Page 903 - TNFlipTest

Toronto Notes 2019
Conjunctiva
Ophthalmology OP13
Blepharitis
• inflammationoflidmargins
Etiology
• Anterior blepharitis
■ staphylococcal (S. aureus): ulcerative, dry scales ■ seborrheic: no ulcers, greasy scales
• posterior blepharitis
■ Meibomian gland dysfunction
Clinical Features
• itching,tearing,foreignbodysensation
• thickened,redlidmargins,crusting,dischargewithpressureonlids(“toothpastesign”)
• recurrenthordeola
• conjunctivitis
• keratitis(frompoortearfilm)
• cornealulcerationandneovascularization
Treatment
• warmcompresses,lidmassages,andlidwashingusingcommerciallyavailableeyelidscrubsolution • topicalorsystemicantibioticsasneeded
• ifsevere,ophthalmologistmayprescribeashortcourseoftopicalcorticosteroids,omega-3fattyacids
Xanthelasma
Definition
• eyelidxanthoma(lipiddepositsindermisoflids)
Clinical Features and Associations
• appearaspale,slightlyelevatedyellowishplaquesorstreaks • mostcommonlyonthemedialupperlids,oftenbilateral
• associatedwithhyperlipidemia(~50%ofpatients)
• commonintheelderly,moreconcerningintheyoung
Treatment
• excisionforcosmesisonly,commonlyrecurs
Conjunctiva
• thin,vascularmucousmembrane
• bulbarconjunctiva:linesscleratolimbus(junctionbetweencorneaandsclera)
• palpebral(tarsal)conjunctiva:linesinnersurfaceofeyelid
Pinguecula
• yellow-whitesubepithelialdepositofhyalineandelastictissueadjacenttothenasalortemporallimbus, sparing the cornea
• associatedwithsunandwindexposure,aging
• benign,sometimesenlargesslowly
• maybeirritatingduetoabnormaltearfilmformationoverthedeposits
• surgeryforcosmesisonly
• irritativesymptomsmaybetreatedwithlubricatingdrops
Pterygium
• fibrovascular,triangular,wing-likeencroachmentofepithelialtissueontothecornea
• mayinduceastigmatism,decreasevision
• excisionforchronicinflammation,threattovisualaxis,cosmesis
• irritativesymptomsmaybetreatedwithlubricatingdrops
• one-thirdrecurafterexcision,lowerrecurrencewithconjunctivalautograft(~5%)
Subconjunctival Hemorrhage
• bloodbeneaththeconjunctiva,otherwiseasymptomatic
• idiopathicorassociatedwithtrauma,Valsalvamaneuver,bleedingdisorders,HTN,anticoagulation
• givereassuranceifnootherocularfindings,resolvesspontaneouslyin2-3wk
• 360oinvolvementshouldbehighlysuspiciousforgloberuptureiftraumahistory
• ifrecurrent,considermedical/hematologicworkup
Complications