PANCE Blueprint EENT (7%)

Lid disorders (PEARLS)

The NCCPA™ PANCE Eyes, Ears, Nose, and Throat Content Blueprint eye disorders ⇒ lid disorders

Blepharitis
Patient will present as → a 34-year-old female with crusting, scaling, red-rimming of the eyelid, and eyelash flaking along with dry eyes. The patient has a history of seborrhea and rosacea.

Eyelid changes: crusting, scaling, red-rimming of eyelid and eyelash flaking along with dry eyes and associated seborrhea and rosacea

DX: Diagnosis is usually by slit-lamp examination

  • Chronic blepharitis that does not respond to treatment may require a biopsy to exclude eyelid tumors that can simulate the condition

TX: Warm compresses, irrigation, lid massage, and topical antibiotics for flare-ups

  • Daily lid wash with baby shampoo
Chalazion
Patient will present as → a 52-year-old male with a foreign-body sensation in the right eye. Over the last 3 weeks, he has had gradually increasing painless swelling around the right lower eyelid. Your examination shows a nontender discrete nodule on the right lower eyelid. There is no evidence of injection or discharge and her visual acuity is normal.

chalazion is a sterile painless (non-infectious) granuloma of the internal meibomian sebaceous gland, painless "cold" lid nodule

DX: Diagnosis is clinical

  • Will present as a hard, nontender eyelid swellingoften NOT very red
  • Unlike a hordeolum (stye), a chalazion tends to have a more gradual onset, is less painful, and affects the middle part of the eyelid

TX: Warm compresses, and eyelid hygiene

  • Injection of corticosteroid or incision + curettage may be necessary for large chalazion that is affecting vision
Ectropion
Patient will present as  a 72-year-old with complaints of dry eyes coupled with excessive tearing. On exam, the conjunctiva appears red and the left eyelid is turned outward.

Ectropion (eversion of the eyelid) occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation

DX: Diagnosis is clinical (the eyelid turns out)

TX: Tear supplements and ocular lubricants at night

  • Definitive treatment is surgery
Entropion
Patient will present as → a 75-year-old with a foreign body sensation and tearing of his right eye. On physical exam you note a red, irritated, right eye in association with an inverted eyelid.

Entropion (inversion of an eyelid) occurs when the eyelid turns inward. It is most commonly caused by age-related tissue relaxation, surgical correction is definitive

DX: Diagnosis is clinical (eyelids turn in)

TX: Tear supplements and ocular lubricants at night

  • Definitive treatment is surgery
Hordeolum (stye) (ReelDx)
ReelDx Virtual Rounds (Hordeolum )

su_note note_color="#eefafe"]Patient will present as → a 15-year-old male with pain, redness, and swelling of the upper eyelid for the last 3 days. There are no visual changes or photophobia. Examination reveals a tendererythematous, and outward-pointing edema of the right eyelid.[/su_note]

Painful, warm (hot), swollen red lump on the eyelid (different from a chalazion which is painless)

  • Think “H” for Hot = Hordeolum. Most common organism S.  aureus

DX: The diagnosis is clinical

TX: Warm compress and topical antibiotics

  • A hordeolum that does not respond to hot compresses can be incised with a sharp, fine-tipped blade
  • Systemic antibiotics (eg, dicloxacillin or erythromycin 250 mg PO QID) are indicated when cellulitis accompanies a hordeolum
Dacryoadenitis (Prev Lesson)
(Next Lesson) Blepharitis (Lecture)
Back to PANCE Blueprint EENT (7%)

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