Pediatric Primary Care (44 page)

1.  Red eyelid margin.

2.  Itching or burning of eyelid margin.

3.  Crusting or scaling of eyelid margin.

4.  Commonly bilateral and chronic or recurrent.

E.  Physical findings.

1.  Seborrhea.

a.  Easy-to-remove yellow, greasy scales along base of eyelashes.

b.  May see concurrent and similar scales on eyebrows, scalp, external ears.

2.  Staphylococcal.

a.  Fibrinous, difficult-to-remove scales along base of eyelashes.

b.  Inflammation or ulceration of lid margins.

c.  Loss of eyelashes.

d.  May see concurrent conjunctivitis.

3.  Pediculosis.

a.  Lice along lid margins.

b.  May see concurrent pubic or head lice.

F.  Diagnostic tests.

1.  Culture of lid margin indicated only if fails to respond to treatment.

G.  Differential diagnosis.

1.  Conjunctivitis (allergic, bacterial, or viral).

2.  Nasolacrimal duct obstruction.

3.  Atopic or contact dermatitis.

4.  Seborrheic dermatitis.

H.  Treatment.

1.  Clean eyelid margins twice a day with diluted baby shampoo.

2.  Seborrhea blepharitis: treat eyebrows, scalp, ears with selenium sulfide shampoo.

3.  Staphylococcal blepharitis: apply topical anti-infective ointment (erythromycin ophthalmic ointment or bacitracin/polymyxin B ophthalmic ointment).

4.  Pediculosis blepharitis: remove parasite by smothering with ophthalmic petrolatum along lid margins.

I.  Follow up.

1.  No routine follow up necessary.

2.  Recheck if fails to improve; sooner if worsens.

J.  Complications.

1.  Loss of eyelashes.

2.  Conjunctivitis.

3.  Hordeolum or chalazion.

K.  Education.

1.  Frequent handwashing.

2.  Discourage rubbing of eyes.

VII. HORDEOLUM

A.  Definition. Infection of meibomian glands (internal hordeolum) or glands of Zeis or Moll (external hordeolum or stye) of eyelid.

B.  Etiology.

1.  Usually Staphylococcal aureus.

C.  Occurrence.

1.  Can occur at any age.

D.  Clinical manifestations.

1.  Internal: painful and tender eyelid, red eye, usually without pustule.

2.  External: painful and tender eyelid, red eye, usually with pustule.

E.  Physical findings.

1.  Internal: large, erythematous, tender mound of one eyelid with associated mild conjunctival hyperemia.

2.  External: smaller, more superficial eyelid pustule with associated mild conjunctival hyperemia.

F.  Diagnostic tests.

1.  None indicated.

G.  Differential diagnosis.

1.  Chalazion.

2.  Eyelid abscess.

H.  Treatment.

1.  Frequent, warm compresses.

2.  May use topical antiinfective ointment (erythromycin ophthalmic ointment or bacitracin/polymyxin B ophthalmic ointment).

3.  Refer if mass fails to disappear after several weeks (may need surgical incision and drainage).

I.  Follow up.

1.  No routine follow up necessary.

2.  Recheck if fails to resolve or worsens.

J.  Complications.

1.  Orbital or eyelid cellulitis.

K.  Education.

1.  Frequent handwashing.

2.  Avoid rubbing eyes.

VIII. CHALAZION

A.  Definition.

B.  Etiology.

1.  Granulomatous inflammation.

C.  Occurrence.

1.  Can occur at any age.

D.  Clinical manifestations.

1.  Hard mass in upper or lower eyelid.

2.  Not red or pustular.

3.  Chronic appearance.

E.  Physical findings.

1.  Firm, nontender nodule in upper or lower eyelid.

2.  Not erythematous or pustular.

3.  No eye discharge.

F.  Diagnostic tests.

1.  None indicated.

G.  Differential diagnosis.

1.  Hordeolum (internal or external).

2.  Orbital cellulitis.

3.  Dacryocystitis (inflammation of the lacrimal sac).

4.  Eyelid abscess.

H.  Treatment.

1.  Most spontaneously subside without treatment.

2.  Surgical removal if size distorts vision.

I.  Follow up.

1.  No routine follow up necessary.

2.  Recheck if fails to improve or worsens.

J.  Complications.

1.  Distorted vision secondary to size of lesion.

K.  Education.

1.  Frequent handwashing.

2.  Avoid rubbing eyes.

IX. CHEMICAL BURN

A.  Definition.

Instillation of alkali or acid solution or substance to eye. True emergency needs immediate referral to ophthalmologist.

B.  Etiology.

1.  Installation of alkali or acid solution or substance into eye.

C.  Occurrence.

1.  Boys > girls.

2.  11- to 15-year olds have highest rate of injury.

D.  Clinical manifestations.

1.  Eye pain.

2.  Unable to open eye(s).

E.  Physical findings.

1.  Eyelid burn.

2.  Opacity of corneal tissue, pale surrounding tissue.

3.  Photophobia.

4.  Tearing, swollen corneas.

F.  Diagnostic tests.

1.  None.

G.  Differential diagnosis.

1.  Foreign body.

2.  Type of chemical burn.

3.  Eyelid injury.

H.  Treatment.

1.  Emergency treatment is immediate irrigation with copious amounts of water or saline.