1
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 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
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
Saline irrigation to
Ophthalmi Neonates: Chlamydia Erythema, Culture (ELISA, eyes until
a trachomatis, chemo PCR), Gram exudate gone;
neonat Staphylococcus aureus, sis, stain, R/O N. follow with
orum Neisseria purule gonorrhoeae, erythromycin
gonorrhoeae, HSV nt chlamydia ointment
(silver nitrate reaction exudat For N.
occurs in 10% of e gonorrhoeae:ceft
neonates) with N riaxone or IM or
IV
, 2
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
For chlamydia:
. erythromycin or
gonorr possibly
hoeae; azithromycin PO
clear For HSV: antivirals
to IV or PO
mucoi
d
exudat
e with
chlamy
dia
Neonates:
Bacterial In neonates 5 to 14 days old, Erythema, Cultures (required Erythromycin
conjun preschoolers, and chemo in neonate); 0.5% ophthalmic
ctivitis sexually active sis, Gram stain ointment
teens: Haemophilus itching (optional); ≥1 year old:
influenzae(nontypeable), , chocolate agar Fourth-
Streptococcus burnin (for N. generation
pneumoniae, S. aureus, g, gonorrhoeae) fluoroquinolone
N. gonorrhoeae mucop R/O For concurrent
urulent pharyngitis, N. AOM: Treat
exudat gonorrhoeae, accordingly for
e, AOM, URI, AOM
matter seborrhea Warm soaks to
in eyes three times a
eyelas day until clear
hes; ↑ No sharing towels,
in pillows
winter No school until
treatment begins
Depends on prior
Chronic School-age children and Same as Cultures, Gram treatment,
bacteri teens: Bacteria, above; stain; R/O laboratory
al viruses, C. trachomatis foreign dacryostenosis results, and
conjun body , blepharitis, differential
ctivitis sensati corneal ulcers, diagnoses
Review
, 3
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
compliance and
(unres on trachoma prior drug
ponsiv choices of
e conjunctivitis
conjun treatment
ctivitis Consult with
previo ophthalmologist
usly
treated
as
bacteri
al in
etiolog
y)
Neonates:
Inclusion Neonates 5 to 14 days old Erythema, Cultures (ELISA, Erythromycin or
conjun and sexually active chemo PCR), R/O azithromycin PO
ctivitis teens: C. trachomatis sis, sexual activity Adolescents:
clear Doxycycline,
or azithromycin,
mucoi EES,
d erythromycin
exudat base,
e, levofloxacin PO
palpeb
ral
follicle
s
Refer to
Viral Adenovirus 3, 4, 7; HSV, Erythema, Cultures, R/O ophthalmologist
conjun herpes zoster, varicella chemo corneal if HSV or
ctivitis sis, infiltration photophobia
tearing present
(bilater Cool compresses
al); three or four
HSV times a day
, 4
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
and
herpes
zoster:
unilate
ral
with
photop
hobia,
fever;
zoster:
nose
lesion;
spring
and
fall
Naphazoline/pheni
Allergic Atopy sufferers, seasonal Stringy, Eosinophils in ramine,
and mucoi conjunctival naphazoline/anta
vernal d scrapings zoline
conjun exudat ophthalmic
ctivitis e, solution (see text)
swolle Mast cell stabilizer
n (see text)
eyelids Refer to allergist if
and needed
conjun
ctivae,
itching
(key
finding
),
tearing
,
palpeb
ral
follicle
s,
headac
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 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
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
Saline irrigation to
Ophthalmi Neonates: Chlamydia Erythema, Culture (ELISA, eyes until
a trachomatis, chemo PCR), Gram exudate gone;
neonat Staphylococcus aureus, sis, stain, R/O N. follow with
orum Neisseria purule gonorrhoeae, erythromycin
gonorrhoeae, HSV nt chlamydia ointment
(silver nitrate reaction exudat For N.
occurs in 10% of e gonorrhoeae:ceft
neonates) with N riaxone or IM or
IV
, 2
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
For chlamydia:
. erythromycin or
gonorr possibly
hoeae; azithromycin PO
clear For HSV: antivirals
to IV or PO
mucoi
d
exudat
e with
chlamy
dia
Neonates:
Bacterial In neonates 5 to 14 days old, Erythema, Cultures (required Erythromycin
conjun preschoolers, and chemo in neonate); 0.5% ophthalmic
ctivitis sexually active sis, Gram stain ointment
teens: Haemophilus itching (optional); ≥1 year old:
influenzae(nontypeable), , chocolate agar Fourth-
Streptococcus burnin (for N. generation
pneumoniae, S. aureus, g, gonorrhoeae) fluoroquinolone
N. gonorrhoeae mucop R/O For concurrent
urulent pharyngitis, N. AOM: Treat
exudat gonorrhoeae, accordingly for
e, AOM, URI, AOM
matter seborrhea Warm soaks to
in eyes three times a
eyelas day until clear
hes; ↑ No sharing towels,
in pillows
winter No school until
treatment begins
Depends on prior
Chronic School-age children and Same as Cultures, Gram treatment,
bacteri teens: Bacteria, above; stain; R/O laboratory
al viruses, C. trachomatis foreign dacryostenosis results, and
conjun body , blepharitis, differential
ctivitis sensati corneal ulcers, diagnoses
Review
, 3
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
compliance and
(unres on trachoma prior drug
ponsiv choices of
e conjunctivitis
conjun treatment
ctivitis Consult with
previo ophthalmologist
usly
treated
as
bacteri
al in
etiolog
y)
Neonates:
Inclusion Neonates 5 to 14 days old Erythema, Cultures (ELISA, Erythromycin or
conjun and sexually active chemo PCR), R/O azithromycin PO
ctivitis teens: C. trachomatis sis, sexual activity Adolescents:
clear Doxycycline,
or azithromycin,
mucoi EES,
d erythromycin
exudat base,
e, levofloxacin PO
palpeb
ral
follicle
s
Refer to
Viral Adenovirus 3, 4, 7; HSV, Erythema, Cultures, R/O ophthalmologist
conjun herpes zoster, varicella chemo corneal if HSV or
ctivitis sis, infiltration photophobia
tearing present
(bilater Cool compresses
al); three or four
HSV times a day
, 4
Clinical
Type Incidence/Etiology Finding Diagnosis Management*
s
and
herpes
zoster:
unilate
ral
with
photop
hobia,
fever;
zoster:
nose
lesion;
spring
and
fall
Naphazoline/pheni
Allergic Atopy sufferers, seasonal Stringy, Eosinophils in ramine,
and mucoi conjunctival naphazoline/anta
vernal d scrapings zoline
conjun exudat ophthalmic
ctivitis e, solution (see text)
swolle Mast cell stabilizer
n (see text)
eyelids Refer to allergist if
and needed
conjun
ctivae,
itching
(key
finding
),
tearing
,
palpeb
ral
follicle
s,
headac
