Term
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Definition
ampulla 2mm
canaliculus (upper and lower) 8mm
common canaliculus 1mm
lacrimal sac 10mm
nasolacrimal duct 12mm
valve of hasner |
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Term
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Definition
hypersecretion (lacrimal gland) from inflam/irritation/FBS/DES -OR-
defective drainage - malposition (ectropion with stenosis) or blockage
blockage: CN7 palsy, *Centurion Syndrome* = anterior nasal malpositioning of puncta out bc prominent nasal bridge
OR eyelash in punctum, conjunctivochalasis, pouting punctum |
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Term
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Definition
hard stop v soft stop (blockage) up against nasolacrimal bone
ways to test for it:
-mariginal tear strip (look inf and sup before and after NaFl)
-NaFl disappearance test (should be gone ~3mins)
-Jones Dye testing (primary tells obstruction, 2nd not so good)
-Marx line (line of mucus at inferior lid/lac lake of stain) |
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Term
| Contrast DCG (Dacrycystography) vs. Nuclear Lacrimal Scintigraphy |
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Definition
-one = radioopaque dye injected into canaliculi (called LIPIODOL) b4 lacrimal sx to establish obstruction - digital subtraction pulls out all but dye for better image
-other = more sensitive with incomplete blocks, radionucleotide-technetium-99 with images recorded DYNAMICALLY over 20 minutes (series of images) |
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Term
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Definition
Primary = in absence of EVERSION, reasons: chronic bleph, ideopathic, HSV/HZV, lid tumor post-irradiation, cicatrizing conjuncitivis/trachoma, systemic cytotoxic drugs (5-fu or mitomycin-c) and requires PUNCTOPLASTY (cut posterior wall and enlarge puncta)
Secondary = due to everted puncta (ie ectropion) - need cautery/elman unit or lid sx to shrink down and reverse ectropion |
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Term
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Definition
congenital common 2ndary to unopened valve of hasner (last to grow) - called "delayed canalization"
acquired (older) bc of chronic sinus disease, involutional stenosis (esp with granulomatous disease like sarcoidosis), trauma to drainage
S/S: epiphora, discharge, mucus, crusting lids, conjunctivitis
tx: CRIEGLER massage (pressure gradient to open valve) or probe but WAIT 12+ months, balloon dilation, tubes
DCR: dacryocystorhinostomy = cxn made between lac sac and nasolacrimal bone with laser beams |
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Term
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Definition
lacrimal stones (dacryoliths) of either epithelial cells or calcium stones
MID-AGE (adult) with intermittent epiphora, recurrent dacryocystitis, lac sac distention withOUT pain
tx: DCR and remove stones - blocks tears from reaching destination |
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Term
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Definition
S-shaped inflammation of upper lid**
expected occurence: main = ideopathic, next = chronic, rarest = acute
if chronic, 2ndary to inflammatory disorder (sarcoid, TED, sjogrens, syphilis, TB)
if acute, infection (staph, mumps, EBV, HZV, gonorrhoeae, MRSA* really rare), and see in palpebral lobe likely with concurrent systemic infection
S/S: edema superior lid, dull pain, swelling, epiphora, discharge, PANs*
meds: AV for HSV/HZV, augmentin/amoxicillin for staph/strep, ceftriaxone (1g IV) For n. gonorrohoeae, izonazid/rimfampin for TB, penicillin G for treponema (syphilis/lymes disease)
may have chemosis/hordeolum/EOM deficit/pain, mucus if bacterial |
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Term
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Definition
INFANTS
amniotic fluid collect in lac sac
looks like acute dacryocystitis
giveaway = BLUE color and NO muc-pur d/charge
too distented without pain/tenderness
tx: observe/balloon/massage/probe |
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Term
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Definition
main cause = Actinomyces Israelii
medial eyelid/puncta red with mucus d/charge w/pressure
may form dacryoliths
sign: pouting puncta, concretions/d-charge and only inflamed just under puncta (small area)
MEDS: penicillin V for actinomyces (most common), fluconazole for candida albicans, amphotericin B for aspergillus, itraconazole for aspergillis |
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Term
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Definition
more ADULTS (less likely kids)
lac sac infection, overlying cellulitis, wants to express
pain/swell/redness/tender
MEDS: augmentin (amoxicillin-clavulanate), bactrim (trimethorprim/sulfamethoxazole), ilotycin (erythro ung) or fluroquinolones |
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Term
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Definition
infect/inflam anterior to orbital septum/tarsus (superficial periorbital tissues only)
swell/red/pain/fever/ptosis
MEDS: augmentin 500mg bid, ceclor (cephalosporin), bactrim if PCN allergy, topical abx ung or combo ung
**BACTRIM may hve stevens-johnsons association so only use if PCN allergy!** |
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Term
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Definition
| mild (1-2mm extra covered), mod (3-4mm), severe (>4mm) |
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Term
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Definition
| OLDER, skin-lags/droop, slip of aponeurosis bc of gravity and decreased muscle tone |
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Term
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Definition
LPS dysfunction prohibits full lid elevation, decreased neurosensory impulse to NMJ or too much breakdown
Main: MG, myotonic dystrophy, CPEO |
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Term
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Definition
dysfunction/damage to oculomotor or sympathetic nerves or CNS
mild = seen in Horner's syndrome (interruption of symp fibers to Mueller's muscle)
indirect causes: DM, tumors, carotid-cavernous aneurysm, MS, MG (both neuro and myogenic)
direct causes: CN3 palsy, Marcus-gunn, CN3 misdirection, Horners |
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Term
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Definition
| eyelid heavy bc tumor, neurofibroma, chalazion, sarcoid granuloma, dermatochalasis |
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Term
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Definition
| post-op pts, go away unless direct LPS effect - and may worsen with life as aponeurosis occurs |
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Term
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Definition
| ptosis, miosis, annhydrosis, PLUS iris hypo-pigmentation |
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Term
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Definition
contralateral lid retraction (TED>MG>mass behind orbit)
prosthetic eye, ipsilateral hypotropia (fixes with forced fixation), or brow ptosis (MALES especially or with bells palsy) |
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Term
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Definition
**downgaze lid = higher than normal (can't relax levator properly), no lid crease, may have SR weakness with EOMS
vs. acquired: lower or level with the normal lid
bilateral giveaway = tilt head back and rotate chin up to see |
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Term
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Definition
evaluate: onset (photos), fatigue? (MG and involutional - look up 30s and then straight - change severity?) any diplopia? (severe MG), constant?
Measure: MRD, IPF ht, upper lid crease height (high in aponeurotic), levator function (normal in aponeurosis, decreased in congenital), fatigue suggests MG, jaw wink = Marcus Gunn CN5 misdirection on way to levator stimulated by pterygoid neurogenic = ptosis in 1' gaze, retration with ab-duction = CN3 misdirection |
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Term
| Ptosis Breakdown of Causes |
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Definition
neurogenic: CN3 palsy (w diplopia, aneurysm, eye down/out/dilated), Horner's syndrome, Marcus-Gunn, CN3 misdirection or congenital
Aponeurotic: involutional or post-operative
Myogenic: MG (shares with neuro), myotonic dystrophy, congenital, blepharophimosis syndrome (cant move EOMs much at all)
Mechanical: dermatochalasis/tumor/edema/ant orbital lesion/scarring
CHECK: hx, pupils, EOMs (if weird ptosis and EOMs think MG) |
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Term
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Definition
OLDER people - laxity of skin eyelid - causes redundancy and assoc with herniation or orbital fat (aponeurotic changes)
-or actinic keratosis
VF check! May cover sx if VF defect related |
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Term
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Definition
recurrent PAINLESS edema in upper eyelid - usually YOUNG WOMEN and grow out of it (<20yo is FIRST episode)
-get atrophy and laxity of upper lid skin w likely lacrimal gland prolapse
acute tx: steroid ung on lid to decrease edema |
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Term
| FES (Floppy Eyelid Syndrome) |
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Definition
usually MEN - apnea/obesity
sleep on one side of body - shouldn't be able to push on brow and evert lid
-chronic papillary conjunctivitis with lax tarsi - mucous discharge on pillow?
tx: tape lid shut at night or Fox shield (bubbles) |
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Term
| Eyelid Imbrication Syndrome |
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Definition
uncommon, upper lid overlaps the lower and can be UNI or BILATERAL
-see FES, eyelid tumors, mucous membrane disease, sx trauma or self-inflicted behavior |
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Term
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Definition
| 1' = TED, 2' = neurogenic (contralateral unilateral ptosis with herring's law) - like CN3 misdirection, marcus-gunn, collier-sign of midbrain (parinaud's sign - dorsal midbrain/MLF injury), parkinsons, sympathetomimetic drops (rule out horners with cocaine or APROCLOMIDINE, 3' = mechanical: ptosis sx over-correct or upper lid scarring of skin |
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Term
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Definition
congenital LR not innervated bc of CN3 dysgenesis - ie fibers not made right and can't ab-duct (outward) or mild ad-duction
50% outgaze, 80% ingaze. when tries to ad-duct, lid retracts. when ad-duct, globe retracts and causes a ptosis**
order of commonality: 1' = limited ab-duction (to ear- get eso posture), 2' = limited ad-duction (to nose - get exo posture), 3' = limited both |
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Term
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Definition
| k-cone with lower lid protrusion with downgaze |
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Term
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Definition
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Term
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Definition
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Term
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Definition
|
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Term
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Definition
| TED upper lid retraction and widened IPF (bug-eyed) |
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Term
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Definition
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Term
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Definition
| midbrain/paranaud syndrome with bilateral retraction of lids |
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Term
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Definition
| hyperthyroid stare/frightened and appear angry |
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Term
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Definition
autoimmune disease with ABs that destroy ACh receptors in STRIATED (only) muscle
increased incidence with: thyroid disease, SLE, Hashimoto's thyroiditis, MS, TED |
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Term
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Definition
1) ocular (50%)
2) bulbar (NOT EYE but other body effects) - dysphagia (cant swallow), dysarthria (cant move), mastication/speaking difficulty
3) generalized (~90%) |
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Term
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Definition
FEMALES >> males (2:1), and presents in THIRTIES.
-hallmark = VARIABILITY In the findings
90% of cases have ocular involvement
-ptosis worse at end of day, maybe bilateral, cogan twitch (look down a while then back and twitch), (+) ice test (ptosis gone in 2 mins with ice), diplopia
tx with muscle sx or botulinium toxin |
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Term
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Definition
1) Tensilon test: not much, could cause cardiac arrest but short-acting endrophonium =acetylcholinesterase (do Ice instead)
2)binding-AB test in lab - look for raised AB-ACh receptors
3) thoracic CT/MRI (thymoma ~10%) - not a bad idea |
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Term
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Definition
acetylcholinesterase drugs like pyridostigmine (longer HL and less aggressive than endrophonium) or neostigmine
-steroids, immunosuppressants (like AZA/cyclosporin), thymectomy (doesn't usually help) |
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Term
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Definition
CHRISTMAS TREE CATARACT, SAD expression, AUTOSOMAL DOMINANT!
presents in 30-60s - weak hands, difficulty walking, generalized "anticipation" with coming generations
-ptosis, CPEO, LIGHT-NEAR dissociation (pupils), bilateral optic neuropathy (do DFE), BALDNESS
-serum creatine kinase WAY high (bc myopathy - normal 500, here 10,000s!) |
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Term
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Definition
female to male 8:1, most common cause of proptosis in adults, bilateral, Grave's disease common, may have MG association
-smoking and Graves = suspect TED!*
-retraction, lid edema, lagophthalmos, lid lag (VG sign), proptosis, limited EOMs (IM SLO order), decreased color vision (sign of optic compression) or VF deficit/blindness
-exposure K or compression can --> blindness
-can be hyper or hypo thyroid OR euthyroid but freq assoc with thyroid disease
HALLMARK: accumulation of inflamamtory materials/edema of recti muscles and eyelids with proptosis (limited orbit volume) |
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Term
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Definition
1- exophthalmometry (>4mm between eyes = concern)
2- VF
3- order serum TSH, T3 and T4 levels, TPO if suspect Hashimoto's
4- orbital CT to see if muscle enlargement
5- endocrinology consult |
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Term
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Definition
thyroidectomy (Grave's disease), or if on thyroid replacement and young - likely thyroiditis in past (autoimmune attack)
*less common to be euthyroid with TED but possible!*
-can only tx with steroids during inflammatory phase, but can't do real work til in the quiet stage (inflam may last 3-18mos but up to 3 yrs before quiet stage) |
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Term
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Definition
| SLK, decreased supraduction, mild lower-lid retraction too, hypotropia, diplopia in some gazes, muscle fibrosis in quiet stage |
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Term
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Definition
1) soft tissue involvement (lid periorbital swelling, epibulbar hyperemia, SLK, lacrimal gland fibrosis --> k. sicca --> DES)
2) lid retraction (v.graefe - look down and get lid lag)
3) proptosis
4) optic neuropathy (desaturation of color, VF defect, check APD, central vision loss, pressure, blurred vision)
5) restricted myopathy (EOM restrict to diplopia, strab 2' to inflammation first, then 2' to fibrosis of muscles), order of frequency (supraduction/IR, abduction/MR, infraduction/SR, adduction/LR = IM SLO) |
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Term
| NO SPECS - TED progression |
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Definition
| no symptoms/signs -> only signs -> soft tissue involvement -> proptosis -> EOMs -> corneal involvement -> sign loss (ulcerate or optic neuropathy/compression) |
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Term
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Definition
as OD: comanage with endocrinology, topical lubricants, steroid topical if chemosis, frenell prisms during diplopia stage, sx referral if still bad during quiet phase
thyroiditis: body's autoimmune attack, can be from a respiratory infection, on lithium/amiodarone, congenital, radiation (head/neck), or tx to fix hyperthyroid with radioactive iodine and now hypothyroid OR SHEEHAN SYNDROME (pregnant women who lose an abnormal amt of blood during pregnancy)
Hypo: tired, cold, joint pain, dry skin, depression of activity, thinned hair/eyebrows, weight gain, lose taste/smell (later), puffy hands/feet/face, hoarse voice/slurred speech, eyebrows fall out, clubbing of fingers |
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Term
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Definition
symptoms: lagopthalmos, inferior staining, FBS, dryness/irritation
diplopia via muscle entrapement, infiltration of muscles/orbit or physical volume pushed out (SOL) if unilateral
-tests: EOMs/exophthalmometry (WNL 12-22mm, but >4mm difference = key concern)
causes: infiltrative disorders (TED), infection (orbital cellulitis, aspergillus), inflamm disease (scleritis, sinus disease, sarcoidosis), vascular conditions (retrobulbar heme, varices (transient), fistula, tumors, hemangiomas, intermittent with valsalva maneuvers
-IMAGE! esp unilateral and unknown cause |
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Term
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Definition
mitochondrial cytopathy - BILATERAL PTOSIS
*comanage with cardiac bc severe cardiac defects*
-CPEO + pigmentary retinopathy, ataxia, fatigue, muscle weakness, increased CSF protein concentration
*ragged red muscle fibers**- ddx with BPES |
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Term
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Definition
epithelium 2-5 layers thick, substantria propria = stroma and is richly vascularized, BM separates it from the epithelium
-3 mucin secretors: goblet cells, crypts of Henle, lacrimal gland
-accessory lacrimal glands: Krause, gland of Manz, Wolfring |
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Term
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Definition
consider:
-symptoms (bact very uncommon, viral more)
-discharge (mucopurulent, watery, mucis = DES/allergy)
-appearance
-lymphadenopathy (lymphangectasia = clear cysts in lymph channel)
-watery d-charge: assoc with viral or allergic conjunctivitis vs mucopurulent = bacterial association |
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Term
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Definition
DONT DX without seeing them!
-episcleritis/scleritis must be ddx from hemorrhage - can see individual RBCs on 25x mag
-SECTORAL= MORE LIKELY EPI, drop with phenyl and if vessels synch up in conj then suspect episcleritis- if still red, suspect scleritis
etiologies: infection, dry eye (bleph, DES), allergy (rosacea, hay fever, VKC/AKC), uveitis (look for 3/9o'clock red called 'ciliary flush'), fungus/HSV (unlikely esp protozoa/acanthomoeba) |
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Term
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Definition
only symptom = RED EYE - mostly sectoral but gets larger and worse before better
-valsalva, trauma, escalated HTN, blood thinners, DM (if recurrent), bleeding disorders
-work-up: hx (bleed disorder, meds, trauma, vomit, systemic health), check IOP, BP, BG, CBC w/diff, and PCP consult?
-brown=iron left from blood that can backup in lymph channels (off-label NSAID thins blood and can help reabsorb quicker*) |
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Term
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Definition
fibrovascular degenerative tissue growing onto the cornea - RBCs accumulate at leading edge with activity, Iron line (Stocker's line) may be at leading edge once activity has halted
-manage: observe unless asymptomatic/cosmetic - sx to reduce recurrence but recurrence has a 50-80% rate (unless use grafts with excision and only 5-15%)
-almost always NASAL with astigmatism and lacrimal lake effects
-3 types: 1) <2mm on cornea, 2) 2-4mm on cornea, 3) >4mm on cornea
-elastotic degen of collagen and fibrovascular proliferation with overlying epithelium
-tx range: simple excision, flaps of conj with or without adjunct beta-radiation therapy or topical chemo agents (like mitomycin-c) |
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Term
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Definition
areas of bulbar thickening in the IPF - elastotic degeneration of the stroma, "bump on eye" turns yellow with age, either N or T
-etiology: UV light exposure, dry environment, wind
-can be inflamed or vascularized (called pingueculitis)
-mainly observe, rarely excise, with -itis = topical steroid to tx inflammation
-likely bilateral (same exposure)
-CIN - ddx - strong similarities |
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Term
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Definition
completely benign finding!
-chronic inflammation in the conj (ie chronic allergy ppl) have mucin secretions of epithelial cells and phospholipids (NOT CALCIUM)
-asymptomatic - flip lids and see, unless break thru epith and get FBS (remove with 27G needle) |
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Term
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Definition
called "conj retention cysts" - usually asymptomatic unless large
-retention in conj lymphatics, no pain, can drain but will fill back up
-tx; 2.5% phenyl to constrict BVs, lance with 11G blade, follow with combo topical and likely repeat
-could change astigmatism if near cornea or large
-dellen = depression in cornea because of a hydration issue
-limbal girdle of vogt = 3/9o'clock and more common with age
-chemosis maybe - OCT aseg to see where fluid areas are
-if chronic/recurrent cystic vs diffuse - worry about conj lymphoma (firmer, pink/violet, and kidney issues associated)
-also TED/orbital apex syndrome can press on nerves/muscles and cause backup |
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Term
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Definition
redundant conj tissue, typically INFERIOR but can be 360degrees
-may cause epiphora, AGE is MAIN CAUSE, SLK suggest superior
-ignore or conj resection |
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Term
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Definition
hard/waxy substance of proteins and polysaccharides from degenerative tissue and is deposited into organs (in body in various chron diseases)
-protein not properly removed from body (amyloid)
-causes thick, prominent corneal nerves (STAIN RED ON CONGO RED!) and have BI-REFRINGENCE
-also have a LIGHT-NEAR DISSOCIATION (same with myotonic dystrophy and syphilis)
-types: 1) primary localized (tumor like without predisposing disease), 2) primary systemic (deposit in vitreous, eyelids, orbit, EOMs, pupils, lens), 3) secondary localized (2' to chronic ocular inflam like trachoma, interstitial keratitis and get conj/cornea deposition, 4) secondary systemic (association with RA (main one) and others) |
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Term
| PEM: Primary Epithelial Melanosis |
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Definition
WE WILL SEE THIS! called "racial melanosis," benign, dark skin, congenital (see in 1st years of life)
-1' at limbus and axenfeld nerve loops and *may extend onto cornea* (melanokeratosis)
-pigment is within epithelium of conjunctiva |
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Term
|
Definition
UNCOMMON melanocytic hyperpigmentation
-3 types: ocular (only eyes, least common), dermal (only skin, 1/3 cases), oculodermal (most common, nevus of ota)
see iris heterochromia LATERALLY or ipsilateral eye |
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Term
|
Definition
oculodermal melanocytosis
-multifocal slate grey pigmentation in the episclera
-MAINLY ASIAN FEMALES
-frequently CN5 V1 or V2 - unilateral with iris heterochromia
10% of cases have GLAUCOMA - monitor IOPs- associated with TM hyperpigmentation/clog, iris mamillations (projections), fundus hyperpigmentation, sampoelesi's line (may see with axenfeld/reigers/peters anomalies) |
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Term
| PAM: Primary Acquired Melanosis |
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Definition
DONT WANT!!!
-in CAUCASIAN patients, light skin=giveaway
-neoplasia of melanocyte at bulbar or palpebral conj that can go to malignant melanoma
-50+ years old, unilateral, light skinned
-two types: with cellular atypia (worse case) or without cellular atypia (rarely becomes malignant)
-metastasis high and tumor-related death also high |
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Term
| SAM: Seconary Acquired Melanosis |
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Definition
hyperpigmentation due to: actinic (sun), radiation, pregnancy, addison's disease (not making cortisol), or inflammation (esp chronic)
-usually perilimbal (take photos, consider hx, observe) |
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Term
|
Definition
chief ddx = melanoma (which isn't common)
-been there a while, no change in color/size/shape, check hx
-abnormal melanocyte proliferation at basal layer of conj epithelium
-discrete, well-demarkated, congenital, most common type of conj tumor
-cant see til pigmented in 2nd/3rd decade of life
-common to have lacunae in lesion but NO feeder vessels
-20% of melanoma WERE nevi- so watch carefully
-nevus on palpebral conj is RARE so consider PAM/malignant melanoma, or on cornea = suspicious
-mainly at caruncle or bulbar conj - PHOTOGRAPH q/6mos |
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Term
|
Definition
nodular, brown, elevated, well-vascularized with feeder vessels, and can be AMELANOTIC!
-usually bulbar conj
-3 main causes: PAM (75%), nevi (20%) or de novo
-typically caucasian, 50-55yo, 25% mortality rate unless via PAM (which is 45% because 1' metastasize to LIVER or lung/pancreas) |
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Term
| CIN: Conjunctival Intraepithelial Neoplasia |
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Definition
-overgrowth of potentially malignant cells within conj/cornea
-risks :UV, HPV, XP, AIDs, heavy smoker, caucasian male, aging
-a disease spectrum: conj basal layer epith dysplagia, carcinoma in-situ, squamous cell carcinoma (inf stroma)
-division: 1) epithelial dysplasia (at epith cells - abnormal growth, may indicate early neoplastic growth), 2) carcinoma in-situ (malignant cells present but not yet metastatic, 3) SCC (malignant cells and have invaded other tissues/lymph nodes |
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Term
|
Definition
1) mild/stage 1: lesions in basal 1/3 of affected area of conj/cornea
2) moderate/stages 2+3: lesions of inner 2/3 of basal layer
3) severe dysplagia: full thickness, invasive lesions - ie SCC with rapid metastatis to stroma and eye |
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Term
| CIN clinical presentations |
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Definition
basal cell dysplasia (cant really see, hazy area at limbus focal, slow-growing)
leukoplakia (fleshy, elevated tissue, gelatinous bubble, grey-white plaque at corneal limbus like pinguecula
papillomatous variant: pink nodules with vessels and firm-appearance, grow rapidly, metastasize quick to nodes
ddx: pannus, bitot's spots, pinguecula, pyogenic granuloma
management: chemotherapeutic agents (5-fu, mitomycin-c), sx excision with cryotherapy (TOC - biopsy too), topical interferon (alpha-2b = newer treatment) and periodic f-up to check for recurrence |
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Term
|
Definition
starts at limbus (in IPF area)
-tumors with gelatinous, papillomatous appearance (unique), may invade thru conj BM to stroma but rarely goes any deeper
-RARE to metastasize! |
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Term
|
Definition
2 presenation types:
1) multiple, pedunculated, KIDS/young adults, likely viral, inf fornix/medial cantus/pretarsal conj, tx = observe or excise but high recurrence rate, maybe oral H2 blocker for a kid
2) broad based, senile, flat, at/near limbus, ELDERLY, either benign or cancerous with malignancy potential - tx = completely excise, more neoplastic if at limbus (may go to bulbar conj or cornea), low recurrence rate after excision
-ddx: pyogenic granuloma (all get looked at) |
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Term
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Definition
BENIGN: congenital overgrowth of normal tissue in abnormal location
-dermoids most common epibulbar tumor of childhood (esp Goldenhars)
-lipodermoid in adults usualy at outer canthus
-osseous epibulbar choristoma = usually located ST and move-able
-can be an anterior fat prolapse and continue beyond lid (to lateral stopping point)
-dermolipoma (lipodermoid) = not issues unless oculoplastics, goes on further behind lid |
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Term
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Definition
HIV/AIDs people - common on skin/lids/adnexa
-highly vascularized reddish-blue, elevated nodules or diffuse plaques
-mimic sub conj hemes (ddx) and respond rapidly to radiation (tx) |
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Term
|
Definition
light pink/salmon colored lesion on bulbar conj or in fornix - slow insidious onset and NOT painful, *20% have systemic lymphoma!** so concern = oncology referral
-firm to the touch, outlined
ddx: conj lymphangectasia, may arise de novo, from orbital lymphoma or from systemic involvement
-most arise from MALT (mucous assoc lymphatic tissue - ie stomach/lung/thyroid/saliv glands/intestines/eyes) and a rare non-hodgkins type lymphoma
-txbk presentation: firmer, band-like lesion on bulbar conj |
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Term
| Superior Limbic Keratitis (SLK) |
|
Definition
a chronic ocular surface disease w/ recurrent inflam of superior cornea and limbus
-high assoc with thyroid dysfunction (50%), BILATERAL but can ahve unilateral disease
-W>>M (TED)
-punctate rose/lissamine green stain on sup bulbar conj - thick inflamed often with SPK or filaments on cornea = hydration issue
-tx: lubricate, 0.5% silver nitrate soln (less), test thyroid, dry eye tx (restasis, steroid management/taper), cautery (burn and loosen - mechanical abrasive effect but not often)
-may see papillae, pannus at sup corneal limbus, FBS, photophobia, irritation |
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Term
|
Definition
-Maxitrol (neo, polyB, dex)
-Poly-Pred (neo, polyB, pred forte)
-Tobradex (tobramycin, dex)
Other topicals:
-cyclosporin (restasis)
-Flarex (acetate), FML (alcohol)
-Loteprednol (0.5% lotemax, 0.2% alrex)
-Pred acetate (forte 1%), pred mild (0.12%), econopred (0.125%)
-pred sodium phosphate (less bc acetate > phosphate) |
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Term
| Membranes/Pseudomembranes |
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Definition
membranes bleed, pseudo can be peeled off without bleeding
-Pseudo: combo of inflam cells and exudate with mucus and proteins (coagulated exudate)
pseudo causes: EKC, ligenous conj (rare, corn-husk like membrane), gonococcal (can be either), chemical burns (cicatrical scar/fibrin release)
-membranes: more intenese inflammation - firmly adhered,
causes: EKC, S-J, pemphigoid, bacterial infections (esp n. gonorrhoeae, b-hemolytic strep, c. diptheriae)
VIRAL: EKC (rugged, adult, more likely to see membrane) vs PCF (kids - less likely formation) |
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Term
| Facticious Conjunctivitis |
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Definition
self-inflicted, drug related?
-mucous fishing syndrome
-use narcs if pain but careful dosage
-ung for conj irritation for combo if aggressive |
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Term
| Parinaud's Oculoglandular Syndrome (Cat Scratch) |
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Definition
-unilateral, preseptal granuloma in eyelid and conj
-CAT (most common cause) - bartinella bacteria
-tularemia (h/a - rabbit cause/flies - francisella)
other bacteria: TB, mycobacterium, syphilis, leukemia, lymphoma, sarcoidosis, mono
-s/s: redness, mucopurulent discharge, FBS. granulomatous nodules on palpebral conj, swollen, PANs, maybe fever/rash, FOLLICULAR CONJUNCTIVITIS, papillitis with swollen disk - MACULAR STAR TOO!
-syphilis rule-outs: FTA-ABS: treponemal AB (if + once, + forever), lymes will be false +, RPR, VDRL (less now)
-tx: topical combo/abx, warm compress on nodes, ibuprofen for fever, try ciprofloxacin b4 cyclines
-if no cat scratch - do biopsy of conj, blood work to rule out sarcoidosis, check x-ray, PPD (test TB),
-tularemia tx: IM streptomycin (1g IM bid x 7d) |
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Term
| Ocular Cicatricial Pemphigoid (Pemphigoid = systemic disease) |
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Definition
systemic auto-immune disease of mucus membranes (attack goblet cells) - dries out cornea/conj and eventually ankyloblepharon forms
-ocular - 75% of cases also have oral, 25% only skin lesions
-signs: bilateral redness, FBS, photophobia,
MEAN age 70, usually >55yo, F>>M
-entropion and trichiasis follow scarring
-predilection for POAG (not sure why)
-pseudo-pemphigoid drug-induced = TIMOLOL (without systemic involvement ) and could give cicatricial- we RX THIS! |
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Term
| Ocular Cicatricial Pemphigoid 4 Stages of Findings |
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Definition
1) transient conj bullae rupture and lead to subepith fibrosis
2) conj shrinks, shorter inferior fornix
3) symblepharon forms
4) end-stage with severe goblet-cell destruction, lac gland ducts drainage keratinizes,
-our tx: lubricate!!! topical steroid unless neurotrophic ulceration (avoid preservative)
-retinoic acid (vitamin A tx), abx if cornea involved, BCTL, scleral RGP to preserve lac lake
-invasive- so internal medicine! full body tx = DAPSONE or immunosuppress (azathiapine, methotrexate)
-MDs tx: subconj MMC injection, punctal occlusion, tarsorrophy (sew lids together), LPS botox (induce droop), amniotic membrane graft or mucous membrane transplant
-skin effects: blistering/bolus |
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Term
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Definition
erythema multiforme major and minor (major = SJS)
-skin involvement of mucous membranes and erosion of them for up to 6wks
-minor = 1' skin and only lasts 2-3wks in acute phase
-acute phase: ocular also 2-3wks
-30-33% mortality rate (co-manage!), M>>W (strange abt Serena Williams)
-1st 3 decades presents (30 or less) but previously healthy people
-30% of skin falls off or more (TEN - toxic epidermal necrolysis)
presentation: fever, malaise, sore throat, arthralgia ~2wks before lesions show up
signs: mucous blisters that erode, hemorhagic crusting of skin/lips, membrane or pseudomembranes form, scar tarsal plate/conjunctivitis, severe DES, keratopathy
TEN = more destructive variety, hallmark - target-lesion (also with lymes)
-20% recurrence rate - stop any meds with preservative that may be causing, add topical steroid/abx if corneal
-tx drugs: trimethoprim, sulfonamide, TCN/PCN, codeine, salicylates, thiazide diuretic
infections: strep, mycoplasma, herpes, fungal
-pt examined daily then weekly |
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