What is chalazion? Fates of chalazion?

 Chalazion/Hailstone/ Internal hordeolum/ Meibomian cyst/ Tarsal cyst:

A chalazion is a chronic, sterile, granulomatous inflammatory lesion caused by retained sebaceous secretion leaking from the meibomian glands or other sebaceous glands into adjacent stroma.

Chalazion:

Chronic granulomatous inflammation of the meibomian gland.

 

Fate of Chalazion:

  1. Spontaneous resolution.
  2. Complications:
    • Increased size and causing mechanical ptosis.
    • Secondary infection-internal hordeolum (painful chalazion).
    • Burst either through skin/conjunctiva.
    • Malignant change- Meibomian carcinoma.

[Ref: Basak/4th/124-126]

Removal of Chalazion

What is stye? Tell its treatment in brief.

Stye/ External hordeolum :

Acute suppurative inflammation of hair follicle of the eyelash or associated gland of zeis and mole usually caused by S. aureus. (s-179)

[ Gland of zeis => opens at hair follicle,

Gland of mole => open in eyelid]

Stye/ External Hordeolum
Stye/ External Hordeolum

Treatment of Stye/ External hordeolum:

  1. Assurance
  2. Analgesics: Ibuprofen or aspirin (with antacid)
  3. Hot compression – 3 to 4 times daily.
  4. Local antibiotic drops like Chloramphenicol/ Ciprofloxacin 1 drop 2-3 hours interval & same preparation eye ointment at bedtime)
  5. Wait for 4-5 days, if not respond or deteriorate, then – Broad sprectrum antibiotic – flucloxacillin 500mg 6 hourly for 5-7 days.
  6. If still not respond –
    • Removal of eyelashes.
    • Incision and drainage (horizontal) – by pulling out the affected eyelash.

[Ref: Basak-4th/123-124]

What is ophthalmia neonatorum? Tell its treatment in brief.

Ophthalmia neonatorum:

Purulent conjunctivitis – occurring during the 1st month of life.

Ophthalmia neonatorum(2):

It is a purulent conjunctivitis develops within 2 weeks of birth as the result of infection transmitted from mother to infant during delivery.

[Ref: Kanski/6th/223]

Ophthalmia-Neonatorum
Ophthalmia Neonatorum

[Extra answer:

Causative organisms ophthalmia neonatorum:

  • Chlamydia trachomatis- most common
  • Staphylococcus aureus
  • Balantidium coli
  • Neisseria gonorrhoeae – is now uncommon        ]

Treatment of Ophthalmia neonatorum:

A.Curative:

  1. Chlamydial infection: Oral erythromycin for 2 weeks. In addition, erythromycin or tetracycline ointment.
  2. Gonococcal infection: Ceftriaxone intravenously or intramuscularly or cefotaxime.
  3. Other bacterial infections: Chloramphenicol or neomycin ointment 6 hourly. Systemic antibiotics may be considered in severe cases.
  4. Herpes simplex: Systemic Acyclovir for 14 days and topical Acyclovir 5 time daily.

B.Prophylaxis:

  1. Povidone-iodine 2.5% is a cheap and effective agent against all of the common pathogens that cause ophthalmia neonatorum.
  2. Erythromycin 0.5% ointment or tetracycline 1% ointment is used by someone.

[Ref: Kanski/6th/225]

What is pterygium? Tell the treatment of pterygium.

Pterygium:

A pterygium is a triangular wing shaped fold of conjunctiva and sub-conjunctival fibrovascular proliferation in the inter-palpebral fissure that has invaded superficial cornea.

Treatment of Pterygium:

A. Atrophic/ regressive pterygium: Left alone with periodic follow up.

B.Progressive pterygium:

  1. Excision of the pterygium with the conjunctiva and keeping the limbus and adjacent scleral area bare.
  2. Sub-conjunctiva dissection of the pterygium.
  3. Transposition operation.

C.Recurrent pterygium:

  1. After excision – the bare sclera is treated with –  Beta irradiation,   –  Thio-TEPA solution,  –  Mitomycin-C
  2. Limbal autograft
  3. Lamellar keratoplasty

What conjunctivitis? Parts of conjunctiva. Treatment of acute bacterial conjunctivitis.

Conjunctivitis:

Inflammation of the conjunctiva is called conjunctivitis.

[Extra answer: Conjunctiva: It is a mucous membrane covering the inner surface of the eyelids and reflected to cover, up to the corneal margin.]

Parts of conjunctiva:

[Mnemonic: Play Ball For Limb]

  1. Palpebral conjunctiva:
  2. Bulbar conjunctiva
  3. Fornix
  4. Limbal

Treatment of acute bacterial conjunctivitis:

Treatment (in short):

  • Cleaning of eyelids of discharge with fresh water.
  • Broad spectrum antibiotic eye drops or ointments such as chloramphenicol, ciprofloxacin, gentamycin, tetracycline, polymyxin-B etc.

[Ref: Kanski/6th/219]

What is proptosis? Five important causes of proptosis.

Proptosis:

Abnormal protrusion of the eyeball beyond the orbital margin is called Proptosis.

Forward protrusion of the eyeball beyond the orbital margin.

5 important causes of Proptosis:

For easy memorizing: CHRONiC

  1. Cavernous sinus thrombosis
  2. Haemangioma
  3. Retro-bulbar hemorrhage
  4. Orbital cellulitis
  5. Neurofibroma
  6. Cysticercosis

[Others:

Panophthalmitis, Pseudo-tumour, Osteoma, Lymphosarcoma, rhabdomyosarcoma, meningioma, Orbital varices, Aneurysm of the blood vessels, Hydatid cyst, Leukaemic deposit, Cranio-sinostosis, colobomatous cyst, Cavernous sinus thrombosis, Xanthomatosis of orbit, neuroblastoma.]

[N:B: Bilateral Proptosis is called exophthalmos]

[Ref: Basak 4th/358-359]

Name the bones that form the medial wall of orbit. Contents of orbit.

Bones that form Medial wall of orbit:

  1. Frontal process of maxilla
  2. Lacrimal bone
  3. Orbital plate of ethmoid
  4. Body of sphenoid.

Contents of orbit:

  1. Eyeball

  2. Fascia: Orbital and bulbar

  3. Muscles: Extraocular muscles

    • 4 recti
    • 2 oblique
    • LPS

       4.Vessels:

  1. Ophthalmic artery
  2. Superior & inferior ophthalmic veins
  3. Lymphatics

     5.Nerves:

  1. Optic
  2. Oculomotor
  3. Trochlear
  4. Abducent
  5. Branches of ophthalmic nerve
  6. Parasympathetic nerves

     6. Lacrimal gland & Lacrimal sac

     7. Orbital fat.

[Ref: Basak/4th/20]

How visual field can be measured?

Measurement of Visual field:

Visual field can be measured by Perimetry.

Methods of Perimetry:

A.     Kinetic methods:(to see peripheral field)

    • Confrontation technique
    • Tangent screen (to see central field) / Bjerrum target screen
    • Lister’s perimeter
    • Goldman’s perimeter
    • Aimark’s perimeter
    • Camphimeter

Static methods: Computed visual field analyzer (to see both central and peripheral field)

  • Humphrey perimeter
  • Octopus perimeter
  • Henson perimeter
  • Fieldmaster perimeter
  • Ocuplot perimeter
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