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Eyelid Swelling

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81. Pre-septal cellulitis

in Denniston AKO and Murray PI: Oxford Handbook of Ophthalmology, 3rd edition, OUP 2014) Contrast-enhanced CT scanning should be performed in all patients with symptoms and signs suggestive of orbital cellulitis Differential diagnosis Preseptal cellulitis: orbital cellulitis hordeolum (external or internal) acute blepharitis viral conjunctivitis with eyelid swelling allergic conjunctivitis with eyelid swelling angioneurotic oedema (if bilateral): could indicate severe systemic allergic reaction, e.g (...) species Predisposing factors Preseptal cellulitis: upper respiratory tract infection dacryocystitis hordeolum impetigo (skin infection) trauma, sharp or blunt, around eye recent surgery around eye Orbital cellulitis: acute sinusitis (especially ethmoid sinusitis) trauma including orbital fracture dacryocystitis preseptal cellulitis dental abscess Symptoms Preseptal cellulitis: acute onset of swelling, redness and tenderness of lids fever malaise irritability in children Orbital cellulitis: sudden

2018 College of Optometrists

82. CRACKCast E119 – Allergy, Hypersensitivity, Angioedema, and Anaphylaxis

, used for BB overdoses) [10] Compare and contrast the management of angioedema with urticaria and without urticaria Urticaria appears as papules or wheals that consist of central swelling with surrounding reflex erythema, and it is associated with itching or a burning-type sensation. These lesions are a result of mediators (predominantly histamine) released from mast cells. They tend to occur on the extremities and trunk and are usually transient, with skin often returning toits normal appearance (...) inhibitor–induced angioedema, the inhibition of ACE, one of the main inactivators of bradykinin, results in increased bradykinin levels. ACE inhibitor–induced angioedema has a predilection for the face, often involving the, lips, eyelids, tongue, larynx, or pharynx. The highest incidence occurs in the first month of therapy but has been reported to occur as many as 10 years after therapy was initiated. Wisecracks [1] List the types of immune reactions and give an example of each Refer to box 109.1

2017 CandiEM

84. CRACKCast E022 – Red and Painful Eye

Etiology Symptoms Important differences to periorbial cellulitis Maxillary/ethmoid sinusitis Orbital trauma Dental Infection Need CT to rule out abscess Eyelid swelling / redness Warmth of skin overlying orbit Tenderness over bone Palpebral injection/chemosis of the conjunctiva Fever Ill / Toxic appearance Blurred vision Proptosis Painful or limited extraocular movements § Binocular diplopia Edema of optic disk Venous engorgement of the retina Management: Further Work Up: Treatments Measure IOP, if >20 (...) to perceive light V: Visual field testing Confrontational field testing (not accurate for small field cuts) But this rarely changes the ED management E: External examination Of both external eyes and surrounding structures (facial bone fracture, etc.) Globe position: exop/enophthalmos (proptosis) Conjugate gaze Periorbital soft tissues, bones, sensation i. Examination of upper a lower eyelids, including eversion*** Ensure no foreign body ii. Assess adjacent structures E: Extraocular muscle movement Assess

2017 CandiEM

85. CRACKCast E128 – Thyroid and Adrenal Disorders

of thyrotoxicosis: Autoimmune, infectious, drug induced, endocrine, silent/subclinical, factitious [2] List 5 ophthalmologic findings in hyperthyroidism / Graves’ Ophthalmopathy is a classic finding in Graves’ disease; it is thought to result in a proliferation of orbital fibroblasts differentiating into adipocytes and orbital infiltration of inflammatory cells. Patients subsequently present with diplopia, photophobia, tearing, grittiness, and pain because of corneal exposure, as well as eyelid edema, hyperemia (...) of destruction and eventual fibrous replacement of the gland’s follicular tissue. Infiltrative disorders, Congenital thyroid dysfunction, Pregnancy, Radiotherapy, Medications, Lithium Amiodarone Infection, Surgery, Inadequate dietary iodine intake, (#1 cause worldwide) Thyroid medication noncompliance, Previous treatment of thyrotoxicosis. Symptoms of hypothyroidism: Sinus bradycardia Diastolic heart failure Dyspnea on exertion Decreased exercise capacity Constipation Menorrhagia Periorbital swelling Goiter

2017 CandiEM

86. CRACKCast E133 – Parasitic Infections

Trypanosomiasis and African Trypanoso miasis American Trypanosomiasis (Chagas Disease): Causative Agent: Trypanosomiasis Cruzi Endemic Region: South America Vector: Reduviidae bug (Assassin/Kissing Bug) Clinical Presentation: Romana sign – swelling of the ipsilateral eye and eyelid to the bite from inadvertent spreading of infected bug feces into the eye Complications: Myocarditis Dilated Cardiomyopathy Meningo-Encephalitis (can be chronic) Treatment: Nifurtimox / Benznidazole African Trypanosomiasis (African

2017 CandiEM

87. CRACKCast E071 – Ophthalmology Part B

management Scleral globe rupture Occurs in setting of blunt or penetrating trauma May be obvious (contents oozing) or subtle Symptoms: VA / pain Signs: Bloody chemosis / severe subconjunctival hemorrhage / Tear drop pupil RAPD / poor VA / no red light reflex Do NOT do tonometry CT: Only 75% sens. Treatment: Eye shield Head of bed > 45 degrees NPO Antiemetics Analgesics Antitussives Broad spectrum abx: Ceftriaxone & gentamicin & vancomycin 7) List 5 indications for ophtho consultation for eyelid (...) lacerations Laceration of the eyelids Need to search for a penetrating injury and foreign body Simple superficial lacerations not involving the eyelid margin can be treated in emerg. Simple 6-0 / 7-0 interrupted sutures removed in 3-5 days Complex lacerations needing referral: Lac of the lid margin Of the canalicular system (medial eyelid) Involving the levator or canthal tendons Through orbital septum Presence of orbital fat*** = no subcutaneous fat in the eyelids so the fat is likely from a globe injury

2017 CandiEM

88. CRACKCast E071 – Ophthalmology Part A

, lubrication Optho follow up PO acyclovir as effective as IV acyclovir for vitreous penetration 8) Define and manage a) Hordeolum, aka “Styes” / Chalazion Localised, nodular, inflammatory processes Hordeolum Chalazion Etiology Begins as a diffuse swelling and erythema of eyeLID margin Inflammation of glands of Zeis or HAIR follicles — Staph. species Obstructed Meibomian gland — > Swelling within the lid surface. ***lid margin is NORMAL*** Symptoms Pain, swelling redness “” Treatment Warm compresses for 15 (...) out abscess Eyelid swelling / redness Warmth of skin overlying orbit Tenderness over bone Palpebral injection/chemosis of the conjunctiva Fever Ill / Toxic appearance Blurred vision Proptosis Painful or limited extraocular movements Binocular diplopia Edema of optic disk Venous engorgement of the retina Further Work Up: Treatments: Measure IOP, if >20 may need surgery Blood cultures CT orbits to rule out: Foreign body Emphysema Hematoma Abscess Osteomyelitis Cavernous sinus thrombosis Consider

2017 CandiEM

89. Guidelines for care of patients with actinic keratosis

/amenability; ??? very ?exible/amenable. First hospital clinic attendance NHS tariff 2014–15: £104. 178 Hospital follow-up attendance: £68. GP visit: £44. 179 © 2017 British Association of Dermatologists British Journal of Dermatology (2017) 176, pp20–43 28 Guidelines for actinic keratosis 2017, D. de Berker et al.8.2 Active treatments All topical therapies for AK may result in side-effects of irrita- tion. Some AKs proceed to ooze, crusting and soreness with local swelling. Details are cited (...) the eye. 162 Studies undertaken in ophthalmology suggest that treatment is possible with close supervision. Treatment can be combined with care of the eye. In a case series of 14 patients treating periocular skin with 5-FU 5% twice daily for 2 weeks, antibi- otic ointment was coprescribed and used until the area had healed. 163 Six of the 14 AKs were on the upper eyelid and nine abutted a lid margin. Five patients required a second course of treatment, but overall clearance was complete in all cases

2017 British Association of Dermatologists

90. Orbits, Vision and Visual Loss

described inflammatory condition that may account for a significant percentage of patients that have been previously described as idiopathic [39-41]. Manifestations include eyelid or periocular swelling, lacrimal gland enlargement, extraocular muscle involvement, intraorbital mass, proptosis, and cranial nerve V involvement. CT CT of the orbits with contrast is often the initial imaging modality in the emergent setting for suspected infection [2,7,42,43]. CT is superior to MRI for foreign body (...) the scope of this article. Discussion of Procedures by Variant Variant 1: Traumatic visual defect. Suspect orbital injury. Initial imaging. Patients with traumatic orbital injury may have injuries that are isolated to the orbit or have intracranial manifestations, depending on the mechanism and severity of injury. In the United States, orbital trauma accounts for approximately 3% of visits to the emergency department [8]. Orbital injury should be suspected if periorbital soft-tissue swelling, hyphema

2017 American College of Radiology

92. Eye Care in the Intensive Care Unit

be clear of the cornea if iatrogenic corneal abrasion is to be avoided). The outside of the eye must be free of the lubricant ointment for tape to stick properly. Micropore TM tape is then applied horizontally across the lids to seal them shut as below: 2017/PROF/350 6 In those patients nursed prone and unconscious, the eyelids and face can become oedematous and conjunctival swelling (chemosis) is common. As in all ventilated patients, exposure keratopathy (a drying of the corneal surface, see below (...) mechanically ventilated, due to greater length of stay, use of sedative/paralysing drugs and the effects of positive pressure ventilation (see below). The main possible problems affecting the front of the eye in ICU are: ? Direct injury to the cornea - most often a superficial corneal abrasion (scratch) (1) ? Exposure keratopathy ? Chemosis (conjunctival swelling) ? Microbial conjunctivitis and keratitis ICU eye care protocols are sometimes haphazardly followed, and documentation of eye care is often poor

2017 Intensive Care Society

93. Noctura 400 Sleep Mask for diabetic retinopathy and diabetic macular oedema

and eyelid swelling, itchy and dry Noctura 400 Sleep Mask for diabetic retinopathy and diabetic macular oedema (MIB144) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 17eyes and general discomfort when wearing the mask. The third study reported limited data as it was an abstract only, but showed no progression of retinopathy (measured through retinopathy grading and best corrected visual acuity) over the course (...) =0.03; group C -12.7%, p<0.05). Adv Adverse e erse ev vents: ents: 75% participants in the healthy control groups and 40% in the DMO group who wore the sleep mask for =1 month reported =1 adverse event. The most common were: eye soreness (n=5; 5 healthy controls, 0 DMO patients); eyelid swelling (n=4; 4 healthy controls, 0 DMO patients); itchy eyes (n=4; 3 healthy controls, 1 DMO patient); and dry eyes (n=3; 2 healthy controls, 1 DMO patient). Events were mostly attributed to the fabric mask. One

2018 National Institute for Health and Clinical Excellence - Advice

94. Insect Bites - Guidelines for Prescribing Topical Hydrocortisone

usually start as a sharp burning pain which may progress to a red, swollen welt. Bites may progress to larger reactions with inflammation, pain, severe itching, and swelling and in some cases fever, hives and joint pain. Severe reactions (anaphylaxis) may cause facial swelling and trouble breathing. Bites from ants may cause a painful, itchy raised pustule. Location of bite may give some clue as to the type of insect which caused it: Flying insects tend to bite or sting exposed skin areas Flea bites (...) that can be treated with antihistamines. Refer to physician for allergy testing if desired. (1 to 2 mm fragile pustules and / or honey-colored, crusted erosions) or other bacterial skin infections - can be the consequence of scratching a bite. - infected hair follicles; presenst as red, often itchy, papules and/or pustules at the base of the hair shaft. Subcutaneous folliculitis forms furuncles ( boils) - tender red swellings often with a central pustule. Adverse drug reactions which may present

2016 medSask

97. Isolated orbital mass as the primary presentation of a triple-hit lymphoma transformed from a systemic follicular lymphoma (PubMed)

Isolated orbital mass as the primary presentation of a triple-hit lymphoma transformed from a systemic follicular lymphoma Triple-hit lymphoma is a highly aggressive B-cell lymphoma. We report a case of triple-hit lymphoma transformed from systemic follicular lymphoma (FL) after 9-year remission and presented primarily as an isolated orbital mass without systemic symptoms or lymphadenopathy.A 58-year-old female presented with intermittent vertical binocular diplopia, left upper eyelid swelling

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2018 American journal of ophthalmology case reports

98. Neonatal infection: antibiotics for prevention and treatment

antibiotics, perform it as soon as possible after starting antibiotics. 1.5.1.4 Do not routinely perform urine microscopy or culture as part of the investigation for early-onset neonatal infection. 1.5.1.5 Do not perform skin swab microscopy or culture as part of the investigation for early-onset neonatal infection in the absence of clinical signs of a localised infection. 1.5.1.6 Be aware that, although minor conjunctivitis with encrusting of the eyelids is common and often benign, a purulent discharge (...) cellulitis (for example, redness, increased skin warmth or swelling), perform a blood culture, take a swab sample for microscopy and Neonatal infection (early onset): antibiotics for prevention and treatment (CG149) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 20 of 40culture, and start antibiotic treatment with intravenous flucloxacillin and gentamicin (see recommendation 1.6.1.3) [1] . If the microbiology results

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

99. Childhood Thyroid Cancer Treatment (PDQ®): Patient Version

young children, who have the changed gene may have a ( to remove the thyroid). This can decrease the chance of developing medullary thyroid cancer. Signs of thyroid cancer include a swelling or lump in the neck. Sometimes thyroid tumors do not cause any signs or symptoms. These and other signs and symptoms may be caused by papillary or follicular thyroid cancer or by other . Check with your child's doctor if your child has any of the following: A lump in the neck. A lump near the that does not hurt (...) . Trouble breathing. Trouble swallowing. Hoarseness or a change in the voice. (irregular heartbeat, shakiness, weight loss, trouble sleeping, frequent , and sweating). These and other signs and symptoms may be caused by medullary thyroid cancer or by other conditions. Check with your child's doctor if your child has any of the following: Bumps on the lips, tongue, or eyelids that do not hurt. Trouble making tears. . Marfan syndrome (being tall and thin, with long arms, legs, fingers, and toes). Tests

2018 PDQ - NCI's Comprehensive Cancer Database

100. Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

). . Chest pain or heart attack. or one or more . disease. Possible signs and symptoms of heart and blood vessel late effects include trouble breathing and chest pain. These and other and may be caused by heart and blood vessel late effects or by other : Trouble breathing, especially when lying down. Heartbeat that is too slow, too fast, or different from the heart's normal rhythm. Chest pain. Swelling of the feet, ankles, legs, or . When exposed to cold or having strong emotions, the fingers, toes, ears (...) of extra after having many . Possible signs and symptoms of liver and bile duct late effects include abdominal pain and jaundice. These and other signs and symptoms may be caused by liver and bile duct late effects or by other conditions: Weight gain or weight loss. Swelling of the abdomen. Nausea and vomiting. Pain in the abdomen. Pain may occur near the ribs, often on the right side, or after eating a fatty meal. (yellowing of the skin and whites of the eyes). Light-colored bowel movements. Dark

2018 PDQ - NCI's Comprehensive Cancer Database

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