EENT #1 Flashcards
What is an ectropion?
-Eyelid and lashes turned outward (everted)
What muscle is relaxed in an ectropion?
Orbicularis oculi muscle
Risk factors for an ectropion?
- Elderly
- Congenital
- Infectious
- Cranial nerve 7 palsy
Symptoms of an ectropion
- irritation
- Ocular dryness
- Tearing
- Sagging of the eyelid
- Increased sensitivity
Management for ectropion
- Lubricating eyedrops
- Surgical correction if needed
What is an entropion?
-Eyelid and lashes are turned inward (inverted)
Pathophysiology of entropion
Spasms of orbicularis oculi muscle
What is dacrocystitis?
Infection of lacrimal sac due to obstruction of nasolacrimal duct
What are some common etiologies of dacryocystitis?
Staph Epidermidis
Staph Aureus
GABHS
Pseudomonas
Symptoms of acute dacryocystitis
Tearing and signs of infection: tenderness, erythema and warm to MEDIAL canthal NASAL side of lower lid area
Purulent discharge
However, symptoms of chronic dacryocystitis are
Mucopurulent drainage from puncta without other signs of infection
For acute dacryocystitis, what is the management?
Warm compresses
Antibiotics: Clindamycin, Vancomycin + Ceftriaxone
What is the treatment for chronic dacryocystitis?
Dacryocystorhinostomy
Topical ABX prior to surgery though
What is blepharitis?
Inflammation of the eyelid margin
Risk factors for blepharitis
- Down Syndrome
- Atopic dermatitis
- Rosacea
- Seborrheic Dermatitis
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
Symptoms of blepharitis
- Burning, erythema, crusting, scaling and red-rimming of eyelid
- Flaking on lashes or lid margins
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
MCC of a hordeolum (stye)
Staph Aureus
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
