanomas arise from primary acquired melanosis?

75%

What nodes can malignant melanoma recur locally and metastasize to?

submandibular and preauricular nodes

What is the mortality rate of malignant melanoma?

25%

What is squamous cell carcinoma?

Cervical intraepithelial neoplasia that has breached the basement membrane of the conjunctival epithelium and invaded the underlying stroma

A patient has a fleshy pink mass that is slightly elevated and diffuse that is irritating to their eye when they put on their contact lenses. Diagnose the condition and what is management?

Diagnose: Conjunctival Lymphoma

Management: excision of small lesions; radiotherapy for larger ones, do a biopsy to check if its benign or malignant

IF you see small whitish peripheral iris speckles arranged in a concentric ring what condition is it most likely? Patients with what other condition normally have this condition?

Diagnosis: Brushfield Spots

Down Syndrome patients

Which condition is a pigmented aggregation of melanocytes and spindle cells in the superficial iris stroma? What type of patients can you find multiple nodules in?

Diagnosis: Lisch Nodules (no malignant potential)

Patients: Patients with NF1

Which layer of the iris is the irsi nevus located?

Iris stroma

If an iris nevus is in what location that would give it risk of malignant transformation?

inferior location

How do you differentiate between an Iris Cyst and a melanoma?

you can do bscan and the melanoma will show up as white as it is filled while the cyst will show up black because it is filled with liquid

Where does orbital fat prolapse normally generate from?

It is a defect in Tenon's capsule into the conjunctival fornix

What is the condition known as a firm, non-movable subcutaneous mass which is most common at the supratemporal bony rim.

Dermoid Cyst

Bacitracin is effective against what type of bacteria?

Gram + bacteria

What are two indications for using Bacitracin?

1. blepharitis

2. conjunctivitis

Erythromycin is effective against what type of bacteria and limited coverage against which type of bacteria?

Good: G+ coverage

Limited: G- coverage

What are the indictions of erythromycin?

1. blepharitis

2. conjunctivitis

3. neonatal prophylaxis (after birth)

4. corneal abrasionn

What drugs are used to form polysporin?

Polymyxin B/ bacitracin

What are indications for polysporin?

1. blepharitis

2. conjunctivitis

3. corneal abrasion

Polytrim is formed from what two medications?

trimethoprim sulfate and polymyxin B

Can you use polytrim for peds patients?

if they are greater than or equal to two months then yes

What are different indications for polytrim?

1. conjunctivitis

2. corneal abrasion

Azasite is an antibiotic that can cover what type of bacterias?

Gram + and Gram - bacteria

What are indications for using Azasite?

1. conjunctivitis

2. Corneal abrasion

What medication can you use to treat G- bacterias including pseudomonas?

Tobrex

What are 3 different indications for Tobrex?

1. Blepharitis

2. conjunctivitis

3. bacterial keratitis

What must you do with Besivance before using it?

its an opthalmic suspension so you must shake before use

What are 3 of the best medications for treating bacterial keratitis.

1. Besivance (white viscous drops)

2. Moxeza (yellow color)

3. Vigamox (yellow color)

good for Gram+ and Gram - bacteria

Moxeza is good for treating what type of bacteria?

Gram + and gram - bacteria

What are 2 contraindications for doxycycline?

1. children under 8 years: adverse effects on developing teeth and bones

2. pregnancy category D: known risk to fetus

High dose of Doxycycline is used to treat what and what is the dosage?

Anti- infective: 200mg qd

Low dose of Doxycycline is used to treat what and what is the dosage?

anti-inflammatory: 50-100mg qd

What are 4 side effects of doxycycline.

1. GI discomfort

2. avoid taking with dairy

3. sun protection due to phototoxicity

4. reduced efficacy of birth control

What are indications for Augmentin

1. internal hordeolum

2. preseptal cellulitis

3. dacrocystitis

Is augmentin safe for pregnant woman

its pregnancy category B: safe for prenant woman and infants

What type of allergy is contraindicated for augmentin?

penicillin allergy

What is the dosage (adult) for mild skin infections?

500 mg q12h

If you are giving Azirthromycin to a patient to treat inclusion conjunctivitis, what is the dosage?

1000mg single dose

If you are giving Azithromycin to a patient to treat internal hordeolum?

250mg BIDx 1d, then qd x 4 d (z pack)

What is a side effect of viroptic?

corneal toxicity

What pregnancy category is VIroptic?

Pregnancy category C: animal studies showed adverse effects on fetus, no studies on humans done

What is the dosage for Zirgan?

5x/day until ulcer heals, then 3x/day for 7 days

What is the dosage for Acyclovir when treating HSV active keratitis?

400mg 5x/day x 7-10d

What is the dosage for Acyclovir when treating HSV prophylaxis?

400mg BID x 1+ year

When is the dosage for Acyclovir when treating HZV active dermatitis?

800 mg 5x/day x 7-10d

What medication is useful for rapid suppression of moderate-severe inflammation.

Durezol

Does durezol need to be shaken before use as an emulsion?

it does not need to be shaken

What is a contraindication of Durezol?

IOP elevation

What are indications of Durezol?

1. Anterior Uveitis

2. subepithelial infiltrates

3. post-operative inflammation control

What are different indications of PredForte?

1. Anterior Uveitis

2. subepithelial infiltrates

3. Post-operative inflammation control

Does Lotemax have a high risk IOP elevation?

NO: it has a low risk of IOP elevation

What is 2 indications for Lotemax?

1. Dry eye

2. Thygeson SPK

What medication is FDA approved for short-term treatment of dry eye

Eysuvis

What three medications are antibiotic/steroid combinations?

1. Tobradex

2. Maxitrol

3. zylet

What two medications can be used for post-operative inflammation and pain?

1. Acular

2. Prolensa

What medication is mainly used for anterior scleritis treatment?

Ibuprofen