The parents of a 7-day-old infant bring her to your office for a swollen eye. Her temperature has b

Discussion in 'MRCPCH forum' started by samuel, Sep 21, 2014.

  1. samuel

    samuel New Member

    The parents of a 7-day-old infant bring her to your office for a swollen
    eye. Her temperature has been normal, but for the last 2 days she has had
    progressive erythema and swelling over the medial aspect of the right lower
    lid near the punctum. Her sclera and conjunctiva are clear. Gentle pressure
    extrudes a whitish material from the punctum. Which of the following
    ophthalmic conditionsis the correct diagnosis?
    a. Chalazion
    b. Dacryocystitis
    c. Preseptal cellulitis
    d. Hyphema
    e. Congenital Sjögren syndrome
  2. samuel

    samuel New Member

    Ans is B
    Dacryocystitis is an infec-tion of the nasolacrimal sac. In newborns it is associated with congenital nasolacrimal duct obstruction, which is seen in 6% of normal infants.
    Nasolacrimal duct obstruction is thought to be caused by the failure of
    epithelial cells forming the duct to canalize. Treatment of this benign, usu-ally self-limited condition involves nasolacrimal massage and cleaning the
    area with warm washcloths; failure to open the duct by 6 months usually
    results in a referral to ophthalmology for surgical opening. When the
    lacrimal sac is infected, as in dacryocystitis, the patient requires a course of antibiotics to clear the infection.
    Chalazion is a firm, nontender nodule that results from a chronic granu-lomatous inflammation of the meibomian gland. Preseptal (periorbital) and
    orbital cellulitis may be distinguished by clinical examination. Blood in the
    anterior chamber of the eye is called a hyphema. Congenital Sjögren syndrome doesn’t exist as an entity; however, mothers with Sjögren syndrome may have infants with congenital lupus.

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