Disease
Cause
Pathophys
Symptoms
Diagnosis
Treatment
Pictures
Notes
Hordeolum
(Stye)
Staphylococcus sp
(usually
S. aureus)
•
Poor eye or hand hygiene
& eye rubbing
•
Increased risk if underlying
skin condition
•
Sharing contaminated
makeup
•
Blockage/inf lammation/infect ion of
Meibomian gla nd or Zeiss or Moll gland
External
is localized, red,
swollen, acutely tender area
on the upper or lower lid
•
Internalis a meibomian gland
abscess that usually points
onto the conjunctival surface
of the lid
•
Clinical
Most resolv e spontaneously
•
Warm compresses (15 min,
4x/day)
•
Abx ointment (bacitr acin or
erythromycin)
•
I&D may be indic ated•
**DO NOT
rub or
squeeze
Chalazion May follow an internal
hordeolum
Chronic blockage/ granulomatous
inflammation of a me ibomian gland
Hard, nontender swelling on
the upper or lower lid with
redness and swelling of
adjacent conjunctiva
Clinical Often resolves
spontaneously
•
Promote drainage by using
warm compresses
•
Incision and c urettage or
corticosteroid injection may
be effective
•
Posterior
Blepharitis
Long-term inflammation >
gland dysfunction and
fibrosis > damage to the
eyelid and ocular surface
More common in adults
and prevalence increases
with age
Chronic inflammation of the lid
secondary to dysf unction of the
Meibomian glands. Leads to instability
of the tear film. Promotes bacterial
growth (coag
-
neg staph,
corynebacterium sp, cutibacterium
acnes)
Usually bilateral •
Red, swollen, or itchy eyelids
•
Gritty or burning sensation •
Excessive tearing
•
Crusting or matting of
eyelashes
•
Flaking or scaling of the
eyelid skin
•
Blurred vision improved with
blinking
•
Trichiasis,
Entropion/Ectropion
•
Dry eye disease(frequent
complication)
•
Mostly clin ical •
Slit lamp exam
allows detailed
exam of
Meibomian
glands and for
dry eye
•
Eyelid hygiene (mainstay)-
warm compresses, lid
massage, lid washing,
artificial tears
•
Bacterial-an tibiotic oint
(bacitracin, erythromycin,
azithromycin)
•
Demodex
-
oral ivermectin or
topical tea tree oil scrub
•
Anterior
Blepharitis
Staphylococcal Type
Fibrinous scales and
crust around
eyelashes; may alter
meibomian gland
secretion
•
Seborrheic Type
Dandruff-like skin
changes and greasy
scales around base of
eyelids/lashes
•
Demodex foliculorum
Cylindrical dandruff
or "sleeves"
•
Chronic inflammation of the lid margins
Same as posterior
Same as
posterior
Same as posterior
Bacterial
Conjunctivitis
S. aureus most common in
adults
•
Pseudomonas more
common in contact lens
wearers
•
More common in children
than adults
•
Acute onset•
Often unilateral
•
Injection (diffuse)•
Constant
purulent/m ucopurulent
discharge
•
Matted eyelids •
Mild discomfort
•
Clinical•
Cultures for
severe,
resistant, or
recurrent cases
•
Staining to
assess for
keratitis or
corneal defect
•
Usually self-limited, (10-14
days)
•
Handwash ing, sepa rate
towels
•
Abx eye gtts- Erythr omycin
oint, tobramycin,
trimethoprim
-
polymyxin B;
Ciprofloxacin gtts in contact
lens wearers
•
Gonorrhea
Conjunctivitis
Neisseria gonorrhoeae
Large amount of purulent
discharge
•
Injection
•
Chemosis
•
Lid swelling
•
Preauricular adenopathy
•
Urethritis
•
Tenderness to palpation
•
Culture
•
Gram stain
•
Refer to ophtha lmologist
•
Ceftriaxone and topical
bacitracin ointment
•
Sometime s
azithromycin/doxycycline
for possible chlamydia co-
infection
•
May require hospitalizatio n
for system ic and topical
therapy and for monitoring-
Keratitis and perfo ration can
occur
•
Viral
Conjunctivitis
Adenovirus (many
serotypes)
May start unilateral but then
progress to bilateral
•
Watery discharge
•
Conjunctival redness •
Crusting in the mornings
•
Gritty sensatio n •
URI symptoms common
•
Clinical
Self
-
limited
; Can last up to 2
wks
•
Cool compresses
•
Allergic
Conjunctivitis
Airborne allergens
(ex.
pollen)
Airborne allergens con tact eye > IgE
response > local mast cell
Bilateral
•
Itching, burning, gritty
•
Clinical
•
Antihistamine/Vaso constrict
or
•
Red Eye
Tuesday, A pril 4, 202 3 8:00 AM
Red Eye Page 1
staph
EY.int
train
sit
Mitient
Crusted watery
digited ita URI
gritty
