OPT 221 Eyelids: Infectious

What is a hordeolum?

Acute bacterial infection of the eyelid's sebaceous glands with retention of oils and inflammatory debris

What is affected for an external hordeolum?

zeis glands

What is affected for an internal hordeolum?

meibomian glands

What is the etiology of hordeolum?

staphylococcal aureus infection

Is a hordeolum unilateral or bilateral?

unilateral

What are symptoms of a hordeolum?

-eyelid swelling and redness (focal but may be diffuse if pre septal cellulitis is present)

-pain in the area of the hordeolum

-discharge from bump

What are external signs of a hordeolum?

-Visible or palpable nodule pointing anteriorly through the skin

-Erythema in the area of the hordeolum

-Eyelash may be at the apex of the hordeolum

What are internal signs of a hordeolum?

-Visible or palpable nodule pointing posteriorly through the palpebral conjunctiva

-Injection in the area of the hordeolum

What are complications associated with a hordeolum?

-Pre-septal cellulitis is commonly present

-Orbital cellulitis

How is a hordeolum managed?

-oral antibiotic x 10-14 days (augmentin, keflex, bactrim)

-warm compress with massage to express the contents of the hordeolum

-lid hygiene

What are clinical pearls of a hordeolum?

-may evolve into a chalazion

-may evolve into pre septal cellulitis

What is pre septal cellulitis?

infection of the subcutaneous tissue anterior to the orbital septum

What is the etiology/what are associations of pre septal cellulitis?

-skin trauma with subsequent bacterial infection

-extension from an adjacent infection

-staph aureus, streptococcus, haemophilus influenzae

Is pre septal cellulitis unilateral or bilateral usually?

unilateral

What are symptoms of pre septal cellulitis?

eyelid swelling, redness, tenderness/pain

What are signs of pre septal cellulitis?

-eyelid edema, erythema with tenderness/pain on eyelid palpatation

-low grade fever

What are complications associated with pre septal cellulitis?

orbital cellulitis

How is pre septal cellulitis managed?

-Oral antibiotic x 10-14 days (Same dosing regimen as a hordeolum Ex: Augmentin 500mg bid)

-If more severe may want to start with increased dosage of oral antibiotic Ex: Augmentin 875mg bid

-If moderate to severe and no improvement or worsening after 24-48 hours of oral antibiotic, refer to ER (Orbital CT to rule out orbital cellulitis)

What are clinical pearls associated with pre septal cellulitis?

my develop into orbital cellulitis (which is an ocular emergency)

What is impetigo?

bacterial infection of the epidermis

What is the etiology of impetigo?

Staphylococcus aureus or streptococcus (group A beta hemolytic)

Who is most commonly affected by impetigo?

infants and children (can be unilateral or bilateral)

What are symptoms of impetigo?

red, itchy skin rash (may be painful)

What are signs of impetigo?

-skin macules (erythematous)

-macules evolve rapidly into thin walled blisters (honey colored crusts)

How is impetigo managed?

-Topical antibiotic, usually an ung

-Oral antibiotic in addition to topical can be considered

-Discuss hand-washing, avoidance of eye rubbing and towel sharing, and stay home from school to reduce risk of transmission

What are clinical pearls associated with impetigo?

-highly contagious

-most commonly affects arms, legs, and around nose and mouth

-most common bacterial skin infection in children

What is molluscum contagiosum?

viral infection of the epidermis

What is the etiology of molluscum contagiosum?

transmitted through skin to skin contact with fomites (inanimate object that can transfer infectious disease)

What are the demographics most affected by molluscum contagiosum?

-infants and children

-if seen in older adults, consider immunodeficiency

(can be unilateral or bilateral)

What are symptoms of molluscum contagiosum?

-bumps on skin

-mild itching of bumps

What are signs of molluscum contagiosum?

skin papules (dome shaped bumps_

-single or multiple

-flesh colored or pearly white

-1-2mm in size

-central umbilication due to central keratin plug

-can cause follicular conjunctivitis

How is molluscum contagiosum managed?

-self limiting within 6-12 months

-if does not go away , curettage for eyelid lesions

-cryotherapy, cautery, chemical, laser can be used for lesions

What are clinical pearls associated with molluscum contagiosum?

-immunocompromised patients may have larger (up to 5mm) and more numerous lesions