External Eye and Tear Duct Infections

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Question 1 of 9

1. Question
When considering the presentation of external eye infections to the emergency department (ED), which one of the following statements is correct?
- Preseptal cellulitis refers to infection anterior to the external ocular muscles
- Orbital cellulitis will lead to blindness in the affected eye in 11% of patients
- Dacryocystitis is defined as an infection of the lacrimal gland
- Hordeolum is an alternative name for a meibomian cyst
Question 2 of 9

2. Question
A basic knowledge of relevant pathophysiology is important in understanding how external eye infections develop.

Which one of the following statements is correct?
- Dacryocystitis is normally caused by a viral infection
- Direct spread from the ethmoid sinuses is the most common cause of orbital cellulitis
- The most common infecting organism in acute hordeolum is haemophilus influenzae
- Gram-negative organisms are normally responsible for preseptal cellulitis
- The meibomian glands are responsible for adding proteins such as lysozyme to the tear film
Question 3 of 9

3. Question
When assessing a patient with a red, swollen eye, which one of the following features does NOT help to differentiate between preseptal and orbital cellulitis?
- Diplopia
- Painful eye movements
- Proptosis
- Reduced visual acuity
- Ptosis
Question 4 of 9

4. Question
A 20-year-old man presents to the ED with a discrete swelling on his right upper eyelid. He believes he has a ‘stye’.

Which of the following findings would lead you to suspect that this was actually a chalazion?
- Sticky discharge noticed on waking
- Duration of more than two weeks
- The lesion is very tender to the touch
- The lesion appears erythematous
- Conjunctivitis also present
Question 5 of 9

5. Question
Which of the following eye conditions and systemic diseases are NOT risk factors for each other?
- Preseptal cellulitis and diabetes
- Orbital cellulitis and systemic sepsis
- Chalazion and Haemophilus influenzae type B (HiB)
- Dacryocystitis and systemic lupus erythematosus (SLE)
- Dacryoadenitis and Epstein-Barr Virus (EBV)
Question 6 of 9

6. Question
A 54-year-old man presents to the ED with a painful left eye. From your history and examination you suspect that he has orbital cellulitis.

Which one of the following statements is correct regarding the investigation of this patient?
- Viral throat swabs are useful to establish the causative organism
- High resolution CT scans can help to confirm the diagnosis
- A lumbar puncture should routinely be performed to exclude intracranial abscess
- An attempt should be made to aspirate pus from the orbit for culture
- Elevated intraocular pressure always indicates orbital cellulitis
Question 7 of 9

7. Question
When treating dacryocystitis, which one of the following is correct?
- All patients should be followed up by an ophthalmologist
- Flucloxacillin is the ideal antibiotic for this problem
- Topical antibiotics are usually all that is required
- Admission to hospital and IV antibiotics are generally required
- Application of warm compresses to the area are usually adequate
Question 8 of 9

8. Question
A patient with orbital cellulitis is most likely to give a preceding history of:
- Mumps
- A punch to the eye
- Insect bite to the eylid
- Sinusitis
- Influenza
Question 9 of 9

9. Question
You have seen a febrile patient with a painful swollen left eye and diagnosed orbital cellulitis. You attempt to refer him to the ophthalmology team, but the on-call registrar is busy in theatre and can’t see the patient for an hour. An enthusiastic FY2 doctor working in the ED offers advice as he claims to have read up on orbital cellulitis recently.

Which of the following statements he makes is correct?
- If antibiotics are started within 24 hours, then significant morbidity is highly unlikely
- Oral antibiotics should be adequate, as long as he is seen in clinic the next day
- The presence of hypotension and tachycardia should prompt a critical care assessment in addition to the ophthalmology review
- A lumbar puncture should be performed to exclude intracranial spread of infection
- The presence of a normal visual acuity excludes orbital cellulitis

External Eye and Tear Duct Infections – Post Test

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