Bacteriology of Lacrimal Duct Obstruction in Adults Br J Ophthalmol: First Published As 10.1136/Bjo.81.1.37 on 1 January 1997

Total Page:16

File Type:pdf, Size:1020Kb

Bacteriology of Lacrimal Duct Obstruction in Adults Br J Ophthalmol: First Published As 10.1136/Bjo.81.1.37 on 1 January 1997 British Journal of Ophthalmology 1997;81:37–40 37 Bacteriology of lacrimal duct obstruction in adults Br J Ophthalmol: first published as 10.1136/bjo.81.1.37 on 1 January 1997. Downloaded from Jouko Hartikainen, Olli-Pekka Lehtonen, K Matti Saari Abstract During the past 20 years there have been Aims—To determine the current bacteri- only a few studies on the bacteriology of adult ology of lacrimal duct obstruction (LDO) LDO. According to them, Staphylococcus epi- and to relate the bacteriological findings dermidis and Staphylococcus aureus are the most to the type of symptoms. frequently isolated organisms in adult lacrimal Methods—127 samples were obtained sac infections.5–7 from the lacrimal sac in 118 consecutive The treatment of LDO in adults is surgery, adult patients with LDO, including nine either external or endonasal dacryocysto- bilateral cases. rhinostomy (DCR), or occasionally silicone Results—Altogether, 156 isolates were re- intubation. Walland and Rose8 reported a five- covered from the 127 samples cultured. fold risk of soft tissue infection after open lac- Cultures were positive from 84% of the rimal surgery without systemic antibiotic samples. Gram positive bacteria were iso- prophylaxis. According to them, postoperative lated in 79 (62%) samples. The most soft tissue infection represents a significant risk frequently cultured bacterial species was of failure in lacrimal surgery. Knowledge of the Staphylococcus epidermidis, represent- bacteriology of LDO contributes significantly ing 27% of the isolates. Gram negative to the choice of prophylactic antimicrobial bacteria were recovered from 26 (20%) agents. samples, and these bacteria were statisti- The purpose of this study was to determine cally significantly more common in cases the current bacteriology of LDO in Finnish with copious discharge than in cases with (white) adults and to determine whether the minor discharge (p=0.000). Cases with bacteriology of SSLD and chronic dacryocysti- simple stenosis of the lacrimal duct tis diVer from each other. (SSLD) showed significantly less Strepto- coccus sp (p=0.004) and Gram negative Materials and methods organisms (p=0.004) than those with PATIENTS chronic dacryocystitis. We examined 118 consecutive adult patients Conclusion—The bacteriology of SSLD with LDO, who had been referred for lacrimal resembles that of normal conjunctival drainage surgery to the outpatient clinic of the http://bjo.bmj.com/ flora. Chronic dacryocystitis in adults is Department of Ophthalmology, Turku Univer- associated with an increased proportion of sity Central Hospital, between April 1994 and Gram negative bacteria which may be a November 1995. The patients ranged in age reservoir for postoperative intraocular from 22 to 89 (mean 63.5) years; 93 (79%) infection. They should also be taken into were women and 25 (21%) were men. Nine of account in selecting antimicrobial the 118 patients with LDO were bilateral cases. Eighteen patients had previously had at least prophylaxis in lacrimal drainage surgery. on September 28, 2021 by guest. Protected copyright. (Br J Ophthalmol 1997;81:37–40) one acute episode of dacryocystitis, and seven of them had suVered from two to five acute episodes. Patients who had undergone lacrimal Lacrimal sac and/or nasolacrimal duct ob- drainage surgery during the past year were struction, which here is defined as lacrimal excluded. Five patients had had previous duct obstruction (LDO), is an annoying and external DCR performed 1–24 years earlier sometimes an eye threatening ophthalmic and one patient had undergone silicone Turku University problem, which aVects patients of every age. intubation 1 year earlier. Altogether, 112 Central Hospital, Turku, Finland The obstruction may be an idiopathic inflam- patients had not undergone previous lacrimal Department of matory stenosis, the primary acquired naso- drainage operations. Informed consent was Ophthalmology lacrimal duct obstruction (PANDO),1 which obtained from all the patients studied. J Hartikainen mostly aVects middle aged and elderly women, K M Saari or may be secondary to trauma, infection, OPHTHALMIC EXAMINATION inflammation, neoplasm, or mechanical ob- We performed a routine ophthalmic examin- Department of Clinical Microbiology struction, the secondary acquired lacrimal ation including biomicroscopy, using Haag– 2 O-P Lehtonen drainage obstruction (SALDO). Distal ob- Streit 900 instruments paying special attention struction converts the lacrimal sac into a stag- to the presence of discharge and epiphora. The Correspondence to: nant pool, which easily becomes infected lead- LDO was confirmed by irrigation of the J Hartikainen, MD, Department of ing to chronic dacryocystitis with epiphora and lacrimal drainage system and by probing up to 3 Ophthalmology, Turku purulent discharge. It is, however, noticeable the nasal wall of the lacrimal sac fossa. University Central Hospital, that many patients tolerate LDO with epiphora FIN-20520 Turku, Finland. 4 for many years without clinical infection, rep- BACTERIAL ISOLATION Accepted for publication resenting simple stenosis of lacrimal duct In all, 127 samples of the contents of the 12 September 1996 (SSLD). lacrimal sac were obtained from 118 patients; 38 Hartikainen, Lehtonen, Saari nine of the patients had cultures obtained from Table 1 Bacteriological findings of the content of the Br J Ophthalmol: first published as 10.1136/bjo.81.1.37 on 1 January 1997. Downloaded from both sides. The collection of the samples was lacrimal sac in 118 adult patients with lacrimal duct obstruction performed either by applying pressure over the lacrimal sac and allowing the purulent material Number of %of to reflux through the lacrimal punctum, or by isolates % of all samples irrigating the lacrimal drainage system with Micro-organisms isolated (n=156) isolates (n=127)* sterile saline and collecting the sample from Gram positive the refluxing material. The samples were organisms: 108 69.2 Staphylococcus collected with sterile cotton wool swabs, ensur- epidermidis 42 26.9 33.1 ing that the lid margins or the conjunctiva were Staphylococcus aureus 19 12.2 15.0 not touched. None of the patients had used Other Staphylococcus sp 13 8.3 10.2 either antibiotic eyedrops or systemic antibiot- Micrococcus sp 1 0.6 0.8 ics for at least a week before their visit to the Streptococcus outpatient clinic. Anaesthetic eyedrops were pneumoniae 8 5.1 6.3 Other Streptococcus sp 10 6.4 7.9 not used before the sample collection. The Corynebacterium sp 4 2.6 3.1 samples were cultured on the day of collection Other Gram positive rods 11 7.1 8.7 onto blood, chocolate, and fastidious anaerobic Gram negative agar and incubated aerobically and anaerobi- organisms: 26 16.7 cally for 4 days. The anaerobic incubation took Haemophilus influenzae 6 3.8 4.7 place in an anaerobic cabinet (Don Whitley, Haemophilus parainfluenzae 2 1.3 1.6 UK). The bacteriological isolates were identi- Escherichia coli 3 1.9 2.4 fied with standard procedures. Pseudomonas aeruginosa 2 1.3 1.6 Citrobacter sp 2 1.3 1.6 STATISTICS Enterobacter sp 3 1.9 2.4 Fisher’s exact fourfold table test was used for Klebsiella pneumoniae 2 1.3 1.6 Moraxella catarrhalis 1 0.6 0.8 comparing the distributions of the isolated Morganella morganii 1 0.6 0.8 micro-organisms between diVerent clinical Acinetobacter lwoYi 1 0.6 0.8 groups withapvalue < 0.05 chosen to be sta- Proteus sp 1 0.6 0.8 Other Gram negative tistically significant. rods 1 0.6 0.8 Gram negative coccus 1 0.6 0.8 Results Anaerobic organisms: 20 12.8 Propionibacterium sp 16 10.3 12.6 CLINICAL FINDINGS Other anaerobic Gram A total of 97 (76%) cases showed chronic positive rods 2 1.3 1.6 dacryocystitis with purulent discharge and epi- Bacteroides fragilis 1 0.6 0.8 Fusobacterium sp 1 0.6 0.8 phora. These cases were divided into two sub- Fungal organisms: 2 1.3 groups according to the quality of discharge. Candida sp 2 1.3 1.6 Forty six cases showed copious purulent Mixed flora 8 6.3 No micro-organism 20 15.7 discharge or thick mucous discharge coming from the lacrimal sac, and 51 cases showed *Number of samples. http://bjo.bmj.com/ epiphora and minor mucopurulent discharge only. negative bacteria being Haemophilus influenzae, Thirty (24%) patients complaining of epi- which represented 4% of the isolates. Anaero- phora did not show any clinical signs of infec- bic micro-organisms were present in 20 (16%) tion of the lacrimal drainage system. In all of samples. They accounted for 13% of the these, the reflux from the irrigated lacrimal sac isolates, the most frequently isolated anaerobic was entirely clear tear fluid and saline. Our bacteria being Propionibacterium sp, which rep- clinical diagnosis for these 30 cases was SSLD. resented 10% of the isolates, and 80% of all the on September 28, 2021 by guest. Protected copyright. anaerobic isolates. BACTERIOLOGICAL FINDINGS Both the 30 cases carrying the clinical diag- The results of the aerobic and anaerobic nosis of SSLD, and the 97 cases with chronic cultures of the 118 patients with LDO are pre- dacryocystitis, showed a preponderance of sta- sented in Table 1. Of the 127 samples 107 phylococci, Gram positive rods, Propionibacte- (84%) yielded a positive culture. Of the 107 rium sp, and a few other anaerobic organisms samples with positive culture results, 51 (48%) (Table 2). Not a single isolate of streptococci had mixed cultures with two to four organisms occurred in samples of the cases with SSLD, isolated. Altogether, 156 organisms were iso- whereas these organisms were isolated signifi- lated. The majority of micro-organisms were cantly more often (20%) in samples of the Gram positive bacteria. Altogether, 108 Gram cases with chronic dacryocystitis (p=0.004). positive isolates were recovered, representing Gram negative organisms were also isolated 69% of the overall 156 isolates cultured. Gram significantly more often (26%) in the cases positive bacteria were found in 79 samples, with chronic dacryocystitis than in the cases accounting for 62% of all the samples.
Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • Chronic Conjunctivitis
    9/8/2017 Allergan Pharmaceuticals Speaker’s Bureau Bio-Tissue BioDLogics, LLC Katena/IOP Seed Biotech COA Monterey Symposium 2017 Johnson and Johnson Vision Care, Inc. Shire Pharmaceuticals Nicholas Colatrella, OD, FAAO, Dipl AAO, ABO, ABCMO Jeffrey R. Varanelli, OD, FAAO, Dipl ABO, ABCMO Text NICHOLASCOLA090 to 22333 to join Live Text Poll Nicholas Colatrella, OD, FAAO, Dipl AAO, Jeffrey Varanelli, OD, FAAO, Dipl ABO, ABO, ABCMO ABCMO Text NICHOLASCOLA090 to 22333 once to join Then text A, B, C, D, E or write in your answer Live Immediate Accurate Chronic conjunctivitis is one of the most frustrating reasons that patients present to the office (1) Time course Often times patients will seek multiple providers searching for a solution The chronicity of their symptoms is extremely frustrating to the (2) Morphology patient and treating physician alike Some conditions can seriously affect vision and create ocular morbidity (3) Localization of disease process Many of these diseases do not respond to commonly used topical antibiotics, topical steroids, artificial tears, and other treatments for external ocular disease (4) Type of discharge or exudate Our hope during this one-hour lecture is to present a process to help aid in the diagnosis of chronic conjunctivitis help you determine the most likely etiology 1 9/8/2017 Three weeks is the dividing point as it is the upper limit for cases of viral infection and most bacterial infections to resolve without treatment. Acute Conjunctivitis Conjunctivitis that has been present for less than 3 weeks
    [Show full text]
  • Quality of Vision in Eyes with Epiphora Undergoing Lacrimal Passage Intubation
    Quality of Vision in Eyes With Epiphora Undergoing Lacrimal Passage Intubation SHIZUKA KOH, YASUSHI INOUE, SHINTARO OCHI, YOSHIHIRO TAKAI, NAOYUKI MAEDA, AND KOHJI NISHIDA PURPOSE: To investigate visual function and optical PIPHORA, THE MAIN COMPLAINT OF PATIENTS WITH quality in eyes with epiphora undergoing lacrimal passage lacrimal passage obstruction, causes blurred vision, intubation. discomfort, and skin eczema, and may even cause so- E DESIGN: Prospective case series. cial embarrassment. Several studies have assessed the qual- METHODS: Thirty-four eyes of 30 patients with ity of life (QoL) or vision-related QoL of patients suffering lacrimal passage obstruction were enrolled. Before and from lacrimal disorders and the impact of surgical treat- 1 month after lacrimal passage intubation, functional vi- ments on QoL, using a variety of symptom-based question- sual acuity (FVA), higher-order aberrations (HOAs), naires.1–8 According to these studies, epiphora negatively lower tear meniscus, and tear clearance were assessed. affects QoL physically and socially; however, surgical An FVA measurement system was used to examine treatment can improve QoL. Increased tear meniscus changes in continuous visual acuity (VA) over time, owing to inadequate drainage contributes to blurry and visual function parameters such as FVA, visual main- vision.9 However, quality of vision (QoV) has not been tenance ratio, and blink frequency were obtained. fully quantified in eyes with epiphora, and the effects of Sequential ocular HOAs were measured for 10 seconds lacrimal surgery on such eyes are unknown. after the blink using a wavefront sensor. Aberration Dry eye, a clinically significant multifactorial disorder of data were analyzed in the central 4 mm for coma-like, the ocular surface and tear film, may cause visual distur- spherical-like, and total HOAs.
    [Show full text]
  • (COVID-19) Outbreak: an Experience from Daegu, Korea
    Infect Chemother. 2020 Jun;52(2):226-230 https://doi.org/10.3947/ic.2020.52.2.226 pISSN 2093-2340·eISSN 2092-6448 Editorial Changes in the Clinical Practice of Ophthalmology during the Coronavirus Disease 2019 (COVID-19) Outbreak: an Experience from Daegu, Korea Areum Jeong 1,2 and Min Sagong 1,2 1Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea 2Yeungnam Eye Center, Yeungnam University Hospital, Daegu, Korea Received: May 24, 2020 The world has been hit hard by the coronavirus disease 2019 (COVID-19) pandemic. Korea Accepted: May 25, 2020 experienced a surge of patients because of a mass infection in an obscure religious group Corresponding Author: in Daegu. With our experience from hospitals in Daegu, the epicenter of the COVID-19 Min Sagong, MD outbreak in Korea, we suggest the strategies that should be followed in order to reduce the Department of Ophthalmology, Yeungnam transmission and assess the risk in the field of ophthalmology. University College of Medicine, 170 Hyunchungro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3443 Fax: +82-53-626-5936 TRANSMISSION OF SEVERE ACUTE RESPIRATORY E-mail: [email protected] SYNDROME CORONAVIRUS 2 (SARS-CoV-2) Copyright © 2020 by The Korean Society We are still learning about how SARS-CoV-2 spreads. The virus is mainly transmitted of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society person-to-person, particularly among those who are in close contact with one another for AIDS within approximately 6 feet. Moreover, it may be possible that a person contract COVID-19 This is an Open Access article distributed by touching a surface that has the virus on it and then touching their own mouth, nose, or under the terms of the Creative Commons possibly their eyes.
    [Show full text]
  • Eye Infections
    CLINICAL Approach Taking a Look at Common Eye Infections John T. Huang, MD, FRCSC and Peter T. Huang, MD, FRCSC he acutely red eye is often seen first by the primary-care physician. The exact Tcause may be difficult to determine and may cause some concern that a serious ocular condition has been missed. Thorough history and clinical examination will help delineate the final diagnosis. When there are doubts, prompt referral to an oph- thalmologist can prevent serious consequences. Often, the most likely diagnosis of an acutely red eye is acute conjunctivitis. In the first day, an acute bacterial infection may be hard to differentiate from viral, chlamydial and noninfectious conjunctivitis and from episcleritis or scleritis. Below is a review of the most commonly seen forms of eye infections and treat- ments. Failure to improve after three to five days should lead to a re-evaluation of the patient and appropriate referral where necessary. CHRONIC BLEPHARITIS Clinical: Gritty burning sensation, mattering, lid margin swelling and/or scaly, flaky debris, mild hyperemia of conjunctiva; may have acne rosacea or hyperkeratotic dermatitis (Figure 1). Anterior: Staphylococcus aureus (follicles, accessory glands); posterior (meibomian glands). Treatment: • Lid scrubs (baby shampoo, lid-care towellettes, warm compresses). Figure 1. Chronic blepharitis. There may be localized sensitivity to the shampoo or the components of the solution in the towellettes (e.g., benzyl alcohol). • Hygiene is important for the treatment and management of chronic blepharitis. Topical antibiotic-corticosteroid combinations (e.g., tobramycin drops, tobramycin/dexamethasone or sulfacetamide sodium-prednisolone acetate). Usage of these medications is effective in providing symptomatic relief, as the inflammatory component of the problem is more effectively dealt with.
    [Show full text]
  • Pediatric Orbital Tumors and Lacrimal Drainage System
    Pediatric Orbital Tumors and Lacrimal Drainage System Peter MacIntosh, MD University of Illinois • No financial disclosures Dermoid Cyst • Congenital • Keratinized epidermis • Dermal appendage • Trapped during embryogenesis • 6% of lesions • 40-50% of orbital pediatric orbital lesion • Usually discovered in the first year of life • Painless/firm/subQ mass • Rarely presents as an acute inflammatory lesion (Rupture?) • Frontozygomatic (70%) • Maxillofrontal (20%) suture Imaging - CT • Erosion/remodeling of bone • Adjacent bony changes: “smooth fossa” (85%) • Dumbell dermoid: extraorbital and intraorbital components through bony defect Imaging - MRI • Encapsulated • Enhancement of wall but not lumen Treatment Options • Observation • Risk of anesthesia • Surgical Removal • Changes to bone • Rupture of cyst can lead to acute inflammation • Irrigation • Abx • Steroids Dermoid INFANTILE/Capillary Hemangioma • Common BENIGN orbital lesion of children • F>M • Prematurity • Appears in 1st or 2nd week of life • Soft, bluish mass deep to the eyelid • Superonasal orbit • Rapidly expands over 6-12 months • Increases with valsalva (crying) • Clinical findings • Proptosis Astigmatism • Strabismus Amblyopia INFANTILE/Capillary Hemangioma • May enlarge for 1-2 years then regress • 70-80% resolve before age 7 • HIGH flow on doppler • Kasabach-Merritt Syndrome • Multiple large visceral capillary hemangiomas • Sequestration of platelets into tumor • Consumptive thrombocytopenia • Supportive therapy and treat underlying tumor • Complications • DIC • death •Homogenous
    [Show full text]
  • Stage Surgery on Inverted Papilloma Which Invaded Lacrimal Sac, Periorbita, Ethmoid and Frontal Sinus
    臨床耳鼻:第 27 卷 第 1 號 2016 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• J Clinical Otolaryngol 2016;27:143-147 증 례 Stage Surgery on Inverted Papilloma which Invaded Lacrimal Sac, Periorbita, Ethmoid and Frontal Sinus Jae-hwan Jung, MD, Minsic Kim, MD, Sue Jean Mun, MD and Hwan-Jung Roh, MD, PhD Department of Otorhinolaryngology-Head & Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea - ABSTRACT - Inverted papilloma of the nasal cavity and the paranasal sinuses is a benign epithelial tumor with a high rate of recurrence, local aggressiveness, and malignant transformation. For these reasons, inverted papilloma has been treated like malignant tumors with extensive surgical resection. With the help of endoscopic sinus surgery tech- nique, it is now available to treat inverted papilloma with stage surgery without severe complications which usu- ally resulted from extensive one stage resection. We report a case of stage surgery on inverted papilloma which invaded lacrimal sac, periorbita, ethmoid and frontal sinus. (J Clinical Otolaryngol 2016;27:143-147) KEY WORDS:Inverted papillomaㆍLacrimal sacㆍPeriorbitaㆍSurgery. Authors present a successful endoscopic stage sur- Introduction gery on IP which invaded lacrimal sac, periorbita, ethmoid and frontal sinus with the literature review. Inverted papilloma (IP) of the nasal cavity and the paranasal sinuses is a benign epithelial tumor with a Case Report high rate of recurrence, local aggressiveness, and ma- lignant transformation.1,2) For these reasons, IP has A 41-year-old female presented in outpatient clinic been treated like malignant tumors with extensive sur- with a complaint of tender swelling mass on the in- gical resection. ner side of her right eye for 5 years which suddenly IP of lacrimal sac and periorbita is rarely reported aggravated 2 months ago.
    [Show full text]
  • Diagnosis and Management of Common Eye Problems
    Diagnosis and Management of Common Eye Problems Review of Ocular Anatomy Picture taken from Basic Ophthalmology for Medical Students and Primary Care Residents published by the American Academy of Ophthalmology Diagnosis and Management of Common Eye Problems Fernando Vega, MD Lacrimal system and eye musculature Eyelid anatomy Picture taken from Basic Ophthalmology for Medical Students and Primary Care Residents published by the American Academy of Ophthalmology n Red Eye Disorders: An Anatomical Approach n Lids n Orbit n Lacrimal System n Conjunctivitis n Cornea n Anterior Chamber Fernando Vega, MD 1 Diagnosis and Management of Common Eye Problems Red Eye Disorders: What is not in the scope of Red Eye Possible Causes of a Red Eye n Loss of Vision n Trauma n Vitreous Floaters n Chemicals n Vitreous detatchment n Infection n Retinal detachment n Allergy n Chronic Irritation n Systemic Infections Symptoms can help determine the Symptoms Continued diagnosis Symptom Cause Symptom Cause Itching allergy Deep, intense pain Corneal abrasions, scleritis Scratchiness/ burning lid, conjunctival, corneal Iritis, acute glaucoma, sinusitis disorders, including Photophobia Corneal abrasions, iritis, acute foreign body, trichiasis, glaucoma dry eye Halo Vision corneal edema (acute glaucoma, Localized lid tenderness Hordeolum, Chalazion contact lens overwear) Diagnostic steps to evaluate the patient with Diagnostic steps continued the red eye n Check visual acuity n Estimate depth of anterior chamber n Inspect pattern of redness n Look for irregularities in pupil size or n Detect presence or absence of conjunctival reaction discharge: purulent vs serous n Look for proptosis (protrusion of the globe), n Inspect cornea for opacities or irregularities lid malfunction or limitations of eye n Stain cornea with fluorescein movement Fernando Vega, MD 2 Diagnosis and Management of Common Eye Problems How to interpret findings n Decreased visual acuity suggests a serious ocular disease.
    [Show full text]
  • Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
    RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos.
    [Show full text]
  • Eye Lid Infections Dr Simon Barnard
    Eye Lid Infections Dr Simon Barnard Eye Lid Infections Dr Simon Barnard PhD BSc FCOptom FAAO DCLP DipClinOptom Director of Ocular Medicine Institute of Optometry, London Visiting Lecturer Department of Optometry & Visual Science City University, London Ocular Therapeutics – what we can treat now Dr Simon Barnard Eye lid infections Acute ulcerative/staphylococcal blepharitis Acute staphylococcal blepharitis presents with brittle crusty, yellow scales along lid margin. The patient may report that the lid margins are tender and red. A secondary keratoconjunctivitis with superficial punctuate keratitis (SPK) with sterile “island” infiltrates at the 2- 4- 8- & 10 o‟clock positions may be present as an inflammatory reaction to alpha exotoxins released by the bacteria. Treatment of acute ulcerative blepharitis Lid hygiene is very important and the first treatment to prescribe. Lid hygiene consists of scrubs and compresses. Lid scrubs should be carried out twice daily for a week and thereafter once daily using cotton wool buds dipped into a dilute solution of Baby Shampoo or using proprietary cleaning pads such as Lid Care (CIBA) or Supranettes (Alcon) In conjunction with the lid scrubs, very warm compresses should be applied by the patient four times per day for the first week tapering to once daily after resolution. Broad spectrum antibiotics (e.g., Brolene, Polyfax (bacitracin + polymyxin B) may be „prescribed‟. For SPK/infiltrates consider a steroid/antibiotic „combo‟ (e.g., framycetin + gramicidin + dexamethasone). The GP will usually co-operate in prescribing medications not currently on our list. It is advisable to follow up the patient in one to two weeks. If not resolving then consider adding oral antibiotic (e.g., oxytetracycline).
    [Show full text]
  • TEAR PRODUCTION and DRAINAGE the Lacrimal Gland Is Located in the Superolateral Aspect of the Eyelid Below the Eyebrow(S)
    Anatomy and Physiology 9 The conjunctiva is a mucous membrane that lines the upper and lower eyelids and extends over the sclera to the corneal margin. It contains lym- phoid tissue, which provides some immunology protection. It is innervated by CN V, the trigeminal nerve. The portion of the conjunctiva that covers the sclera is termed the bulbar conjunctiva; the portion covering the inner surface of the eyelids is termed the palpebral conjunctiva. Figure 1. Eyelid Muscles TEAR PRODUCTION AND DRAINAGE The lacrimal gland is located in the superolateral aspect of the eyelid below the eyebrow(s). It secretes watery (aqueous) tears and produces about 0.2 ml of tears in 24 hours. Aqueous tears flow downward and inward toward the tear drainage system at the inner canthus. In addition to aqueous tears, several glands located in the conjunctiva and eyelid margins secrete oily and sticky (mucous) tears. The meibomian glands are located within the tarsal plate of the eyelid and secrete oily tears. The glands of Zeiss, Moll, Wolfing, and Krause secrete sticky tears. These three types of tears provide moisture and protection to the surface of the eye(s). With each blink, tears are pushed across the eye toward the puncta located at the medial junction of the upper and lower eyelids. From the puncta, tears are pushed into the canaliculi and then into the lacrimal sac. 10 Essentials of Ophthalmic Nursing They are drained from the lacrimal sac and nasolacrimal duct to the inside of the nose and down the throat (see Figure 2). Figure 2. Lacrimal System TEAR FILM The tear film has three distinct layers.
    [Show full text]
  • Eyelid and Orbital Emergencies Charles D
    Eyelid and Orbital Emergencies Charles D. Rice M.D. Financial Disclosure Speaker, Charles Rice, M.D. has a financial interest/agreement or affiliation with Lansing Ophthalmology, where he is a shareholder and employed as a oculoplastic surgeon. Eyelid Emergencies/Urgencies • Chalazion with localized cellulitis • Preseptal Cellulitis • Contact Dermatitis • Canaliculitis • Dacryocystitis • Eyelid/Conjunctival Foreign Body Orbital Emergencies • Orbital Cellulitis • Orbital Inflammation • Thyroid Orbital Inflammation • Orbital Hemorrhage • Orbital and Eyelid Trauma Management • History • Exam Visual Acuity Pupillary Reaction Eyelid and Lacrimal Exam Globe position and Extraocular Motility Management • Diagnosis Differential Testing • Treatment Medications Surgery Referral Chalazion Chalazion with Localized Cellulitis • May be diffuse cellulitis • Usually painful • Consider dacryocystitis, canaliculitis, orbital cellulitis • Localized swelling and redness later Chalazion with Localized Cellulitis Treatment • Oral antibiotic Cephalosporin, Cipro, Bactrim • Topical antibiotic/steroid • Hot compresses • Incision and drainage later • 45 yo female • 1 month history of progressive redness and itching of eyelid area • Started on tobramycin and erythromycin topical • Benadryl • Lid scrubs • Problem continued to worsen Contact Dermatitis • Usually acute process • Redness, edema, flaking of skin • Unilateral or bilateral • Ocular exam usually normal • Exposure to chemicals or allergens • Pesticides, make-up, nail polish, plant materials • Consider bacterial
    [Show full text]