Lids and Lashes (pt 3)

Potential Dx for “Red and swollen eyes”

• Hordeolum

• Cellulitis

• Allergies

• Herpes simplex and zoster

Hordeolum

Acute ocular infection of sebaceous glands in the upper or lower lid

Can be internal or external

Key signs of hordeolums

Pain, heat, swelling

External hordeolum

Localized infection of a gland of Zeis or Moll caused by staph A

External hordeolum risk factors

• Poor lid hygiene

• Chronic bleph

• Rosacea

• Immunocompromsied (diabetes, HIV, chemo)

External hordeolum clinical signs

• Hyperemic eyelid margin

• Localized lid edema

• Pustule along lid margin

• Pain

External hordeolum complications

Preseptal cellulitis and orbital cellulitis

External hordeolum Tx

Lid scrub and warm compress to open up skin

Topical antibiotic

Lash epilation

External hordeolum hallmark signs

Localized pustule at lash

Internal hordeolum

Localized infection of meibomian gland caused by staph A

Internal hordeolum risk factors

Chronic posterior bleph and rosacea

Internal hordeolum clinical findings

• Localized swelling of meibomian gland

• Hot eyelid

• Lid hyperemia

• Pain

Internal hordeolum complications

Preseptal cellulitis and orbital cellulitis

Internal hordeolum Tx

Lid scrubs and warm compress

Oral antibiotics

Internal hordeolum hallmark signs

Localized infection of meibomian gland

Cellulitis

Bacterial infection of the skin and tissues underneath

Preseptal and orbital

Preseptal cellulitis

Bacterial infection of the subcutaneous skin that is anterior to the orbital septum

Caused by staph A, strep, or hemophilus

Preseptal cellulitis risk factors

Skin trauma and local infections (hordeolum, sinus, nasolacrimal)

Preseptal cellulitis clinical findings

• Lid swelling

• Lid hyperemia

• Hot lids

• Pain

Preseptal cellulitis complications

Orbital cellulitis

How can you tell an internal hordeolum from preseptal cellulitis?

Palpate the lid to find a nodule and look at glands to see if its blocked

If there is a nodule and blocked gland → hordeolum

Preseptal cellulitis Tx

Oral antibiotics

Preseptal cellulitis hallmark signs

Lid swelling with normal vision and EOM movement

Orbital cellulitis

Bacterial infection of tissue posterior to the orbital septum

Caused by many gram positive strep or staph species

Orbital cellulitis risk factors

• Periorbital infection (sinus, nasolacrimal, dental)

• Trauma

• Intraorbital infection

Orbital cellulitis clinical findings

• Periorbital edema

• Hot periorbital area (upper and lower)

• Proptosis: Inflammation within orbit pushes eye out

• Pain with EOM movement: EOMs inflamed

• Diplopia: Restricted EOM movement

• Reduced vision: ON compression

• Changes in color vision

• APDs

Orbital cellulitis complications

• Vision loss

• Systemic spread of infection

• Death

Orbital cellulitis Tx

Immediate hospitalization with IV antibiotics

Orbital cellulitis hallmark signs

• Proptosis

• APD

• EOM restriction

• Vision and color changes

Blepharochalasis

Idiopathic episodes of painless non-pitting edema of the upper and lower lids

Affects females more, onset is around 11 years old

Blepharochalasis clinical findings

Painless lid swelling

Blepharochalasis complications

• Ptosis

• Skin wrinkles from being streched

• Prolapse of orbital fat or lacrimal gland

Blepharochalasis Tx

Nothing during inflammation episode

Surgery to remove excess skin or fat

Blepharochalasis hallmark signs

Painless episodic swelling of upper lid

Allergies

Inflammatory reaction to an antigen

Pts will present with itching and will benefit from palliative care

Allergic edema

Eyelid swelling from an allergic reaction

Allergic edema clinical findings

• Bilateral periorbital edema

• Lid hyperemia

• Chemosis

Allergic edema complications

PEEs

Allergic edema Tx

Oral antihistamines

Allergic edema hallmark findings

Bilateral lid edema

Contact dermatitis

Inflammatory skin reaction triggered by contact with substance

Mainly caused by preservative, medications, cosmetics, or metals

Contact dermatitis clinical findings

• Lid and conj hyperemia

• Scaling of lids (similar to angular bleph)

• Chemosis

• Papillae

Contact dermatitis complications

PEEs

Contact dermatitis Tx

Allergen removal, topical steroid, oral systemic antihistamine

Contact dermatitis hallmark findings

Pt uses a new product

Atopic dermatitis

Chronic, non-contagious inflammatory skin condition caused by genetics or environmental factors

Atopic dermatitis risk factors

Asthma and hay fever

Atopic dermatitis clinical findings

Thickening and crusting of the eyelids, lid hyperemia

Atopic dermatitis complications

Blepharitis, madarosis

Atopic dermatitis Tx

Facial cream to hydrate the skin

Topical steroid

Atopic dermatitis hallmark signs

Pt has asthma or hay fever

Herpes Simplex 1

Causes ocular manifestations

Primary infection in childhood, reactivation causes corneal involvement

Herpes simplex eyelid dermatitis

Localized viral infection of the eyelid

Herpes simplex eyelid dermatitis clinical findings

• Facial and lid tingling for 24 hrs

• Lid or periorbital vesicles, rupture after a week

• Lid swelling

Herpes simplex eyelid dermatitis associated signs

Follicular conjunctivitis and corneal dendrites

Herpes simplex eyelid dermatitis Tx

Oral antivirals

Topical antibiotic cream to prevent bacterial infection when vesicles rupture

Herpes simplex eyelid dermatitis hallmark signs

Maculopapular rash

Herpes Zoster Ophthalmicus

Localized viral infection of the eyelid caused by varicella zoster (chicken pox/shingles)

More common in elderly and immunocompromised pts

Herpes zoster ophthalmicus clinical findings

• Maculopapular rash on forehead

• Hyperemia and edema of lids

• Pain along first division of the trigeminal nerve

Herpes zoster ophthalmicus associated findings

• Corneal involvement

• Follicular conjunctivitis

Herpes zoster ophthalmicus complications

Scarring of the skin from maculopapillary rash

Herpes zoster ophthalmicus Tx

Oral antibiotic

Topical antibiotic to prevent bacterial infection when rash crusts over

Herpes zoster ophthalmicus hallmark findings

Vesicles on eyelid margin