EENT #3 Flashcards by Tyler Cichowski

In allergic conjunctivitis, contact of the allergen with the eye causes ______ and ______

Mast cell degranulation and release of histamine

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Symptoms of allergic conjunctivitis

Conjunctival erythema (red eyes)
Normal vision
Allergic symptoms (nasal congestion, sneezing)
Marked pruritus (hallmark)
Atopic history (hay fever)

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Name some physical exam findings of a patient with allergic conjunctivitis

Cobblestone mucosa to inner upper eyelid
Watery or mucoid discharge
Erythema
Chemosis (conjunctival edema)
No visual deficits

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Treatment for allergic conjunctivitis

Symptomatic Treatment is mainstay
-Topical antihistamines: Olopatadine, Pheniramine-Naphazoline
-Topical NSAIDs: Ketorolac

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True or False: Alkali ocular burns are worse than acid burns?

True

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What happens in an alkali ocular burn?

-Causes liquefactive necrosis, denatures proteins and collagen, causes thrombosis of vessels

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What happens in an acidic ocular burn?

Coagulative necrosis (cleaners, batteries)

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Symptoms of an ocular chemical burn

Ocular pain
Decreased vision
Blepharospasm (inability to open eyelid)
Photophobia

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Management for an ocular chemical burn

Immediate irrigation until neutral pH (7.0-7.4) with lactated ringers or normal saline for 30 minutes
Topical Antibiotic: Polymyxin-Trimethoprim, Erythromycin ointment or Moxifloxacin

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What is strabismus?

Misalignment of one or both eyes

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Stable ocular alignment is not usually present until age _______

2-3 months

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When is a referral needed for strabismus?

If it persists > 4-6 months of age to reduce incidence of amylopia

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What is esotropia?

Convergent strabismus (deviated inward/nasally) - cross eyed

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What is exotropia?

Divergent strabismus (deviated outward) - temporally

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Symptoms of strabismus?

Diplopia
Scotomas
Amblyopia
Asymmetric corneal reflex

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What is often used as the initial screening for strabismus?

Hirschberg corneal light reflex testing: asymmetric deflection of the corneal light reflex in one eye

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What other diagnostic can be done to diagnose strabismus?

Cover-uncover test

Convergence testing

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Management of strabismus

Patch (occlusive) therapy is first-line: normal eye covered to strengthen the affected eye
Eyeglasses
Corrective surgery if unresponsive to patching

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What is orbital (septal) cellulitis?

Infection of the orbit posterior to the orbital septum

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Orbital cellulitis is often polymicrobial. What are some common causes?

S. Aureus
Streptococci
GABHS
H. Influenzae

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MC etiology of orbital cellulitis

Secondary to sinus infections (Ethmoid)

Symptoms of orbital cellulitis

Ocular pain with eye movement
Ophthalmoplegia (EOM weakness)
Diplopia
Proptosis
Visual changes
Eyelid edema and erythema

What diagnostic can be done for orbital cellulitis?

High resolution CT scan

Management of orbital cellulitis

-Admission + IV ABX (Vancomycin + Ceftriaxone/Cefotaxime) (Ampicillin-Sulbactam), Piperacillin-Tazobactam), (Clindamycin) are all options

What is preseptal cellulitis?

Infection of the eyelid and orbit anterior to orbital septum

MCC of preseptal cellulitis

Staph A (including MRSA), Streptococci, and anaerobes

Symptoms of preseptal cellulitis

- Unilateral ocular pain - Eyelid erythema - Edema - Absence of proptosis, ophthalmoplegia, ocular pain with EOM movements

How do you distinguish orbital cellulitis from preseptal cellulitis?

Orbital has ocular pain with eye movement, ophthalmoplegia and proptosis Preseptal does not have any of these symptoms

What is the best test to distinguish between preseptal and postseptal cellulitis?

CT scan

Management of preseptal cellulitis?

- Outpatient if > 1 year of age and mild - -MRSA coverage: Oral Clindamycin - -Other options: Bactrim + Amoxicillin/Augmentin (Amox-Clav)

What exactly is keratitis?

Corneal inflammation

What are the common causes of bacterial keratitis?

- Staph Aureus - Streptococci - Pseudomonas in contact lens wearers

Risk factors for bacterial keratitis

- Improper contact lens wear (greatest risk factor) - Dry ocular surfaces (such as inability to close eye with Bell palsy) - Topical corticosteroid use

Symptoms of bacterial keratitis

- Ocular pair - Photophobia - Eye Redness - Vision changes - Discharge - FBS - Difficulty keeping eye open

What is seen on physical exam with a patient with bacterial keratitis?

- Conjunctival erythema - Ciliary injection (limbal flush) - Hazy cornea (opacification and ulceration) - Increased fluorescein uptake on slit lamp

Management for bacterial keratitis

Fluoroquinolone topical: Moxifloxacin, Gatifloxacin - Do not patch the eye - Same day ophthalmology consult

Herpes Keratitis is from

reactivation of herpes simplex virus in the trigeminal ganglion

Although the herpes keratitis symptoms are the same as bacterial keratitis, what is hallmark on fluoroscein staining?

-Dendritic (branching) corneal ulceration

Treatment for herpes keratitis

- Topical antivirals: Trifluridine, Ganciclovir ointment - PO Acyclovir - Corneal transplant may be needed in severe cases

Common etiologies of Uveitis (Iritis)

- Systemic inflammatory and autoimmune diseases: HLA-B27, Sarcoidosis, IBD - Infectious: CMV, Toxoplasmosis, Syphilis, TB - Trauma

Symptoms of iritis (uveitis)

Anterior: unilateral severe ocular pain and photophobia, redness, blurriness, decreased vision, tearing Posterior: blurry or decreased vision, floaters. May not be painful.

What is the difference between anterior and posterior uveitis?

Anterior: inflammation of iris and ciliary body Posterior: choroid inflammation

What is seen on examination in a patient with uveitis (iritis)?

- Conjunctival erythema - Ciliary injection (limbal flush) - Consensual photophobia - Constricted pupil (miosis)

On slit lamp, what is seen in a patient with uveitis (iritis)?

- Inflammatory "cells and flare" | - WBCs and proteins in the vitreous humor

Management of uveitis (iritis)

- Anterior: Topical glucocorticoids. Cyclopentolate or Homatropine relieves spasm - Posterior: Systemic glucocorticoids

What is a cataract?

Lens opacification (thickening)

True or False: Cataract is the MCC of blindness in the world?

True

Risk Factors for cataracts

- Aging (MC > 60) - Cigarette Smoking - Glucocorticoid Use - Diabetes Mellitus - UV Light - Malnutrition - Trauma

Symptoms of cataracts

Painless, slow, progressive blurred vision loss over months to years Difficulty with night driving, reading signs

What is seen on physical exam in a patient with a cataract?

Absent red reflex, opaque lens

How to treat a cataract

- Observation if mild | - Surgery if vision changes are affecting everyday life