ENT Flashcards
Symptoms of blepharitis
irritated red eyes (typically a burning sensation)
Increases in tearing, blinking, and photophobia
eyelid sticking or contact lens intolerance
Seborrheic blepharitis
eyelid deposits are matted and scaly
rarely exhibit eyelash loss or misdirection
staphylococcus blepharitis
Eyelash loss or misdirection
eyelid deposits are oily and greasy
MGD blepharitis
thickening of eyelid margin and formation of chalazia
eyelid deposits are fatty and sometimes foamy
plugging of meibomian orifices that may lead to atrophy
nonpharmacologic treatment for all types of blepharitis
strict eyelid hygiene and warm compress
when should you refer a patient to an eye care specialist r/t blepharitis
suspected new cases of seborrheic or MGD blepharitis
pharmacologic treatment of blepharitis
bacitracin or erythromycin ointment is first line
if a solution is preferred a fluoroquinolone would be appropriate
types of conjunctivitis
viral
bacterial
allergic
when would you refer to an eye specialist r/t conjunctivitis
moderate to severe pain
light sensitivity
blurred vision that does not improve with blinking
symptoms of bacterial conjunctivitis
eyelids stuck together upon waking (d/t purulent drainage)
usually starts in one eye and become bilat in a few days
symptoms of viral conjunctivitis
profuse watery discharge
usually starts in one eye and becomes bilat a few days later
examination may reveal tender preauricular
symptoms of allergic conjunctivitis
itching is hallmark symptom
what should you suspect with copious purulent eye drainage
N. gonorrhea
abts for conjunctivitis
decision is often empirical
5-7 days therapy with erythromycin or bacitracin-polymyxin B ointment/solution is usually effective
drug therapy for conjunctivitis
antibiotics antihistamines mast cell stabilizers antihistamine/mast cell stabilizer ophthalmic NSAIDs vasoconstrictors (decongestants) topical corticosteroids
tx for gonococcal eye infection
must be treated immediately d/t risk of permanent eye damage
ceftriaxone plus azithromycin
when should you refer to eye specialist r/t dry eye syndrome
if patient reports moderate to severe pain, vision loss, corneal infiltration or ulceration, or no response to therapy
Treatment for dry eye syndrome
artificial tears and lubricants
cholinergic agonists
topical cyclosporine
topical corticosteroids
types of glaucoma
primary open-angle
acute closed-angle
normal-tension
narrow-angle
how is glaucoma diagnosis made
by eye care professional
pharmacologic treatment for glaucoma
beta-blockers prostaglandins carbonic anhydrase inhibitors (CAI) adrenergic agonists cholinergic agonists combo products
side effect of prostaglandins used for glaucoma tx
darkening of eyelid skin
usually reverses 3-6mo after therapy is dc’d
1st line therapy for glaucoma
prostaglandins because they have the best balance between efficacy, safety, and ease of dosing
2nd line therapy for glaucoma
addition of beta-blockers if IOP has decreased with prostaglandin but fails to meet goal
switch to beta-blocker if prostaglandin ineffective
3rd line therapy for glaucoma
topical CAI
if this fails dc dorzolamide for brimonidine
most common bacterial respiratory tract infection in children and predominately affects infants and children 6mo-2yrs
acute otitis media
typical cause of AOM
typically follows URI in which eustachian tube closes due to inflamed mucus membranes
presentation of acute otitis media (AOM)
abrupt onset of symptoms (less than 48h)(fever, otalgia, irritability, tugging on ear)
tympanic membrane appears bulging, erythematous, and immobile on otoscopy
Otitis media with effusion
absence of inflammatory s/s
typically asymptomatic except for c/o full sensation in ear and hearing loss
when would AOM be treated observationally
> 2yr with bilat AOM w/o otorrhea or severe symptoms
1st line therapy for AOM
Amoxicillin if no amoxicillin in previous 30 days otherwise Augmentin. If PCN allergy a second or third-generation cephalosporin
2nd line therapy for AOM
Augmentin if amoxicillin fails. If Augmentin fails, a cephalosporin or 1 dose ceftriaxone IM or 3 day course IV ceftriaxone
standard course of treatment of AOM
<2y = 10 days to manage severe
>2y = 7 days
>6y may benefit from 5 days
Tx for OE
topical abt preferred over systemic to achieve high concentration at the site of infection
when would you use systemic abt for tx of OE
infection that extends beyond the ear canal uncontrolled DM immunocompromised hx of radiotherapy inability to deliver topical antibiotics
1st line therapy for OE
fluoroquinolone abt (ciprofloxacin or ofloxacin)
2nd line therapy for OE
neomycin/polymyxin B combos
3rd line therapy for OE
AF can be considered if patient fails to respond to topical abt therapy
symptom resolution after tx initiation for OE
improvement with 48-72h
complete resolution of symptoms may take 2 weeks
