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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Evidence to support the use of antibiotic eye ointment is poor. Occasionally erythromycin ophthalmic ointment is recommended. Other antibiotics, such as chloramphenicol or amoxicillin may also be used. Chloramphenicol is used successfully in many parts of the world, but contains a black box warning in the United States due to concerns about aplastic anemia, which on rare occasions can be fatal.
Antibiotics are normally given to people with multiple styes or with styes that do not seem to heal, and to people who have blepharitis or rosacea.
Most cases of styes resolve on their own, without professional care. The primary treatment is application of warm compresses. As a part of self-care at home, people may cleanse the affected eyelid with tap water or with a mild, nonirritating soap or shampoo (such as baby shampoo) to help clean crusted discharge. Cleansing must be done gently and while the eyes are closed to prevent eye injuries.
People with styes should avoid eye makeup (e.g., eyeliner), lotions, and wearing contact lenses, since these can aggravate and spread the infection (sometimes to the cornea). People are advised not to lance the stye themselves, as serious infection can occur. Pain relievers such as acetaminophen may be used.
Oral Antibiotics: Ophthalmologists or optometrists may prescribe a low-dose, oral antibiotic such as Doxycycline.
Topical Antibiotics: If prescribed, topical creams or ointments can be applied after the cleansing of the lid margin. A small amount of antibiotic ophthalmic ointment is spread along the lid fissure with a swab or fingertip, while the eyes are closed. It is prescribed for use prior to bedtime to avoid blurred vision. Another method to reduce side effects of blepharitis are antibiotics such as erythromycin or sulfacetamide, which are used via eye drops, creams, or ointments on the eyelid margin. blepharitis caused by Demodex mites can be treated using a diluted solution of tea tree oil, via application by a cotton swab, for 5–10 minutes per day.
Steroid eyedrops/ointments: Eye drops or ointments containing corticosteroids are frequently used in conjunction with antibiotics and can reduce eyelid inflammation.
Warm Compresses: "Soften lid margin debris and oils" by placing a very warm wet compress such as a clean, warm, wet washcloth over the closed eyelids for five minutes. Re-wet and reapply it as it cools. This warms, softens, and loosens crusty and oily eyelid gland deposits.
Eyelid Hygiene: "Remove lid margin debris" immediately after the warm compresses by gently washing the eyelids with a warm, wet, soapy washcloth to remove accumulated debris. Use a diluted, hypoallergenic baby shampoo. Gently rub along the lid margins, keeping the eyes shut. Too much soap or shampoo may remove the essential oil layer of the eyes' tear film and create further stress to the eye, as well as dry eye discomfort. A moist cotton swab soaked in a cup of water and baby shampoo may be used to rub along the lid margins while tilting the lid outward with the other hand to avoid this problem. Finally, rinse the eyelid with warm water and gently dry with a towel. "Eye make-up" should not be used while inflammation is present. "Dandruff shampoo" can be helpful if dandruff is contributing to blepharitis and may relieve blepharitis symptoms.
Topical antibiotic eye drops or ointment (e.g., chloramphenicol or fusidic acid) are sometimes used for the initial acute infection, but are otherwise of little value in treating a chalazion. Chalazia will often disappear without further treatment within a few months, and virtually all will reabsorb within two years. Healing can be facilitated by applying a warm compress to the affected eye for approximately 15 minutes 4 times per day. This promotes drainage and healing by softening the hardened oil that is occluding the duct.
If they continue to enlarge or fail to settle within a few months, smaller lesions may be injected with a corticosteroid, or larger ones may be surgically removed using local anesthesia. This is usually done from underneath the eyelid to avoid a scar on the skin. If the chalazion is located directly under the eyelid's outer tissue, however, an excision from above may be more advisable so as not to inflict any unnecessary damage on the lid itself. Eyelid epidermis usually mends well, without leaving any visible scar. Depending on the chalazion's texture, the excision procedure varies: while fluid matter can easily be removed under minimal invasion, by merely puncturing the chalazion and exerting pressure upon the surrounding tissue, hardened matter usually necessitates a larger incision, through which it can be scraped out. Any residual matter should be metabolized in the course of the subsequent healing process, generally aided by regular appliance of dry heat. The excision of larger chalazia may result in visible hematoma around the lid, which will wear off within three or four days, whereas the swelling may persist for longer. Chalazion excision is an ambulant treatment and normally does not take longer than fifteen minutes. Nevertheless, owing to the risks of infection and severe damage to the eyelid, such procedures should only be performed by a medical professional.
Chalazia may recur, and they will usually be biopsied to rule out the possibility of a tumour.
Chalazion surgery is a simple procedure that is generally performed as a day operation, and the person does not need to remain in the hospital for further medical care.
Chalazion removal surgery is performed under local or general anesthesia. Commonly, general anesthesia is administered in children to make sure they stay still and no injury to the eye occurs. Local anesthesia is used in adults and it is applied with a small injection into the eyelid. The discomfort of the injection is minimized with the help of an anesthetic cream, which is applied locally.
The chalazion may be removed in two ways, depending on the size of cyst. Relatively small chalazia are removed through a small cut at the back of the eyelid. The surgeon lifts the eyelid so he or she can access the back of its surface and makes an incision of approximately 3 mm just on top of the chalazion. The lump is then removed, and pressure is applied for a few minutes to stop any oozing of blood that may occur because of the operation. Surgery of small chalazia does not require stitches, as the cut is at the back of the eyelid and therefore the cut cannot be seen, and the cosmetic result is excellent.
Larger chalazia are removed through an incision in front of the eyelid. Larger chalazia usually push on the skin of the eyelid, and this is the main reason why doctors prefer removing them this way. The incision is not usually larger than 3 mm and it is made on top of the chalazion. The lump is removed and then pressure is applied on the incision to prevent oozing. This type of surgery is closed with very fine stitches. They are hardly visible and are usually removed within a week after the surgery has been performed. Although chalazia are rarely dangerous, it is common to send the chalazion or part of it to a laboratory to screen for cancer.
When surgery for a chalazion is considered, patients who take aspirin or any other blood-thinning medications are advised to stop taking them one week prior to the procedure as they may lead to uncontrollable bleeding. There are several tests taken prior to surgery to make sure the patient is in good condition for the operation.
In rare cases, patients are kept overnight in the hospital after chalazion surgery. This includes cases in which complications occurred and the patient needs to be closely monitored. In most cases however, patients are able to go home after the operation has ended.
The recovery process is easy and quite fast. Most patients experience some very minor discomfort in the eye, which can be easily controlled by taking painkilling medication. Patients are, however, recommended to avoid getting water in the eye for up to 10 days after surgery. They may wash, bathe, or shower, but they must be careful to keep the area dry and clean. Makeup may be worn after at least one month post-operatively. Patients are recommended to not wear contact lenses in the affected eye for at least eight weeks to prevent infections and potential complications.
Commonly, patients receive eye drops to prevent infection and swelling in the eye and pain medication to help them cope with the pain and discomfort in the eyelid and eye. One can use paracetamol (acetominophen) rather than aspirin to control the pain. Also, after surgery, a pad and protective plastic shield are used to apply pressure on the eye in order to prevent leakage of blood after the operation; this may be removed 6 to 8 hours after the procedure.
People who undergo chalazion surgery are normally asked to visit their eye surgeon for post-op follow-up three to four weeks after surgery has been performed. They may start driving the day after surgery and they may return to work in one or two days.
Chalazion surgery is a safe procedure and complications occur very seldomly. Serious complications that require another operation are also very rare. Among potential complications, there is infection, bleeding, or the recurrence of the chalazion.
If epiphora is caused by ectropion or entropion, lid repair is indicated. Punctal irrigation is also required. In infants with nasolacrimal defects, a nasolacrimal duct probe is used and a tube replacement, either temporary (Crawford) or permanent (Jones), is carried out. A surgical procedure called a dacryocystorhinostomy is done to join the lacrimal sac to the nasal mucosa in order to restore lacrimal drainage.
Some of the adverse outcomes associated with intra-operative injuries include:
- Increased length of stay. This is due to ophthalmology consults required, associated infections and treatment.
- Increased costs. This is due to increased length of stay, cost of treating the complications.
- Pain and discomfort for the patient. Corneal abrasions are extremely painful for the patient and the treatment consists of drops and ointments applied in the eye which may cause further discomfort for the patient.
Ligneous conjunctivitis may be managed by topical treatments of plasminogen, topical and subconjunctival fresh frozen plasma, and fibrinolytic therapy.
Cherry eye, if caught early, can be resolved with a downward diagonal-toward-snout closed-eye massage of the affected eye or occasionally self-corrects alone or with antibiotics and steroids. Sometimes the prolapse will correct itself with no interference, or with slight physical manual massage manipulation as often as necessary coupled with medication.
Due to the different underlying causes, proper diagnosis, treatment, and prognosis can only be determined by an eye care professional. Punctate epithelial erosions may be treated with artificial tears. In some disorders, topical antibiotic is added to the treatment. Patients should discontinue contact lens wear until recovery.
The most commonly employed method is to use tape or a general purpose adhesive dressing. Unfortunately the adhesive used on the tape or dressing will generally be inappropriate for this use. The adhesive strength may change when reaching body temperature, or over time.
As the operation progresses this can cause the adhesive to stop working and become gooey, allowing the eyelids to move apart, and leaving behind a sticky residue. This leaves the cornea exposed to epithelial drying and/or abrasions, sometimes caused by the tape that was originally applied to protect the cornea. Alternatively, the adhesive strength may increase, which upon removal can result in eyelid bruising, tears, or eyelash removal.
Rolls of tapes are often “laying around” the operating theatre or kept in health care workers' pockets.
Therefore, they can be a source of hospital-acquired infections (HAI's) such as Methicillin-resistant Staphylococcus aureus (MRSA) & Vancomycin-resistant Enterococcus (VRE), with a 2010 study showing that 50% of partially used tape rolls tested positive for MRSA, VRE or both.
Most tapes and dressings are non-transparent and so it is not possible to see if the patient’s eyes are opened or closed throughout the case. It is not uncommon for the eyelids to move open as the case progresses, even with adhesive tapes stuck onto them. In a practical sense, these medical tapes/dressings may be difficult to remove from a patient because their ends can become stuck flush with the skin. The possibility of tape removal causing trauma is also significantly increased in older people, people with sensitive skin, dermatitis, dehydration or side effects of medications.
As noted above, there have been several studies looking at the efficacy and safety of eye ointments/lubricants as adjuncts with tape or as a stand-alone management for intra-operative eye closure. Unfortunately many in common use have problems. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia.
They have been implicated in blurred vision in up to 75% of patients and they do not protect from direct trauma.
Specially made eyelid occlusion dressings are available commercially, such as EyeGard (manufactured in the USA by KMI Surgical and marketed by Sharn Anesthesia), EyePro (Andsco Medical Pty Ltd, Australia) and Anesthesia-Aid (Sperian Protection). These dressings overcome most of the problems associated with tape or general purpose dressings.
Treatment of lagopthalmos can include both supportive care methods as well as surgical. If unable to receive surgery, artificial tears should be administered at least four times a day to the cornea to preserve the tear film. Leading up to a surgery, a patient can undergo a tarsorrhaphy which partially sews the eye shut temporarily to further protect the cornea as the patient waits for care. Multiple surgical treatments exist for Lagopthalmos but the most prevalent method includes weighing the upper eyelid down by surgically inserting a gold plate. Due to possible complications in conjunction with both the upper and lower eyelid, it might also be required to undergo a second surgery to tighten and elevate the lower eyelid to ensure both the upper and lower eyelids can fully close and protect the cornea.
Madarosis has different possible treatments and can be reversed if treated early enough. The treatments for madarosis are completely dependent upon the pre-existing condition. When suffering from blepheritis, antibiotics are used to combat the bacterial infection. People who are suffering from trichotillomania need to seek behavioral and psychological help. Many people look to hair transplant surgeries, especially in non-scarring cases. These surgeries are mainly used as a cosmetic reason rather than a medical one. There are also other treatments that can be used for cosmetic purposes.
Immediate treatment is very important for someone with orbital cellulitis. Treatment typically involves intravenous (IV) antibiotics in the hospital and frequent observation (every 4–6 hours). Along with this several laboratory tests are run including a complete blood count, differential, and blood culture.
- Antibiotic therapy – Since orbital cellulitis is commonly caused by "Staphylococcus" and "Streptococcus" species both penicillins and cephalosporins are typically the best choices for IV antibiotics. However, due to the increasing rise of MRSA (methicillin-resistant "Staphylococcus aureus") orbital cellulitis can also be treated with Vancomycin, Clindamycin, or Doxycycline. If improvement is noted after 48 hours of IV antibiotics, healthcare professions can then consider switching a patient to oral antibiotics (which must be used for 2–3 weeks).
- Surgical intervention – An abscess can threaten the vision or neurological status of a patient with orbital cellulitis, therefore sometimes surgical intervention is necessary. Surgery typically requires drainage of the sinuses and if a subperiosteal abscess is present in the medial orbit, drainage can be performed endoscopically. Post-operatively, patients must follow up regularly with their surgeon and remain under close observation.
Although orbital cellulitis is considered an ophthalmic emergency the prognosis is good if prompt medical treatment is received.
Antibiotics are aimed at gram positive bacteria. Medical attention should be sought if symptoms persist beyond 2–3 days.
Surgery is the most common means of repairing a cherry eye. Surgery involves gland replacement, not excision, by anchoring the membrane to the orbital rim. In severely infected cases, preoperative antibiotics may be necessary by means of antibiotic eye ointment. Removal of the gland was once an acceptable treatment, and made the eye appear completely normal. Despite cosmetic appeal, removal of the gland reduces tear production by 30 per cent. Tear production is essential in maintaining and protecting the eye from the external environment. Reduced tear production is especially problematic in breeds of animals predisposed to Keratoconjunctivitis sicca (KCS). With surgeries performed in this manner, KCS often results later in life.
KCS is common in dogs, affecting one per cent of the dog population. KCS is a chronic degenerative conjunctivitis that can lead to impaired vision and blindness. KCS has a wide array of causes including drug toxicity, cherry eye, previous surgery, trauma, and irradiation. KCS can be treated, but treatment often spans the entirety of the animal’s life.
In contrast to this, several replacement surgical procedures exist to remedy cherry eye. Replacement of the gland results in lower instances of dry eye later in life. Surgery types are broken into two groups: anchoring procedures and pocket/envelope procedures. At least 8 surgical techniques currently exist. In anchoring procedures, the prolapsed gland must be sutured to the periorbital fascia, the sclera, or the base of the third eyelid. In contrast, pocket procedures involve suturing healthy tissue around the prolapsed to enclose and secure it. Each of these techniques may be performed with an anterior or superior approach, depending on which direction of suturing will cause the least complications to the eye.
A surgeon trained to do eyelid surgery, such as a plastic surgeon or ophthalmologist, is required to decide and perform the appropriate surgical procedure. The following procedures have been described for blepharochalasis:
- External levator aponeurosis tuck
- Blepharoplasty
- Lateral canthoplasty
- Dermis fat grafts
These are used to correct atrophic blepharochalasis after the syndrome has run its course.
There are restoration surgeries for the eyebrows in severe cases. Many surgeons opt for nylon implants, but have been banned in some countries due to infections. Follicular transplantation is now the procedure of choice. In this surgery, hair samples are individually taken for a donor area and transplanted into the thinning area. Small incisions are made and grafts are placed individually according to the amount of hair in each follicle, eyebrows single. In this procedure, there are no scars or stitches and hair begins to grow after a few months post surgery.
Treatment is a relatively simple surgery in which excess skin of the outer lids is removed or tendons and muscles are shortened with one or two stitches. General anesthesia is sometimes used before local anesthetics are injected into the muscles around the eye. Prognosis is excellent if surgery is performed before the cornea is damaged.
@Congenital entropion:: may resolve with time ,or Hotz procedure
@Cicatricial entropion::
1 Anterior lamellar resection
2 Tarsal wedge resection
3 Transposition of tarso conjunctival wedge
4 Posterior lamellar graft
@Senile entropion::
1 Wies operation
2 Transverse everting suture
3 Quicker procedure
If not treated properly with oral antibiotics, the symptoms may escalate and cause blindness, which is the result of ulceration and consequent scarring of the cornea. Surgery may also be necessary to fix eyelid deformities.
Without intervention, trachoma keeps families shackled within a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.
If dermatochalasis is severe enough to obstruct the peripheral or superior visual fields, then it may be treated with a surgical procedure called blepharoplasty. In blepharoplasty surgery, excess skin, muscle and fat are removed. While the improvement of vision is an indication for blepharoplasty on the superior eyelid, if the visual fields are not obstructed, it may be performed for cosmetic reasons. In general, blepharoplasty of the inferior eyelid is considered cosmetic, as dermatochalasis in the lower eyelid does not interfere with vision.
A boil may clear up on its own without bursting, but more often it will need to be opened and drained. This will usually happen spontaneously within two weeks. Regular application of a warm moist compress, both before and after a boil opens, can help speed healing. The area must be kept clean, hands washed after touching it, and any dressings disposed of carefully, in order to avoid spreading the bacteria. A doctor may cut open or "lance" a boil to allow it to drain, but squeezing or cutting should not be attempted at home, as this may further spread the infection. Antibiotic therapy may be recommended for large or recurrent boils or those that occur in sensitive areas (such as the groin, breasts, armpits, around or in the nostrils, or in the ear). Antibiotics should not be used for longer than one month, with at least two months (preferably longer) between uses, otherwise it will lose its effectiveness. If the patient has chronic (more than two years) boils, removal by plastic surgery may be indicated.
Furuncles at risk of leading to serious complications should be incised and drained if antibiotics or steroid injections are not effective. These include furuncles that are unusually large, last longer than two weeks, or occur in the middle of the face or near the spine. Fever and chills are signs of sepsis and indicate immediate treatment is needed.
Staphylococcus aureus has the ability to acquire antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of "S. aureus" is important in the selection of antimicrobials for treatment.
Antibiotic selection: Azithromycin (single oral dose of 20 mg/kg) or topical tetracycline (one percent eye ointment twice a day for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is expensive, it is generally used as part of the international donation program organized by Pfizer through the International Trachoma Initiative. Azithromycin can be used in children from the age of six months and in pregnancy. As a community-based antibiotic treatment, some evidence suggests that oral azithromycin was more effective than topical tetracycline; however, there was no consistent evidence that supported oral or topical antibiotics as being more effective. Antibiotic treatment reduces the risk of active trachoma in individuals infected with chlamydia trachomatis.