EENT #1 (Eyes) Flashcards
Ectropion
-Muscle involved
-What is it?
-Risk Factors
-Symptoms
-Treatment
-Relaxation of orbicularis oculi muscle
-Eyelid and lashes turned outward (Everted)
-RF: Elderly, congenital, infectious
-Irritation, dryness, tearing, sagging eyelid
-Artificial tears, surgical correction
Entropion
-Muscle involved
-What is it?
-Risk Factors
-Symptoms
-Treatment
-Spasms of orbicularis oculi muscle
-Eyelid and lashes turned inward (inverted)
-RF: Elderly
-Corneal abrasion, erythema, tearing, irritation
-AT and surgical correction
Dacryocystitis
-What is it?
-Etiologies
-Symptoms (acute vs chronic)
-Management (acute vs chronic)
-Infection of the lacrimal sac due to obstruction of nasolacrimal duct
-Staph epidermis, Staph A, GABHS
-Acute: tearing, signs of infection (tender, warmth to medial canthal (nasal) side of lower lid, edema, erythema). Purulent discharge maybe.
-Chronic: mucopurulent discharge without other signs of infection.
-Treatment (Acute): warm compresses + ABX (Clinda, Vanco + Ceftriaxone)
-Treatment (Chronic): dacryocystorhinostomy.
Blepharitis
-What is it?
-Risk Factors
-Posterior vs Anterior etiologies
-Symptoms
-Treatment
-Inflammation of the eyelid margin
-RF: Down syndrome, Atopic dermatitis, Rosacea, Seborrheic dermatitis
-Posterior (MC): MGD
-Anterior: Infectious (Staph A) or Seborrheic
-Crusting, scaling, red-rimming of eyelid, flaking of lashes
-Eyelid hygiene: warm compresses, lid scrubs
Hordeolum (Stye)
-What is it?
-Etiologies (MCC)
-Symptoms
-Treatment
-Localized abscess of eyelid margin
-Staph Aureus MCC
-Erythematous, painful, warm, nodule or pustule on eyelid
-Warm compresses mainstay
–I&D if no drainage after 48 hours
Chalazion
-What is it?
-Pathophysiology
-Symptoms
-Management
-Painless, indurated granuloma of internal meibomian gland
-Obstruction of Zeis or Mebomian glands
-Non-tender, localized eyelid swelling
-Eyelid hygiene and warm compresses, resolves on it’s own most times
Pinguecula
-What is it?
-Symptoms
-Risk Factors
-Management
-Slow growing thickening of bulbar conjunctiva
-Yellow, slightly elevated nodule on nasal side of sclera. Does NOT grow onto cornea.
-RF: Irritation (windy, sunny, ocular trauma)
-No treatment needed
Pterygium
-What is it?
-Risk Factors
-Symptoms
-Treatment
-Slow growing thickening of the bulbar conjunctiva
-RF: UV exposure in sunny climates, sand/wind/dust
-Elevated, superficial, fleshy triangular-shaped growing fibrovascular mass that starts medially and extends laterally
-Observation, AT, removal if it affects vision
Retinoblastoma
-MC primary intraocular malignancy in childhood
-Most diagnosed before age _____
-Associated with what gene?
-Symptoms
-What diagnostic to diagnose it?
-Management
-Age 3
-RB1 gene
-Leukocoria (abnormal white reflex instead of red), strabismus or nystagmus
-Ocular US (intraocular calcified mass)
-Radiation, chemo
–Can be associated with bone neoplasms, fatal if untreated
Macular Degeneration
-MCC of permanent blindness in older adults
-Two Types
-Symptoms
-Fundus Exam of Both Types
-Treatment for Dry
-Treatment for Wet
-Dry (atrophic) MC type, Wet (exudative/neovascular)
-Bilateral, progressive central vision loss (including detailed and color vision). Central scotomas, metamorphopsia, micropsia
-Fundus (Dry): Drusen bodies (small, round, yellow/white spots on outer retina).
-Fundus (Wet): new, abnormal vessels that can cause retinal hemorrhaging and scarring
-Treatment (Dry): Zinc, Vitamins C and E, Amsler grid
-Treatment (Wet): VEGF Inhibitors (Bevacizumab, Aflibercept). Laser photocoagulation.
Strabismus
-What is it?
-Referral needed for strabismus if persists > _____ what age?
-Two Types
-Symptoms and Exam Findings
-Diagnostics
-Management
-Misalignment of one or both eyes
-Refer if persists > 4-6 months of age
-Exotropia: divergent, deviated outward (temporally)
-Esotropia: convergent, deviated inward (nasally)
-Diplopia, scotomas, amblyopia, asymmetric corneal reflex
-Hirschberg corneal light reflex testing (initial), cover-uncover test (deviates inward or outward)
-Patch therapy over normal eye to strengthen weak eye
Viral Conjunctivitis
-MCC
-Transmission
-Symptoms
-Management
-Adenovirus
-Direct contact, highly contagious, swimming pools are common source during outbreaks
-FBS, ocular erythema, itching, normal vision.
-Starts unilateral and progresses to bilateral in 1-2 days
-Ipsilateral preauricular LAD, copious watery tearing, punctate staining on slit lamp
-Supportive treatment: warm/cool compresses, ATs, Antihistamines (Olopatadine)
Allergic Conjunctivitis
-Symptoms
-Physical Exam Findings
-Management
-Conjunctival erythema, normal vision
-Allergic symptoms, marked pruritus, often bilateral
-Atopic history
-Cobblestone mucosa, erythema, watery or mucoid discharge, chemosis, no visual deficits
-Symptomatic treatment: Topical antihistamines (Olopatadine), Pheniramine-Naphazoline, Topical NSAIDs (Ketorolac)
Bacterial Conjunctivitis
-MC due to
-Symptoms
-Diagnostics
-Treatment (Non-Contacts, Contacts)
-MC due to Staph Aureus
-Purulent discharge, lid crusting, eye stuck shut in morning, conjunctival erythema, no vision changes
-Clinical, Culture/Gram Stain of discharge
-Non-Contacts: Topical ABX (Erythromycin ointment, Trimethoprim-Polymyxin B, Moxifloxacin, Ofloxacin)
-Contacts (cover Pseudomonas): Topical Ciprofloxacin, Ofloxacin
Ocular Chemical Burns
-Alkali burns (worse than acids): causes liquefactive necrosis, denatures proteins and collagens
-Acid burns: causes coagulative necrosis: cleaners, batteries
-Symptoms
-Treatment
-Symptoms: ocular pain, decreased vision, blepharospasm (can’t open eye), photophobia
-Immediate irrigation until pH neutral (7.0-7.4) with LR or normal saline. Then, examine eye.
-Topical ABX: Poly-Trim, E-mycin ointment, or Moxifloxacin
Retinal Detachment
-Risk Factors
-MC type
-Symptoms
-Diagnostics
-Treatment
-RF: Myopia (nearsighted), previous cataract surgery, older age, trauma
-Rhegmatogenous: full-thickness tear from choroid plexus
-Photopsia (flashes), floaters, progressive unilateral peripheral vision loss or shadow/curtain coming down. No ocular pain or redness.
-Funduscopy: Positive Shafer’s Sign (clumping of brown-colored pigment vitreous cells in AC resembling tobacco dust)
-Emergency!! Keep patient supine with head turned toward side of detachment. Laser, cryotherapy, ocular surgery.
Orbital (Septal) Cellulitis
-Infection of orbit posterior to orbital septum
-MC in ______
-MC secondary to _______
-Symptoms
-Diagnostics (what is best)
-Management
-MC in kids 7-12 years of age
-MC secondary to sinus infection (ethmoid)
-Ocular pain with EOM, ophthalmoplegia (EOM weakness), diplopia, proptosis, vision changes, eyelid erythema and edema
-High resolution CT scan
-Admission + IV ABX (Vanco + ONE OF THE FOLLOWING: Ceftriaxone/Cefotaxime, Amp-Sulbactam, Piper-Tazo, Clindamycin)
Preseptal (Periorbital) Cellulitis
-Infection of the eyelid and periocular tissue anterior to orbital septum
-MCC include…
-Symptoms
-Diagnostics (what is best)
-Management
-MCC include Staph A (including MRSA), Strep, anaerobes
-Unilateral ocular pain, eyelid edema and erythema, NO proptosis, ophthalmoplegia, ocular pain with EOM**
-High resolution CT scan
-Outpatient management if > 1 year of age
–MRSA coverage: Oral Clindamycin
Globe Rupture
-Immediate consult, emergency!
-Symptoms
-What test/exam finding is positive?
-Management?
-Diplopia, VA decreased, enophthalmos/exophthalmos, 360 degree conj hemorrhage. Teardrop/irregularly shaped pupil.
-Positive Seidel’s Test: parting of fluoro dye by clear stream of aqueous humor from AC.
-Rigid eye shield. Impaled objects left undisturbed. Emergent ophthalmology consult.
Orbital Floor (Blowout) Fractures
-MC Type
-Symptoms
-Diagnostics
-Management
-Inferior MC Type: Orbit fat and inferior rectus may prolapse into the maxillary sinus.
-Diplopa with upward gaze (inferior rectus muscle entrapment), orbital emphysema (eyelid swelling after blowing nose), anesthesia to anteromedial cheek (stretching of infraorbital nerve)
-CT scan: Teardrop sign
-Nasal decongestants, avoid blowing nose or sneezing, ABX (Amp-Sulbactam or Clindamycin)
Diabetic Retinopathy
-MC type of new permanent vision loss in 20-74 years old
-Types
-Symptoms of both
-Management for each type
-Nonproliferative: micro aneurysms, cotton wool spots, hard exudates (yellow spots that circinate), blot and dot hemorrhages, flame-shaped hemorrhages.
-Proliferative: neovascularization, vitreous hemorrhage.
-Maculopathy: macular edema or exudates, blurred or loss of central vision. Can occur at any stage.
-Treatment
–Nonproliferative: strict glucose control, laser.
–Proliferative: VEGF Inhibitors, laser photo treatment, strict glucose control.
–Prevention: annual eye exams in diabetics.
Hypertensive Retinopathy
-Mild
-Moderate
-Severe
Mild: Abnormal light reflexes on dilated tortuous arteriole. AV nicking. Copper wiring = moderate narrowing. Silver wiring = severe narrowing.
Moderate: Hemorrhages (flame or dot shaped), cotton wool spots, hard exudates, and micro aneurysms.
Severe: All of the above + papilledema (blurring of optic disc). This is an ophthalmic emergency!
Ophthalmia Neonatorum (Neonatal Conjunctivitis)
-Day 1 MCC
–Treatment
-Day 2-5 MCC
–Treatment
–Prevention
-Days 5-7 MCC
–Treatment
–Prevention
Day 1: Chemical conjunctivitis due to silver nitrate. ATs once it occurs.
Days 2-5: Gonoccocal MCC.
-Treatment: IM or IV Ceftriaxone.
-Prophylaxis: Topical E-mycin
Days 5-7: Chlamydia Trachomatis MCC.
-Treatment: Oral E-mycin.
-May occur up to 23 days after birth.
-Prevention: None successful.
Ocular Foreign Body and Corneal Abrasion
-Symptoms
-Diagnostics
-Management
–Non contact lens wearer
–Contact lens wearer
–FB removal
–Corneal abrasions
–Rust ring
–When should you NOT patch?
-FBS, tearing, red/painful eye, photophobia, blepharospasms.
-Check VA first. Fluoro staining: corneal abrasion = ice rink/linear abrasions.
-Non contacts: E-mycin ointment, Poly-Trim B.
-Contacts: Topical Cipro or Ofloxacin.
-FB removal: sterile irrigation and cotton swab.
-Abrasions: Patch if > 5mm but not longer than 24 hours. 24 hour ophthalmology follow up.
-Rust ring: remove with burr at 24 hours.
-Do not patch if you suspect Pseudomonas**
