Chalazion Chalazion is a chronic sterile inflammation of the eyelid resulting from a lipogranuloma of the meibomian glands that line the posterior margins
... [Show More] of theeyelids (see Fig. 29-7). It is deeper in the eyelid tissue than a hordeolum andmay 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
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: Fourth- generation 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
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
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