EENT trigger Flashcards
pain with EOM is a red flag for what diagnosis
orbital cellulitis
Antiparkinsons, antispasmodics, antipsychotics, MAOIs and TCAs all increase the risk of what disorder?
glaucoma
also dilating eye drops
treat with keflex or augmentin. PCN allergy = clinda
periorbital cellulitis (OUTPATIENT adults and older children w/ mild symptoms)
IV rocephin OR Unasyn +vanc OR FQ + metro/clinda (PCN allergy)
- periorbital cellulitis for young children/severe presentation
- orbital cellulitis (add topical nasal decongestant)
when is the only time you use HOT or warm compresses?
HOT = periorbital cellulitis
Warm = hordeolum or chalazion
a young child presents with a hx of maxillary sinusitis and now has symptoms of erythema, edema and pain with movement of the eye. The child will not hold still long enough for a proper exam. What imaging will be used for this child? will you use contrast?
orbital CT and YES YOU WILL USE CONTRAST
this is suspicious of orbital cellulitis
when do you treat with polymyxin B?
bacterial conjunctivitis
unless they wear contact lenses, then treat with FQ or tobramycin d/t pseudomonas
when do you treat with topical antihistamines
viral conjunctivitis and allergic conjunctivitis
when do we see preauricular lymphadenopathy
- HSV keratoconjunctivitis
- viral conjunctivitis
ciliary flush with diminished VA and poor pupillary reactivity to light. photophobia is also present
anterior uveitis/iritis
“ciliary flush”
“consensual photophobia”
poor reactivity to light = miosis
diminished VA = clouding of aqueous humor
intense itching with papillae on inferior conjunctiva and cobblestoning
allergic conjunctivitis
photophobia with consensual photophobia is hallmark for which diagnosis. what else would you see in these patients?
Iritis/ anterior uveitis
also see:
conjunctival injection/ciliary flush
miosis w poor reactivity
diminished VAs d/t clouded aqueous humor
pt presents with periorbital edema but no chemosis and IOP is normal. you decide to treat them outpatient but they have a PCN allergy, what will you treat them with?
Clindamycinnnn
this is periorbital cellulitis
Slit lamp exam shows keratic precipitates and aqueous flares. you could also see hypopyons in these patients
anterior uveitis / Iritis
3 year old patient presents with periorbital edema and erythema. Orbital CT is negative for orbital cellulitis. you decide to still admit this patient d/t their young age and presentation. you find they have a PCN allergy, what is the tx
FQ + Metro/clinda
periorbital cellulitis
when would you use prednisolone drops and a long acting cycloplegic (cyclogyl, cyclopentolate or homatropine)?
anterior uveitis (iritis)
remember anterior uveitis can be seen in other diagnoses such as HZV ophthalmicus and blunt eye trauma. prednisolone would also be given if it is seen in those scenarios.
DO NOT give topical steroids if infectious anterior uveitis or if there is an abrasion or elevated IOP.
Fluorescein stain shows a staining defect with a white hazy infiltrate.
can also see hypopyon or iritis
corneal ulcer (culture this ulcer!!!!)
When do we use ophthalmic FQs (ofloxacin, cipro or tobramycin) and topical cycloplegics
corneal ulcers
ALSO for contact wearers who develop bacterial conjunctivitis or a corneal abrasion
when should we avoid eye patching and topical steroids
corneal ulcers
fluorescein stain shows geographic ulcer upake pattern
HSV keratoconjunctivitis
you could also see a dendritic lesion uptake
topical trifluridine (viroptic) with erythromycin ointment along with oral acyclovir is used in what diagnosis?
HSV keratoconjunctivitis
what nerve does HZV ophthalmicus affect
V1 of the trigeminal nerve
Fluorescein stain shows small, elevated dendrites with no terminal bulbs or central ulcerations.
herpes zoster ophthalmicus (these stain findings are called peudodendrites)
slit lamp showing diffuse, punctate corneal edema. Fluorescein shows punctate corneal abrasions
UV keratitis
when do we use ketorolac drops with erythromycin ointment?
corneal abrasions. (unless contact wearer, then FQ/tobra)
DO NOT PRESCRIBE TOPICAL ANESTHETICS TO THESE PATIENTS!!!!
when is the seidel test indicated
any time there is a suspected globe perforation such as with a corneal foreign body.
this test reveals leakage of the aqueous humor.
when do you treat with oral keflex, erythromycin and a cold compress
lid laceration (also stitch it up w soft 6/7-0 sutures if its >1mm)
tear drop pupil and limited EOM suggest what diagnosis? what test can confirm
globe rupture
seidel test can confirm as long as the wound is unsealed
if you have one of these you also wanna get a CT scan of the orbit
Vanc + ceftazidime + zofran
globe rupture
give eye shield, NPO, sit upright (avoid IOP increase)
emergent oph consult
restricted upward/lateral gaze with associated bruising around the eye suggest what diagnosis
orbital blow out fracture