Blepharitis, Hordeolum, Chalazion Handout PDF

8/25/2024 Eye Conditions: Blepharitis, Hordeolum, Chalazion NU RS 641 F NP1 Pre pared and Presente d by Lori -Jeanne West ©Lori-Jeanne West, 2024 Rep roduction of th is mater ia l is proh ibited w ith out the auth or’s co nsen t. Post...

8/25/2024 Eye Conditions: Blepharitis, Hordeolum, Chalazion NU RS 641 F NP1 Pre pared and Presente d by Lori -Jeanne West ©Lori-Jeanne West, 2024 Rep roduction of th is mater ia l is proh ibited w ith out the auth or’s co nsen t. Postin g or sharin g of these mate rials w itho ut the autho r’s con sen t is a copyright vio lation. Blepharitis 1  8/25/2024 Overview and Presentation Blepharitis: inflammation of the eye lids and margins, affect either the anterior (eyelash follicles) or posterior (obstruction of meibomian glands) eyelid Complaints: – eye itching, burning, tearing, redness, foreign body sensation – Unilateral or bilateral – Symptoms worse in the morning Physical Exam Lid margins are edematous, erythematous Use magnifying glass or woods lamp- may reveal scaling, erythema, crusting, scale fragments along lid margins Palpate eyelid and lid margins for masses Gentle pressure on eyelid- white sebaceous discharge from meibomian gland may indicate gland problem Stayphylococcus blepharitis- pustules at the base of the hair follicles may crust or bleed Severe- associated with rosacea Diagnostics Evaluate visual acuity bilaterally – With and without corrective lenses Eyelid and conjunctival cultures not usually needed 2  8/25/2024 Differentials Persistent inflammation and thickening of eyelid margin – Squamous cell, basal cell, sebaceous cell carcinoma – Hordeolum – Conjunctivitis – Herpes simplex infection – Orbital cellulitis – Dacryocystitis – Foreign body Treatment Mainstay: warm compresses and gentle eyelid scrub bing at base of th e lashes Staphylococcal: ba citracin or erythromycin 0.5% oin tment 1-3 times/day for 7-10 days, if infe ction persists then refe r to ophthalmologist Posterior: compresses/massage to Meibomian gland, if resistant then topical fluoroq uinolone or bacitracin, o ral doxycyclin e, or refe r to ophthalmologist Severe: o ral d oxycycline 100mg 2 x/day, or tetracycline 250mg 4x/da y fo r several weeks then ta per, or refer to ophthalmologist Patient Education Wash hands often Avoid irritants Hypoallergenic soap and makeup Careful with contact lenses Long term eyelid hygiene for recurrent blepharitis 3  8/25/2024 Hordeolum and Chalazion Overview and Presentation Both caused by du ctal o bstructio n of meib omia n gla nd, often seco ndary sta phylo coccus infection Hordeolum (Stye): acute, er ythemato us eyelid lump caused b y inflammation or infection of the eye lid margin – Presents as tender, erythematous lump localized to eyelid affecting hair fo llicles of eyelash or me ibom ian glan ds Chalazion: gra nulomatou s inflammation due to gland ular blockage (meib omia n gla nd) – Presents as nontender lump/painless swelling of the eyelid May init ially be tender and eryth ematous, slo w developing, high re curren ce Physical Exam Evaluate visual acuity (typically unaffected) Hordeolum: erythema, localized tenderness with palpation, drainage from the lesion, pustule Chalazion: inversion of eyelid reveals red, elevated, painless mass Pain with eye movement and eyelid edema, erythema should raise concern for orbital cellulitis → urgent referral 4  8/25/2024 Diagnostics Usually diagnosed by appearance, cultures not indicated for uncomplicated/first time occurrences Refer to ophthalmologist if persistent Differentials Persistent inflammation and thickening of eyelid margin – Squamous cell, basal cell, sebaceous cell carcinoma – blepharitis – Conjunctivitis – Herpes simplex infection – Orbital cellulitis – Dacryocystitis – Foreign body Treatment Mainstay for both: warm compresses and gentle eyelid scrubbing followed by gentle massage Hordeolum infection/inflammation: erythromycin ointment or sulfacetamide ointment 4x/day or ciprofloxacin ointment 3x/day to eyelid margin Hordeolum resistant/recurrent: oral antibiotics such as cephalexin, referral to ophthalmologist for I&D Chalazion unresolved: if persists >4 weeks referral to ophthalmologist for I&D, biopsy, local injection of glucocorticosteroids 5  8/25/2024 Patient Education Wash hands often Eyelid cleansing and warm compresses Do not share towels or sunglasses Hypoallergenic soap and makeup Careful with contact lenses Long term eyelid hygiene References Buttaro, T.M., Polgar-Bailey, P., Sandberg-Cook, J., & Trybulski, J. (2021). Primary care: Interprofessional collaborative practice (6th ed.). Elsevier. Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2022). Primary care: The art and science of advanced practice nursing and interprofessional approach (6th ed.). F. A. Davis Company. 6