scienceyoucanlove: The root cause of diabetes may have been found.
Fiorina and his team studied hundreds of pathways in animals with diabetes. They eventually isolated one, known as ATP/P2X7R, which triggers the T-cell attacks on the pancreas, rendering it unable to produce insulin.
“By identifying the ATP/P2X7R pathway as the early mechanism in the body that fires up an alloimmune response, we found the root cause of diabetes,” says Fiorina. “With the cause identified, we can now focus on treatment options. Everything from drug therapies to transplants that require less immunosuppression is being explored.”
The mainstays of treatment are warm compresses and gentle massage of the closed lid toward the lid margin. In some cases, as seen in this image, the cyst may begin to “point” through the skin. If this occurs, discontinue warm compresses.
Although antibiotics are not indicated for management of chalazions, they should be ordered if preseptal cellulitis cannot be ruled out. Excision should be considered if the chalazion does not resolve after several months.
Children and parents should be warned that the chalazion will increase and decrease in size as it resolves and may occur in other parts of the lids.
History: Inflammation of a blocked meibomian gland that can occur on either eyelid. They are often recurrent, so previous episodes may be elicited on history. Begins as a mildly tender, swollen eyelid and may be confused with preseptal cellulitis.
Exam: A palpable firm nodule that may be tender when acute. Unlike a stye, it occurs in the tarsal plate rather than at the lid border.
History: The child will typically present with localized redness, pain, swelling, and occasional crusting at the base of the eyelashes. Symptoms may worsen over the course of several days.
Exam: Begins as a red papule, typically at the base of the eyelashes; may appear yellow as pus develops. A lump is usually palpable and tender to palpation.
Management: Warm compresses are the usual treatment. Topical antibiotic ointments may be needed if there is accompanying bacterial conjunctivitis.
Styes are typically caused by staphylococcal organisms. Reassure children and parents that styes resolve without a residual lump.
History: Most common in spring and fall. Redness, tearing, and rubbing the eyes are universal. If the child is not rubbing, it’s not allergic conjunctivitis.
Exam: Swelling of the conjunctiva (chemosis) may occur. The parent will describe it as a bubble on the white of the eye. Pronounced clear follicles in the bulbar conjunctiva near the cul-de-sac is also typical.
Management: A stepwise treatment approach begins with cool compresses, artificial tears, over-the-counter antihistamines (diphenhydramine [Benadryl®] is the most effective oral agent), and/or topical antihistamines (emedastine [Emadine®]) or decongestants (naphazoline [Clear Eyes®; Vasocon A]). Second-line therapy includes mast cell stabilizers (lodoxamide [Alomide®], nedocromil [Alocril®]), or a combination antihistamine/mast cell stabilizer (olopatadine [Patanol®]).
History: Viral illness within the previous week may sometimes be reported, but this is not always the case. Copious tearing and foreign body sensation are typical.
Exam: Redness and swelling of the lids are common. Prominent follicles in the bulbar conjunctiva may be seen.
Management: Artificial tears may be soothing. There is no response to topical antibiotics. However, some school systems may have policies mandating use of antibiotics in order for the child to be readmitted.
Viral conjunctivitis is highly contagious and may last for weeks. Wipe down the examination room. Children are contagious for about 7-10 days after symptoms develop and may shed virus for the 3-4 days before redness appears.
History: Painless, rapid onset.
Exam: Red conjunctiva is found with all etiologies and is not a reliable indicator that the cause is bacterial. Discharge is always present and may be any color. Photophobia is not typical.
Management: Bacterial conjunctivitis responds quickly to topical antibiotic drops, and there is no need to use the newest, greatest antibiotic!
If the child is a contact lens wearer, ask about lens hygiene. Patients should not wear contact lenses if their eyes are red. Contact lens wearers who report pain should be referred to an eye care professional.
What are the steps to evaluating this patient?
History: When evaluating a red eye, ask about the presence of tearing, discharge, itching, pain, foreign body sensation, photophobia, and vision changes.
Exam: Always check vision.
Children with suspected conjunctivitis who have symptoms for >1 week or do not respond to therapy within 48-72 hours should be referred.