EENT #1 Flashcards by Tyler Cichowski

What is an ectropion?

-Eyelid and lashes turned outward (everted)

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What muscle is relaxed in an ectropion?

Orbicularis oculi muscle

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Risk factors for an ectropion?

Elderly
Congenital
Infectious
Cranial nerve 7 palsy

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Symptoms of an ectropion

irritation
Ocular dryness
Tearing
Sagging of the eyelid
Increased sensitivity

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Management for ectropion

Lubricating eyedrops

- Surgical correction if needed

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What is an entropion?

-Eyelid and lashes are turned inward (inverted)

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Pathophysiology of entropion

Spasms of orbicularis oculi muscle

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What is dacrocystitis?

Infection of lacrimal sac due to obstruction of nasolacrimal duct

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What are some common etiologies of dacryocystitis?

Staph Epidermidis
Staph Aureus
GABHS
Pseudomonas

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Symptoms of acute dacryocystitis

Tearing and signs of infection: tenderness, erythema and warm to MEDIAL canthal NASAL side of lower lid area
Purulent discharge

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However, symptoms of chronic dacryocystitis are

Mucopurulent drainage from puncta without other signs of infection

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For acute dacryocystitis, what is the management?

Warm compresses

Antibiotics: Clindamycin, Vancomycin + Ceftriaxone

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What is the treatment for chronic dacryocystitis?

Dacryocystorhinostomy

Topical ABX prior to surgery though

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What is blepharitis?

Inflammation of the eyelid margin

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Risk factors for blepharitis

Down Syndrome
Atopic dermatitis
Rosacea
Seborrheic Dermatitis

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For blepharitis, posterior is MC due to ______ whereas anterior has two types, name them

Posterior: meibomnian gland dysfunction
Anterior: Infectious (Staph A or Staph Epidermidis) or Seborrheic

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Symptoms of blepharitis

Burning, erythema, crusting, scaling and red-rimming of eyelid
Flaking on lashes or lid margins

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Management for blepharitis

Eyelid hygiene is the mainstay of treatment: warm compresses, eyelid scrubbing, lid washing with baby shampoo, artificial tears
If severe or refractory, Azithromycin ointment, Erythromycin ointment), topical Cyclosporine, topical glucocorticoids

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MCC of a hordeolum (stye)

Staph Aureus

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There is increased risk for a hordeolum with what two things?

Rosacea and Seborrheic dermatitis

What are the two types of hordeolums?

External: infection of eyelash follicle or external sebaceous glands
Internal: infection of meibomian gland

Symptoms of a stye

-Erythematous, painful, warm nodule or pustule on the eyelid

Management of a hordeolum

Warm compresses is the mainstay of treatment
Incision and drainage if no spontaneous drainage after 48 hours
May add topical Erythromycin or Bacitracin if actively draining

What is a chalazion?

Painless indurated granuloma of the internal meibomian sebaceous gland away from the eyelid margin

Symptoms of a chalazion

Non-tender localized, eyelid swelling (nodule) on conjunctival surface of the eyelid -Often larger, firmer, and slower growing and less painful than hordeolums

Treatment for a chalazion

- Conservative: eyelid hygiene and warm compresses | - Refractory: incision and curettage at ophthalmologist if no resolution

What is a pinguecula?

Slow growing thickening of the bulbar conjunctiva | -Yellow, slightly elevated nodule on nasal side of sclera that does NOT grow onto cornea

What three things does a pninguecla consist of?

Fat, protein, calcium

Risk factors for a pinguecula?

Often develop when the eye is irritated (dry, windy, sunny conditions, ocular trauma)

Treatment for a pinguecula?

No treatment is needed | -May be resected if chronically inflamed or cosmetic reasons

Risk factors for a pterygium

Associated with ultraviolet exposure in sunny climates (tropics) Sand, wind and dust exposure

Symptoms of a pterygium

- Elevated, superficial fleshy, triangular-shaped growing fibrovascular mass that usually starts medially (nasal side of eye) and extends laterally - May cause irritation, erythema, or foreign body sensation

Treatment for a pterygium

- Observation for most - Artificial tears for irritation and erythema - Removal only if affects vision (if grows over cornea or causes astigmatism)

Globe rupture is considered an

Ophthalmologic emergency: immediate consult

What are some findings on a globe rupture examination?

- Visual acuity: markedly reduced, diplopia. - Orbits: exophthalmos (proptosis) or enopthalmos (posterior displacement of eye/pushed in). Severe conjunctival hemorrhage (360 degrees) - Cornea/Sclera: teardrop or irregularly-shaped pupil, Positive Seidel's Test (parting of fluroscein dye by a clear stream of aqueous humor). Hyphema (blood in anterior chamber)

Management of a globe rupture

- Rigid eye shield - Impaled objects left undisturbed - IV ABX - Tetanus prophylaxis if needed - Emergent consult by ophthalmology - Avoid any procedures that applies pressure to eyeball (tonometry, eyelid retraction, etc.)

What bones make up the orbital floor?

Zygomatic Palatine Maxillary

MC type of orbital floor (blowout) fractures

-Inferior (floor, blowout)

What muscles are affected when there is an inferior orbital floor fracture?

Orbital fat and inferior rectus muscle may prolapse into maxillary sinus

Symptoms of an orbital floor fracture

- Decreased visual acuity - Diplopia with upward gaze (inferior rectus muscle entrapment) - Orbital emphysema from air in maxillary sinus (eyelid swelling after blowing nose) - Epistaxis - Anesthesia to anteromedial cheek (due to stretching of infraorbital nerve)

What is the diagnostic of choice for an orbital fracture?

CT scan: Teardrop sign (inferior herniation of orbital fat inferiorly)

Treatment for orbital floor fracture

- Nasal decongestants (decreases pain) - Avoid blowing nose or sneezing - Corticosteroids (reduce edema) - Antibiotics (Ampicillin-Sulbactam or Clindamycin) - Surgical repair: if enophthalmos or persistent diplopia

What is the MC primary intraocular malignancy in childhood?

Retinoblastoma

Most retinoblastoma are diagnosed by what age and are found almost exclusively in children?

3 years old

What gene is affected with a retinoblastoma?

RB1

Symptoms of a retinoblastoma

- Leukocoria (presence of an abnormal white reflex instead red reflex) - May develop strabismus or nystagmus

How do you diagnose a retinoblastoma besides an ocular examination?

-Ocular ultrasound: intraocular calcified mass

What is the management for a retinoblastoma?

- Radiation therapy, chemotherapy, enucleation | - Fatal if untreated, but survival > 95% if treated promptly

What is the MCC of permanent legal blindness and vision loss in older adults?

Macular degeneration