NR 602 Midterm Review.

Chalazion Chalazion is a chronic sterile inflammation of the eyelid resulting from a lipogranuloma of the meibomian glands that line the posterior margins of the eyelids (see Fig. 29-7). It is deeper in the eyelid tis ...

Chalazion Chalazion is a chronic sterile inflammation of the eyelid resulting from a lipogranuloma of the meibomian glands that line the posterior margins of the eyelids (see Fig. 29-7). It is deeper in the eyelid tissue than a hordeolum and may result from an internal hordeolum or retained lipid granular secretions. Clinical Findings Initially, mild erythema and slight swelling of the involved eyelid are seen. After a few days the inflammation resolves, and a slow growing, round, nonpigmented, painless (key finding) mass remains. It may persist for a long time and is a commonly acquired lid lesion seen in children (see Fig. 29-7). 727 Management • Acute lesions are treated with hot compresses. • Refer to an ophthalmologist for surgical incision or topical intralesional corticosteroid injections if the condition is unresolved or if the lesion causes cosmetic concerns. A chalazion can distort vision by causing astigmatism as a result of pressure on the orbit. Complications Recurrence is common. Fragile, vascular granulation tissue called pyogenic granuloma that enlarges and bleeds rapidly can occur if a chalazion breaks through the conjunctival surface. Types of Conjunctivitis Type Incidence/Etiology Clinical Finding s Diagnosis Management* Ophthalmi a neonat orum Neonates: Chlamydia trachomatis, Staphylococcus aureus, Neisseria gonorrhoeae, HSV (silver nitrate reaction occurs in 10% of neonates) Erythema, chemo sis, purule nt exudat e with N Culture (ELISA, PCR), Gram stain, R/O N. gonorrhoeae, chlamydia Saline irrigation to eyes until exudate gone; follow with erythromycin ointment For N. gonorrhoeae:ceft riaxone or IM or IV 1 Type Incidence/Etiology Clinical Finding s Diagnosis Management* . gonorr hoeae; clear to mucoi d exudat e with chlamy dia For chlamydia: erythromycin or possibly azithromycin PO For HSV: antivirals IV or PO Bacterial conjun ctivitis In neonates 5 to 14 days old, preschoolers, and sexually active teens: Haemophilus influenzae(nontypeable), Streptococcus pneumoniae, S. aureus, N. gonorrhoeae Erythema, chemo sis, itching , burnin g, mucop urulent exudat e, matter in eyelas hes; ↑ in winter Cultures (required in neonate); Gram stain (optional); chocolate agar (for N. gonorrhoeae) R/O pharyngitis, N. gonorrhoeae, AOM, URI, seborrhea Neonates: Erythromycin 0.5% ophthalmic ointment ≥1 year old: Fourthgeneration fluoroquinolone For concurrent AOM: Treat accordingly for AOM Warm soaks to eyes three times a day until clear No sharing towels, pillows No school until treatment begins Chronic bacteri al conjun ctivitis School-age children and teens: Bacteria, viruses, C. trachomatis Same as above; foreign body sensati Cultures, Gram stain; R/O dacryostenosis , blepharitis, corneal ulcers, Depends on prior treatment, laboratory results, and differential diagnoses Review 2 Type Incidence/Etiology Clinical Finding s Diagnosis Management* (unres ponsiv e conjun ctivitis previo usly treated as bacteri al in etiolog y) on trachoma compliance and prior drug choices of conjunctivitis treatment Consult with ophthalmologist Inclusion conjun ctivitis Neonates 5 to 14 days old and sexually active teens: C. trachomatis Erythema, chemo sis, clear or mucoi d exudat e, palpeb ral follicle s Cultures (ELISA, PCR), R/O sexual activity Neonates: Erythromycin or azithromycin PO Adolescents: Doxycycline, azithromycin, EES, erythromycin base, levofloxacin PO Viral conjun ctivitis Adenovirus 3, 4, 7; HSV, herpes zoster, varicella Erythema, chemo sis, tearing (bilater al); HSV Cultures, R/O corneal infiltration Refer to ophthalmologist if HSV or photophobia present Cool compresses three or four times a day 3 Type Incidence/Etiology Clinical Finding s Diagnosis Management* and herpes zoster: unilate ral with photop hobia,