Ocular Disease - Midterm 1 Lids Part 1

Horner's syndrome

Sturge-Weber syndrome

Moh's syndrome

Noon's syndrome

It has a high chance of metastasis

Surgery by Moh's technique is less likely to be successful, thus treatment will be limited to cryo and conventional surgery

It is more likely to directly extend intracranially without apparent nature when grossly observing the lesion

It is less dangerous in this region because it is further from the regional lymph node

Capillary hemangioma

Existing actinic keratosis or a cutaneous horn

Nevus of Ota

Hutchison's freckle

Port wine stain

Marcus Gunn jaw winking syndrome

Neonatal myasthenia gravis

Congential Horner's syndrome

Duane's retraction syndrome

Euryblepharon

Ankyloblepharon

Vitiligo

Cicatricial entropion

Atonic entropion

Distichiasis

Epiphora

Poliosis

Trichiasis

Blepharospasm

Cicatricial entropion

Dermatochalaisis

Spastic entropion

Blepharochalaisis

Erythema

Elevated WBC count

Puffy from fluid accumulation

Tender to palpation

Acute changes due to hypersensitivity

Actinic keratosis

Bullous Impetigo

Benign melanotic lesions

Keratoacanthoma

Functional (hysterical)

Myokymia

Tardive dyskinesia caused by antipsychotic medications (Prolixin, Haldol)

Blepharoclonus

Ocular disease (local irritation, inflammatory process, or foreign body)

Causes include anemia, anterior segment irritation, excessive use of alcohol or tobacco

Medications interfering with nerve conduction are variably, but not consistently successful. Recently people have been reporting success with therapy coupled with Botulin A toxin injections, the symptoms will subside for an average of 3 months.

Suggest oral quinine 200-300mg qd to tid for stubborn cases, but contraindicated in pregnant women since increases risk of abortion.

Dirty water orally bid to tid is another suggestion for the treatment of myokymia

Ankyloblepharon causes pseudostrabismus and is often the result from significant mucocutaneous disease such as ocular pemphigoid or as a congential anomaly

Spastic entropion occurs in elderly due to age-related lid changes

Vitiligo is usually accompanied by poliosis and alopecia

Symblepharon typically occurs as the tarsal conjunctiva and bulbar conjuntiva heal it results generally from significant inflammatory disease, Stevens-Johnson syndrome, pemphigoid, alkali burn

When evaluating entropion having the patient open their mouth will help differentiate between cicatricial and involutional entropic. Cicatricial entropion will get worse when the patient opens their mouth.

Cicatricial entropion is usually caused by inflamation of tarsal conjunctiva from infection such as trachoma

Atonic entropion can occur due to elongation of lid stuctures laxity of tarsal plate and orbital septum, orbicularis spasm, atrophy of orbital fat with age, and also lower lid retractors

Management for congential entropion is surgical reformation of tarsal plate

Trichiasis can cause corneal epithelial defects such as corneal infections, ulcers, damage and scarring in anterior stroma

Orbital cellulitis can worsen into preseptal cellulitis

Causes include dental surgery, ethmoidal wall fracture or other trauma

Common organisms involved include H.influenzae in children and Strep and Staph in adults

Signs include diplopia, pain on eye movement, external ophthalmoplegia, optic nerve edema and ischemia with variable/mild VA loss

The drug of choice for treatment is a topical antibiotic steroid combo

Erythromycin

Bactrim

Maxitrol

Augmentin

Can also be referred to as posterior blepharitis, when this occurs there can be a significant build-up of fatty esters

There is frequent occurrence with dermatologic conditions such as Rosacea

Signs include frothing of tear film at outer canthi, papillary conjunctivitis, bulbar conjunctival hyperemia, retention cysts and concretions

First line therapy is lid hygiene and Azasite or TobradexST

Inflammation exists concurrently with stagnation spotty, scattered involvement of abnormal glands

Azasite or TobradexST 1 gtt BID for 2days, then 1 gtt qHS for 1 month

Cyclosporine/Restasis 1 gtt BID

Doxycycline 50mg BID x 2 weeks, then taper to 20mg qDaily

Tetracycline 250mg QID x 2 weeks. Slow taper to maintenance dose of 250mg per day or every other day

Sulfacetamide is the drug of choice in the treatment of staphylococcal blepharitis. However there is a risk of sunburned eyelids with increased photosensitivity

Erythromycin causes extreme hypersensitivity reactions and high toxicity to tissue

Tobramycin is very good against staphylococci and must primarily reserve it for keratitis, due to its effectiveness against Pseudomonas aeruginosa

There is no risk of delayed hypersensitivity reaction and very little resistance of staphylococci to Neomycin

Gentamicin is a very poor choice against staphylococci at present so it should never be used long term

Bacitracin is has high toxicity, it is available only in oral form, there is extreme resistance and hypersensitivity.

They are the first line of treatment for blepharitis

Doses of oral antibiotics depend on patient's age, weight, and severity of condition

If considering using oral antibiotics, consider culture and sensitivity testing (best oral or topical to use) and choose least irritating oral antibiotic

Tetracycline is contraindicated for pregnant and lactating females as well as children under 12

Ciloxan/ciprofloxacin 0.3%

Ilotycin/erythromycin 0.5%

Tobrex/tobramycin 0.3%

Neosporin/polymyxin B/neomycin/gramicidin

Ciloxan/ciprofloxacin 0.3%

Azasite/azithromycin 1%

Zymar/gatifloxacin 0.3%

Vigamox/moxifloxacin 0.5%

When epilating the lashes it is important not to clip the lashes but to grasp firmly at its base and pluck

Cauterization of follicles is a highly valued and useful treatment

Electrolysis destroys lash follicles, however the procedure is quiet painful

If > 1/3 of lashes are turned in, surgery is warranted rather than electrolysis: cryosurgery and argon laser photocoagulation

The most common cause of madarosis is staph blepharitis

Management of an ingrown cilia requires prophylaxis with a topical antibiotic ointment

Dermatochalasis may have a herniation of orbital fat through the orbital septum causing puffy, "swollen" appearance.

A verruca is generally a non-viral version of a papilloma

Blepharochalaisis is the recurrences of edema that result in streching of periorbital skin, loss of elasticity.

Are elevated rounded lesions caused by blockage of the gland of Moll

Can be divided into three types: Dermal, compound, and junctional

Have their cystic nature apparent in indirect/proximal illumination

Can manifest as subcutaneous or superficial in depth

Oracea 40mg BID

Achromycin 250-500 QID

Erythromycin EES 400mg QID

Doryx 50,100,200mg BID