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Disease

Presentation
-Inward turning of the eyelashes. occurs in older people as a result of degeneration of the lid fascia, or may follow extensive scarring of the conjunctiva and tarsus

Labs/ Tests

Treatment
-Surgery if the lashes rub on the cornea. - Botulinum toxin injections may also be used for temporary correction of the involutional lower eyelid.

Entropion

Ectropion

Blepharitis

Chalazion

-Usually involves the lower lid and has a component of horizontal lid laxity resulting in abnormal eversion (outward turning) of the lid margin away from the globe. - Corneal exposure, tearing, keratiization of the palpebral conjunctiva, and visual loss may result. (cant keep cornea moist) -Inflammation of the eyelid, eyelashes, and glands of Zeiss/Moll. -It may be ulcerative, due to infection with staphylococci, or caused by conditions such as Seborrheic dermatitis. - May have inflamed, erythematous eyelid margin - Eyelid margin may appear greasy, ulcerated, and crusted with scaling debris that clings to lashes. -NOT an infection -subacute non-tender nodule involving the meibomian gland -Will have been present several days -Presents with eyelid swelling and erythema then evolves into a painless, rubbery, nodular lesion. Infectious (Bacterial) -caused by a wide range of gram positive and gram negative organisms. -abrupt onset, develops in one eye initially, then spreads to the opposite eye within 48 hours. -Tearing and ocular irritation are early presenting symptoms. -discharge develops within one or two days, with a collection of debris at the base of the lashes and matting of the lids, particularlyon awakening. -Examination reveals diffuse hyperemia of the bulbar and tarsal conjunctiva, generallywithout marked lymphadenopathy. -most common causes: 1. Strep p., 2. Staph a., 3. Haemo i. -Eye stuck shut in morning Infectious (Viral) -preauricular adenopathy common -Bacteria, PMNs present

-Lubrication and moisture shields are temporizing measures until lid surgery can be performed.

-Cleanliness of the lid margins, eyebrows, and scalp. -Scales should be removed from the lids daily with a warm wash cloth and baby shampoo. -In acute exacerbations, an antistaphylococcal antibiotic eye ointment such as bacitracin or erythromycin can be applied daily to the lid margins. -Warm compresses applied for 15 minutes four times a day. -Topical antibiotic (bacitracin or erythromycin) may be used if signs of infection are present. -If the lesion persists after four weeks of medical therapy, it may be incised and drained. Mild/ Moderate: Erythromycin, Sulfacetamide Moderate/Severe: Ciprofloxacin, Ofloxacin, Gentamicin, Tobramycin

Conjunctivitis

-Monocytes present

-Cool compresses -Artificial tears

Disease

Presentation
-profuse tearing -lids may be swollen -conjunctiva is usually hyperemic -edematous with a watery discharge. -Adenoviruses are the most common cause -may be associated with pharyngitis, fever, malaise Non-infectious (Allergic) -no sore throat or fever -A type of hypersensitivity to pollen, animal dander, or dust. *The hallmark is itchy eyes -often accompanied by tearing, nasal congestion - Sneezing can also be present Non-Infectious (Non-Allergic) -An infection of the lacrimal sac due to obstruction of the nasolacrimal system. inflammation of the medial lacrimal apparatus, which usually follows occlusion of the nasolacrimal duct. - Peaks in infancy and after 40 years . - pain, erythema, and swelling over the medical lacrimal apparatus, tearing, and mucopurulent discharge from the punctum. -Commonly implicated organisms include S aureus, Streptococcus pneumoniae, Haemophilus influenza, and Pseudomonas aeruginosa. -staphylococcal abscess that is characterized by a localized, red, swollen, acutely tender area on the upper or lower lid. - occurs with infection of the glands of Zeiss or Moll.

Labs/ Tests

Treatment
-Meticulous hand washing -no relief after 7 days ophthalmic referral

-Eosinophils present -a cobblestone appearance pathognomonic for vernal conjunctivitis.

-Systemic antihistamines for prolonged allergic conjunctivitis (Histamine H1 antagonists, Topical mast cell stabilizers) -Topical vasoconstrictors are of limited efficacy in allergic eye disease and may produce rebound hyperemia and follicular conjunctivitis.

Dacrocystitis

- amoxicillin-clavulanate -gentle massage, and warm compresses. -In adults w/ chronic dacryocystitis the procedure for obstruction of the lacrimal drainage system involves surgical exploration of the lacrimal sac and formation of a fistula into the nasal cavity.

Hordeolum

Pinguecula

-A harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris. -Appears frequently with aging, first on the nasal and then on the temporal side.

-Histologically identical to pterygium but does NOT cross limbus

-usually drain spontaneously after one week of treatment with warm compresses 3-4 times a day for 1015 minutes. -Incision may be indicated if resolution does not begin within 48 hours. -An antibiotic ointment (bacitracin or erythromycin) applied to the eyelid every 3 hours may be beneficial during the acute stage. None

Disease

Presentation
-Benign, degenerative conjunctival lesion seen in hot, dusty climates, in those who spend time outdoors and are exposed to UV light. -Develops over a period of years and is asymptomatic, but the disorder may be manifested as acute redness of the eye if the lesion becomes inflamed and irritable. -The redness is confined largely to a raised,yellowish, fleshy plaque that is usually located on the nasal side of the bulbar conjunctiva. -The lesion may extend into the peripheralcornea, but unless the paracentral cornea is involved, vision is unaffected.

Labs/ Tests

Treatment
-Lubrication with artificial tears often provides adequate relief.

Pterygium

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