Term
| Meibomian gland dysfunction is... |
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Definition
Not considered an infectious entity,
alters meibomain gland metabolism |
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Term
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Definition
| thickened and block the gland opening. The stagnant material then becomes growth medium for bacteria. |
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Term
| Bacteria on the lids, then, start producing? |
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Definition
| lipase. The released fatty acids trigger inflammation. |
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Term
| Meibomian gland dysfunction is often associated with? |
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Definition
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Term
| Etiology of Meibomian gland dysfunction |
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Definition
| Chronic inflammatory disorder involving the skin and eye. |
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Term
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Definition
| modified sweat glands. (Sebaceous). |
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Term
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Definition
| Meibomian Gland Dysfunction |
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Term
| Epidemiology of MGD - who does it affect? |
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Definition
| Mostly norther european, middle aged adults. |
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Term
| What are the primary symptoms of Acne Rosacea? |
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Definition
| Redness (Erythema) in the "facial flush area", as well as papules and pustules in the "flush areas. |
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Term
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Definition
Seen in Rosacea. A red and inflamed lesion on the skin's surface. It contains no pus or white head.
After the cellular debris and bacteria spill into the dermis - often progresses to a pustule |
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Term
| What type of mediated reaction creates the papule? |
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Definition
| Type IV cell mediated reaction. White blood cells come to fight the bacteria. When they migrate to the area, they die off, which then creates pus. It often progresses to a pustule |
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Term
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Definition
[Seen in Rosacea.]
A pimple.
Red and inflamed with a white head. sometimes brown core can be seen.
Pustules follow papules after WBC's invade.
What cap on pustule is pus; sebaceous matter and cellular debris. |
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Term
| Where might we see Telangictasis? - what is it? |
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Definition
in Rosacea.
It is visable (dilated) small blood vessels on nose or cheeks. |
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Term
| Rhinophyma. What is it, and where might we see it? |
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Definition
| Red, bullous nose (sebaceous gland hypertrophy). |
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Term
| What is the treatment of roacea? |
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Definition
Doxycyclin 100 mg bid x 4-6 weeks. (anti-inflammatory and antibiotic)
Topical metrodiazole gel (antibiotic) .75% x 5-8 weeks for the face. |
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Term
| What behavior alterations should you be aware of when you've got rosacea? |
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Definition
Dietary restrictions that trigger inflammation (like spices, alcohol, heated beverages, chocolate, tomatoes, citrus) Cheese and milk are fine.
Restricting Sunlight - UV can trigger
Emotional factors (stress, fear, anxiety)
H. pylori bacteria - linked w/ stomach ulcers |
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Term
| What kind of drug can trigger Rosacea? |
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Definition
| ACE inhibitors. because they help dilate the blood vessels to lower BP. |
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Term
| What are some ocular manifestations of Rosacea? |
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Definition
| #1!: Meibomianitis/MGD. Therefore....... Poor lipid tear film because Mei glands dont secrete lipid secretion. |
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Term
| RE-CAP: What are the signs of Rosacea? |
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Definition
Papules and pustules,
Telageietasias
Staph Blepharitis
Madarosis
Meiobiam gland dysfunction
Conjuctivitis. |
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Term
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Definition
infection and inflammation of the lids itself. not the rest of the face.
We get: meibomian gland dysfunction, blepharitis, and corneal vascularization. |
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Term
| What is a biggie that you see in ocualr rosacea? |
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Definition
| Keratitis! Corneal vascularization and thinning! |
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Term
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Definition
MGD: warm compress, lid scrub and gland expression
Blepharitis: same as staph bleph
Keratitis: artificial tears/ointments. steroids if severe infection. |
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Term
| When do you want to follow up? |
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Definition
With corneal involvement... in a couple days.
Without corneal involvement: in a couple weeks. |
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Term
| What kinds of things would you educate your patients about? |
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Definition
Lid hygiene,
Dietary restrictions (triggers)
Environmental triggers. |
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Term
| What causes Meibomain gland dysfunction? |
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Definition
| Plugged Meibomian glands. We get meibomian "caps" - that come off with warm water. |
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Term
| What are some signs that you see in a patient with MGD? |
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Definition
| Pouting of the meibomian glands, Inflammation of the lid surrounding the glands, serrated lid margin, tarsal conjunctival streaking, conjunctival infection |
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Term
| How do you make a MGD diagnosis? |
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Definition
| it is usually made clinically via slit lamp. You do the "toothpaste test" - where you push on the lid and you should see thickened secretions forced out of some glands. |
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Term
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Definition
warm compresses
In-office and at-home meibomian gland expression. (digital massage) |
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Term
| How do you treat severe MGD? |
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Definition
Doxycycline == inhibits lipase production. low dose.
f overlap with staph bleph, treat both conditions. |
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Term
| After treatment, what do you want to do with the patient? |
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Definition
follow-up and patient eduction.
if cornea is involved,then 1 week. if not, then 3-4 weeks. |
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Term
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Definition
| Thermal pulsation system that is used for meibomian expression in office treatment. adjust heat and pressure, 12 minute sessions. 79% of patients reported improvement. |
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Term
| What is impetigo? What kinds of patients is it seen in? |
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Definition
Skin infection with staphylococcus aureus or streptococcus pyogenes (rash with crusts in the face/digital extremities - looks like herpes, but its not!)
It is most common in children under 6 or elderly exposed too poor hygiene conditions.
It is very contagious |
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Term
| How do you treat Impetigo? |
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Definition
| Give an oral antibiotic. -culture the bacteria. Wash rea, topical antiobiotic. |
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Term
| What 3 oral antibiotic drugs might you use? |
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Definition
Cephalosporin,
Macrolide
Dicloxacillin |
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Term
| What 2 topical antibiotics might you use? |
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Definition
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Term
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Definition
Skin infection involving the dermis. The superficial dermal lypmatics swell, and you get local redness, heat, swelling, and highly characteristic raised indurated border.
The legs and face are most affected areas. |
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Term
| What kinds of patients do you see it in? |
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Definition
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Term
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Definition
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Term
| What kinds of systemic signs might you see? |
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Definition
it affects the immune system! you get fever, chills, malaise, painful edematous patches on the skin,
swelling and redness. |
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Term
| What is Erysipelas easy to confuse with? |
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Definition
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Term
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Definition
| Penicillen G. also refer to PCP for dermatologic consult. |
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Term
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Definition
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Term
| What is a hordeolum (stye)? |
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Definition
| it is an abscess (bag of pus) that is caused by Staph aureus |
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Term
| What are the 2 types of hordeolum? |
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Definition
1. Internal: infection of meibomian gland. More PAINFUL!
2. Infection of zeis gland; along the lid margin. |
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Term
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Definition
Patients complain of a localized painful swelling of one eyelid. in some cases, the complaint starts as a localzied general edema and erythema (redness) of the lid, that later becomes localized.
Pt usually has a history of similar problems. |
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Term
| Constitutional signs and symptoms are ________ with a hordeolum. |
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Definition
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Term
| What is the epidemiology - who do you see this with? |
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Definition
found more frequently in people with
- diabetes
- chronic bleph
- seborrhea
- High serum lipids; these increase the blockage rate of sebaceous glands, but lowering of serum lipid levels in these patients hasnt decrease teh frequency of recurrence. |
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Term
| What, specifically, is an external hordeolum? |
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Definition
| localized, raised, red bumps near the lid margin, tender to the touch |
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Term
| How does a hordeolum feel? |
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Definition
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Term
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Definition
| Yes, pustules form. Not a good idea to squeeze. It can spread the inflammation across the lid and become preseptal cellulitis. |
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Term
| What else might you see with a horedolum? |
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Definition
| Blepharitis, madarosis, conjuctivitis (sometimes we call it a blepharoconjuctivitis) |
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Term
| How do you treat an external Horedolum? |
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Definition
1. No treatment: they are usually self-limiting (discharge anteriorally, close to the lashes).
2. Warm soaks (qid for 15 mins)
3. Topical antibiotics - which dont work too well since glands are deep and hard for antibi to reach.
4. Epilation of eyelash associated with the infected follicle. |
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Term
| What, specifically, is an internal hordeolum? |
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Definition
localized, red, raised bump that is tender tot he touch. Usually on the conj side of the lid.
Sometimes they look like they're external because glands are large therefore more swelling. |
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Term
| Which are more common, internal or external hordeolums? |
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Definition
| internal. because the meobomian glands are bigger. |
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Term
| Can you have a combined internal and external hordeolum? |
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Definition
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Term
| What is an indicator that a pt has internal hordeolum? |
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Definition
| bumps; papillae which indicate that there is an infection/inflammation. |
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Term
| What can an internal hordeolum potentially lead to? |
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Definition
Preseptal cellulitis -infection spread from the gland to the connective tissue.
This would reqire both oral and topical antibiotics. |
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Term
| How do you treat an internal hordolum? |
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Definition
These are usually self limiting.
They most eventually point and drain by themselves.
Use warm soaks (qid for 15 mins).
Topical antibiotics can be used for recurrent lesions.
Surgical drainage can speed the healing process
Systemic antibiotics, when inflammation has spread beyond the immediate area of the hordolum. |
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Term
| How do you drain a hord.? |
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Definition
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Term
| What is a calazion also known as? |
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Definition
|
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Term
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Definition
| lipogranulamatous infiltration of meibomian gland. |
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Term
| Chalazion may follow....? |
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Definition
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Term
| What are the signs of chalazion: |
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Definition
| firm nodule within tarsal plate. non-tender, non-inflamed. |
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Term
| How do you tell if its a hordeolum or a chalazion? |
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Definition
hot to the touch = hordeolum. Ask pt if its painful and how long they've had this.
chalaz can be there for weeks or months. Hord is pretty quick to come. |
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Term
| How do you treat chalazion? |
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Definition
1. Warm comopresses.
2. Steroid injection (trimcinolone) injected thru the conj
3. incision and curettage (curettage = scrape out material/pus). |
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Term
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Definition
| suderiferous cyst or apocrine hidrocystoma. |
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Term
| What does cyst of mole come from? |
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Definition
| it comes from a blocked sweat-secreting gland associated with the cilia (GLAND OF MOLL) |
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Term
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Definition
| dome shaped, non-tender, non-inflamed, translucent, fluid filled bubble on anterior lid margin. Can have multiple. |
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Term
| How do you treat cyst of moll? |
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Definition
This is primarily a cosmetic concern.
you can aspirate with a fine needle but recurrence is common.
Excision with removal of sac to avoid recurrence. |
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Term
What is a cyst of zeis?
What does it look like? |
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Definition
it arises from a blocked oil-secreting gland associated with the cilia (gland of zeis).
Less translucent than cst of moll.
looks like a pustule. very focalized white head, right on the lash margin. |
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Term
Sepacerous cyst... ?
Where do you find it? |
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Definition
Yellow-white lumps on the skin that have a central punctum.
forms when an oil gland in teh skin is blocked.
This can be found on any part of the body.
if squeezed, exudes a stringly white material. |
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Term
| How do you treat a sebaceous cyst? |
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Definition
this is primarily a cosmetic concern.
The total ssac of the cyst must be removed.
if infected, oral antibiotic. |
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