EENT #3 Flashcards
In allergic conjunctivitis, contact of the allergen with the eye causes ______ and ______
Mast cell degranulation and release of histamine
Symptoms of allergic conjunctivitis
- Conjunctival erythema (red eyes)
- Normal vision
- Allergic symptoms (nasal congestion, sneezing)
- Marked pruritus (hallmark)
- Atopic history (hay fever)
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
Treatment for allergic conjunctivitis
- Symptomatic Treatment is mainstay
- -Topical antihistamines: Olopatadine, Pheniramine-Naphazoline
- -Topical NSAIDs: Ketorolac
True or False: Alkali ocular burns are worse than acid burns?
True
What happens in an alkali ocular burn?
-Causes liquefactive necrosis, denatures proteins and collagen, causes thrombosis of vessels
What happens in an acidic ocular burn?
Coagulative necrosis (cleaners, batteries)
Symptoms of an ocular chemical burn
- Ocular pain
- Decreased vision
- Blepharospasm (inability to open eyelid)
- Photophobia
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
What is strabismus?
Misalignment of one or both eyes
Stable ocular alignment is not usually present until age _______
2-3 months
When is a referral needed for strabismus?
If it persists > 4-6 months of age to reduce incidence of amylopia
What is esotropia?
Convergent strabismus (deviated inward/nasally) - cross eyed
What is exotropia?
Divergent strabismus (deviated outward) - temporally
Symptoms of strabismus?
Diplopia
Scotomas
Amblyopia
Asymmetric corneal reflex
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
What other diagnostic can be done to diagnose strabismus?
Cover-uncover test
Convergence testing
Management of strabismus
Patch (occlusive) therapy is first-line: normal eye covered to strengthen the affected eye
Eyeglasses
Corrective surgery if unresponsive to patching
What is orbital (septal) cellulitis?
Infection of the orbit posterior to the orbital septum
Orbital cellulitis is often polymicrobial. What are some common causes?
- S. Aureus
- Streptococci
- GABHS
- H. Influenzae
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
