Eye Diseases

Etiology/Risk Factors Ectropion

• most common in elderly patients

• can also be congenital, infectious, or facial nerve (CN VII) palsy

Pathophysiology Ectropion

caused by relaxation of the orbicularis occuli muscle causes the eyelid to droop and evert overtime

Clinical Presenation Ectropion

• eversion of the eyelid/lashes

• irritation, dryness

Treatment Ectropion

• artifical tears

• ocular lubricants

• sx correction

Pathophysiology of Entropion

• scarring of the palpebral conjunctiva and loosening of the fasical attachment

• spasm of the orbicularis oculi muscle

• trachoma (chronic chlymydia infection)

Clinical Presentation Entropion

• inversion of the eyelid/lashes

• eye redness, corneal irriation, ulceration, scarring

treatment entropion

• lubricating eye drops

• boulinum toxin

• sx correction

etiology/risk factors horedeolum

• caused by s. coccus spp (usually s. aureus)

• risk factors are poor hand/eye hygiene, contaminated makeup

pathophysiology hordelum

blockage, inflammation or infection of the meibomein gland, ziess, or moll gland

clinical presentation hordelum

• external: localized, red, swollen, acutely tender area on upper lid

• internal: meibomian gland abscess that usually points onto the conjunctival surface of the lid

treatment hordeolum

• most resolve spontaneously

• warm compress

• abx ointment

• needle drainage or I&D

pathophysiology chalazion

• chronic sterile blockage/granulomatous inflammation of meibomian gland

• may follow an internal hordeolum

clinical presentation chalazion

• hard, nontender, swelling on the upper or lower lid w/ redness and swelling of adjacent conjunctiva

treatment chalazion

• often resolves spontaneously

• warm compresses

• incision and curettage or corticosteriod injection may be effective

etiology/risk factors blepharitis

• posterior blepharitis is the mostcommon in adults and prevalence increases w/ age

pathophysiology blepharitis

• posterior: chronic inflammation of the lid secondary to dysfunction of the meibomian glands, which leads to instability of the tear film, which promotes bacterial growth

• anterior: chronic inflammation of the lid margins bacterial, seborrheic type, demodex foliculorum

clinical presentation blepharitis (both)

• bilateral

• red, swollen, or itching eyelids

• gritty or burning sensation

• excessive tearing

• crusting or matting of eyelashes

• flaking or scaling of the eyelid

• blurred vsn

• dry eye disease

clinical presenation anterior blepharitis

• staphlyococcal: fibrinous scales and crust around eyelashes

• seborrheic: dandruff-like skin changes and greasy scales around base of eyelids/lashes

• demodex folliculorum: cylindrical dandruff or sleeves around the eyelashes

treatment blepharitis

• eyelid hyigene: warm compress, lid massage, lid washing, artifical tears

• bacterial: abx ointment, oral abx

• demodex: ivermectin or tropical tea tree oil

difference between anterior and posterior blepharitis

anterior effects the lash line, whereas posteior affects the inner eyelid margins where the meiobiman gland

etiology/risk factor dacryocystitis

• infants and ppl >40

• s. aureus (if acute)

pathophysiology dacrocystitis

infection of the lacrimal sac due to obstruction of the nasolacrimal duct

clincial presentation dacryocystitis

• often unilateral

• tearing discharge

• redness, swelling, pain in the area of the lacrimal sac

treatment dacryocystitis

• warm compress

• oral abx (amoxicilin-clavulanate, cephalexin, ciprofloxacin, clindamycin, bactrim)

• correction of obstruction

etiology/risk factors keratoconjuctivitis sicca

• systemic drugs

• illness

• hormonal changes

• radiation

• CN V or CN VII lesions

• age

• excessive evaporation of tears

pathophysiology keratoconjunctivitis sicca

• decreased tear production: lacrimal gland dysfunction which leads to reduced volume of aqueous fluid and hyperosmolarity of tear flim/ocular surface, this then leads to inflammation of the ocular surface

• increased evaporative loss: meibomian glanddysfunction which alters the lipid component of tear film, this leads to increased evaporation and inflammation of the ocular surface

• can also be caused by decreased blink function, medications, contact lenses, low humidity

clinical presentation keratoconjunctivits sicca

• gritty/burning/FBS

• injection

• photophobia

• blurred vsn

diagnosis keratoconjunctivits sicca

• tear break time <10 sec abnormal

• schirmer’s test (<5 mm in 5 mins suggestive of dry eye)

etiology/risk factor bacterial conjunctivitis

• s. aures most common in adults (except pseudomonas which is common in contact lense wearers)

• more common in children than adults

• caused by s. aures, pneumoniae, h. influeza, catarrhalis, pseudomonas

clinical presentation bacterial conjunctivitis

• acute onset

• often unilateral

• infection

• constant purulent/mucopurulent discharge

• mild discomfort

diagnostic bacterial conjunctivits

• clinical

• cultures for severe cases

• fluorescein staining

treatment bacterial conjunctivitis

• usually self-limiting

• abx eye drops (erythromycin, tobramycin, polytrim, cipro)

• handwashing, separate towels

etiology/risk factors gonorrhea conjunctivitis

• considered emergent dur to risk of corneal perforation

• caused by neisseria gonorrhoeae

clinical presentation gonorrhea conjunctivitis

• large amount fo purulent discharge

• injection

• chemosis

• lid swelling

• preauricular adenopathy

• urethritis

• tenderness to palpation

diagnositcs gonorrhea conjunctivitis

• culture

• gram stain (gram negative diplococci)

treatment gonorrhea conjunctivitis

• refer to opthalmologist

• ceftriaxone and topical bacitracin ointment

• can do azithro/doxy for co-infection

• hospitalization possible

etiology/risk factors viral conjunctivits

adenovirus

clinical presentation viral conjunctivitis

• unilateral more often then bilateral

• watery discharge

• conjunctival redness

• crusting in the morning

• gritty sensation

• URI symptoms

treatment viral conjunctivitis

• self limiting can last 2 wks

• cool compresses

etiology/risk factors allergic conjunctivitis

airborne allergies

pathophysiology allergic conjunctivitis

airborne allergens contact the eyes which leads to IgE response, this then leads to local mas cell degranulation and release of chemical mediators

clinical presentation allergic conjunctivitis

• bilateral

• itching, burning, gritty sensation, redness, watering

• clear muscoal discharge

• chemosis

• cobblestone papillae on upper palpebral conjunctiva

treatment allergic conjunctivitis

• antihistamines/vasoconstrictors

• antihistamines w/ mast cell stabilizing properties

• mast cell stabilizers

• topical NSAIDs

• glucocorticoids