Hyphema, Inflammatory Disorders, Lacrimal Disorders, and Lid Disorders

hyphema

What is a hemorrhage into the anterior chamber that can cause glaucoma or permanent vision loss?

elevate HOB, pain management, patching, dilating eyedrops

AND

rest until complete resolution has occured

What is the tx for hyphema

hyphema

iritis

What is characterized by leukocytes in the anterior chamber and can be present with keratic precipitates?

iritis

uveitis

What are cells that occur in the citrous and imflammatory lesions in the retina or choroids that can be bilateral or unilateral - have floaters, and slow onset symptoms?

uveitis

scleritis

What presents with intense pain, inflammation of the eye, blue discoloration in advanced disease, and vessels DO NOT blanch?

scleritis

topical corticosteroids

What is the 1st line tx for anterior uveitis (iritis)?

systemic corticosteroids

What is the tx for posterior uveitis?

systemic corticosteroids

What is the tx for chronic uveitis?

CBC, chemistry, UA, ESR, CRP

- CXR- for infiltrates or nodules

What should the work-up/ dx include for scleritis?

◦NSAIDS

◦Systemic Glucocorticoids

◦Immunosuppressive drugs

◦Treat underlying cause

REFER!!!

What is the tx for scleritis?

episcleritis

What has minimal discomfort and red vessels that BLANCH with phenylEPI- dry eye syndrome is a common cause?

episcleritis

topical analgesics or steroids

- oral NAIDS

What is the tx for episcleritis?

dacryoadenitis

What is inflammation of the lacrimal gland?

•Treat underlying disorder

•May require systemic steroids

•Surgical debulking

•If bacterial infection à antibiotics

What is thew tx for dacryoadenitis?

dacryoadenitis

dacryostenosis

What is lacrimal duct obstruction that presents with no erythema, and tearing or debris on eyelashes?

dacryostenosis

•Lacrimal sac massage

•Antibiotic ointment to prevent infection

•Surgery - lacrimal duct probing, balloon dacryocystoplasty

What is the tx for dacryostenosis?

dacryocytitis

What is infection of the lacrimal sac that is caused by staph aureus and can present with swelling over the lacrimal sac, redness, tearing, eyelash matting and crusting?

dacrocytcystitis

warm compresses, oral clinda

- REFER

What is tx for dacrocytcystitis?

keratoconjunctivitis sicca

What is aka dry eye disease

- typically associated with Sjogrens diease that has dryness, red eyes, irritation, gritty, burning, or foreign bodies?

keratoconjunctivitis sicca

• Artificial tears

• Warm compresses

• Discontinue medications that contribute to dryness

• Refer to ophthalmology

What is the tx for keratoconjunctivitis sicca?

blepharitis

blepharitis

What is inflammatory condition of the eyelid margins and presents as irritation, burning, light sensitivity, excessive tearing, crusting, pink eye, and itchingy?

anterior

What type of blepharitis are the eyes red rimmed and scared or collarettes are seen clinging to lashes?

posterior

What type of blepharitis are lid margins hyperemic with telangiectasias and the meibomian glands are inflamed?

•Eyelid hygiene

•Warm compresses

•Gentle eyelid massage and lid scrubs with baby shampoo or 0.01% hypochlorous acid

•Bacitracin or erythromycin in acute exacerbations

What is tx for anterior blepharitis?

•Meibomian gland expression and warm compresses

•May need long-term low-dose oral antibiotic therapy

•Tetracycline (250 mg twice daily for 2-4 weeks)

What is tx for posterior blepharitis?

chalazion

chalazion

What is a painless granulomatous inflammation of a meibomian gland that is hard, rubbery, nontender, and swollen?

warm compresses! then refer for I&D if not improving

What is the tx for chalazion?

hordeolum

hordeolum

What is a localized red, swollen, acutely tender area of the upper or lower lid (aka stye)?

S. aureus

What is the common pathogen of hordeolum?

internal

Internal or external hordeolum:

•Meibomian gland abscess

external

Internal or external hordeolum:

•Smaller and on the lid margin and

•Abscess of the gland of Zeis

•Warm compresses

•Antibiotic ointment

•Incision if not resolved within 48hrs- refer

What is the tx for hordeolum?

ectropion

What is the OUTward turning of the lower lid commonly with age?

ectropion

surgery if excessive tearing, keratitis, or cosmetic problem

What is the tx for ectropion?

entropion

What is the INward turning of the lower lid- occurs in older ppl due to degeneration of lid fascia?

entropion

surgery if lashes rub on cornea- or botox

What is the tx for entropion