Red Eye - Lids/ Orbit/ Lacrimal System
Lids
Hordeolum (Stye)
Treatment
Chalazion
Blepharitis
- Acute inflammation of eyelid gland - either Meibomian glands (internal lid) or glands of Zeis (modified sweat gland) or Moll (modified sebaceous gland in external lid)
- Infectious agent is usually S. aureus
- Painful, red swelling of lid
Treatment
- Warm compresses, lid care, gentle massage
- Topical antibiotics (e.g. erythromycin ointment BID)
- Usually resolves in 2-5 d
Chalazion
- Chronic granulomatous inflammation of Meibomian gland often preceded by an internal hordeolum
- Acute inflammatory signs are usually absent
- Diifferential diagnosis: basal cell carcinoma, sebaceous cell adenoma, Meibomian gland carcinoma
- Warm compresses
- If no improvement after 1 month, consider incision and curettage
- Chronic, recurrent lesion must be biopsied to rule out malignancy
Blepharitis
- Inflammation of lid margins
- 2 main types
- Staphylococcal (S. aureus): ulcerative, dry scales
- Seborrheic: no ulcers, greasy scales
- Itching, tearing, foreign body sensation
- Thickened, red lid margins, crusting, discharge with pressure on lids ("toothpaste sign")
- Recurrent chalazia
- Conjunctivitis
- Keratitis (from poor tear film)
- Corneal ulceration and neovascularisation
- Warm compresses and lid scrubs with diluted "baby shampoo"
- Topical or systemic antibiotics as needed
- If severe, an ophthalmologist may prescribe a short course of topical corticosteroids
Lacrimal System
Dacrocystitis
Dacroadenitis
Source
Toronto Notes 2012
- Acute or chronic infection of the lacrimal sac
- Most commonly due to obstruction of the nasolacrimal duct
- Commonly associated with S. aureus, S. pneumoniae, Pseudomonas species
- Pain, swelling, redness over lacrimal sac at medial canthus
- Epiphora (overflow of tears onto face), crusting, ± fever
- Digital pressure on the lacrimal sac may extrude pus through the punctum
- In the chronic form, epiphora may be the only symptom
- Warm compresses, nasal decongestants, systemic and topical antibiotics
- If chronic, obtain cultures by aspiration
- Once infection resolves, consider dacryocystorhinostomy
Dacroadenitis
- Inflammation of the lacrimal gland (outer third of upper eyelid)
- Acute causes: S. aureus, mumps, EBV, herpes zoster, N. gonorrhoeae
- Chronic causes (often bilateral): lymphoma, leukemia, sarcoidosis, tuberculosis, thyroid ophthalmopathy
- Pain, swelling, tearing, discharge, redness of the outer region of the upper eyelid
- Chronic form is more common and may present as painless enlargement of the lacrimal gland
- Supportive: warm compresses, oral NSAIDs
- Systemic antibiotics if bacterial cause
- If chronic, treat underlying disorder
Source
Toronto Notes 2012