may or maynot be mildly red sandy, gritty, foreign body sensation tearing

poor tear quality decreased tear production menopause defects eyelid problems. collagen vascular disease (RA) Bell's palsy drugs anticholinergics, beta-blocker, diuretic environment wind, air, high altitude LASIK

When using drops, only 1 drop because of limited eye volume Artificial tears: starting point 3-5 times a day, blink cellulose esthers: viscosity PVA: spreading agent povidone: preservative Non-medicated ointment at bedtime white petroleum Environmental strategies blink at computer move fans inserts/plugs Cyclosporine Restasis, immunosuppresent, anti-inflammation

Chronic, common inflammation of eyelid margins Red, scaly, thickened eyelids, loss of eyelashes, itching and burning Treatment: Good hygiene Hot compress Lid scrubs Wash hair with Selsun blue, Head and Shoulders

Stye Infection of gland of eyelid Swelling, palpable, tender Treatment: usually clear in 1 week if not, refer hot compress external/oral antibiotic

Like stye, but not tender to touch "Sterile granuloma" may need to be drained, or else keep growing

ENT Flashcards by Rachael Gerboth

Reasons to refer opthalimic disorders

Eye pain
Blurred vision i.e. change in visual activity
Sensitivity to light (photophobia)
Contacts
Blunt trauma to eye
Chemical, heat, sun exposure to eyes
Symptoms persist >72 hours

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Dry Eye: Symptoms

may or maynot be mildly red
sandy, gritty, foreign body sensation
tearing

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Dry Eye: Causes

poor tear quality
decreased tear production
- menopause
- defects
  - eyelid problems.
- collagen vascular disease (RA)
- Bell’s palsy
- drugs
  - anticholinergics, beta-blocker, diuretic
- environment
  - wind, air, high altitude
- LASIK

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Dry Eye: Treatment

When using drops, only 1 drop because of limited eye volume
Artificial tears: starting point
- 3-5 times a day, blink
- cellulose esthers: viscosity
- PVA: spreading agent
- povidone: preservative
Non-medicated ointment at bedtime
- white petroleum
Environmental strategies
- blink at computer
- move fans
inserts/plugs
Cyclosporine
- Restasis, immunosuppresent, anti-inflammation

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Allergic Conjunctivitis: Symptoms and Causes

Sx:
- Red, watery, itchy eyes
Causes:
- Allergens
- Pollen, dander, topical eye preps, etc.

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Allergic Conjuctivitis: Treatment

Articifical tears (always helpful) then…
Opthalmic antihistamine/descongestant
- DO NOT use
  - pregnant, HT, diabetes, CV diseases
- Combo drug can be cheaper than singular antihistamine (ex: Napchon-A)
- Naphazoline/tetrahydrozoline won’t cause rebound and thus good combo
- Naphazoline/pheniramine
- Naphazoline/pheniramine
- Naphcon-A, Visine-A
- antihistamine/mast cell stabalizer
  - alleviate watery eyes, itchiness
  - use for long process
  - prevents further redness
  - Zaditor and Alaway: Ketotifen
- decongestant: reduce redness/tearing
  - short term
  - can get eye rebound
  - quick/cheap
  - Visine: Tetrahydrozoline
  - Naphcon/Clear Eyes: Naphazoline
  - Phenylephrine
  - Oxymetazoline

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Viral Conjuctivitis: Symptoms

Symptoms:
- red, watery discharge, with viral URI
  - bacterial: not stringy/thick discharge, eyes stuck after nap. Need antibiotics
”Pink Eye”

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Viral Conjunctivits: Treatment

Self-limiting in 1-3 weeks
Artificial tears and ocular decongestants
Strict hygiene

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Foreign Bodies in Eye/Chemical burns

Referral if corneal abraisons
Irrigation
- A liter of saline
- Use isotonic solution
- See a physician for burns

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Preservatives in Optic Solutions

Surfactants
- long half-life, stability, coverage
- long-term: toxic
- bactericidal
- BAK, benzathonium Cl
- Polyquad, chlorhexidine
Metals (Hg/I), Alcohols
- allergic reactions
- Thimerosal: contact blepharitisk conjunctivitis
- **Chlorbutanol: **weak, disappears with time
- **Methylparaben: **unstable, allergic rxns, common in tears
- EDTA
- **Sodium Perborate: **dissociates on contact

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Blepharitis

Chronic, common inflammation of eyelid margins
Red, scaly, thickened eyelids, loss of eyelashes, itching and burning
Treatment:
- Good hygiene
- Hot compress
- Lid scrubs
- Wash hair with Selsun blue, Head and Shoulders

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Hordeolum

Stye
Infection of gland of eyelid
Swelling, palpable, tender
Treatment:
- usually clear in 1 week
  - if not, refer
- hot compress
- external/oral antibiotic

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Chalazions

Like stye, but not tender to touch
“Sterile granuloma”
may need to be drained, or else keep growing

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Otic Disorder: Exclusions

Signs of infection
Pain w/ discharge
bleeding/signs of trauma
Ruptured tympanic membrane
Ear surgery within 6 months
Tympanostomy tubes
Clutz/unable to follow direction
hypersensitivity to recommended agents

Self-treatment should be restricted to external ear disorders (water-clogged/cerumen)

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Cerumenosis: Etiology

Narrow or mishapen EAC
excessive hair growth
overactive glands
hearing aid use
earplug use
oldsters

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Cerumenosis: Symptoms

Sense of fullness and/or ear pressure
Gradual hearing loss
Ocassional dull pain
Vertigo

Cerumenosis: Treatment

Carbamide Peroxide
- softens wax
- 12 yo and older
- twice daily up to 4 days
Glycerin, mineral oil, olive oil
- softens wax
Docusate
- not very effective
Dilute H2O2
After softening wax, irrigate using otic bulb syringe filled with warm water
- use caution when recommending irrigation
- show patient how to do it
Prevent with frequent removal/clearning or hearing aid
Improper or excessive removal of cerumen can damage EAC
Q-Tips/Fingernail: can push cerumen further in, abrade skin and allow pathogens in

Water-Clogged Ears: Etiology

Shape of EAC, cerumen, climate, swimming, bathing
NOT the same as “swimmer’s ear” (otitis external)
- wiggle ear and hurts
- need steroid and antibiotics

Water-Clogged Ears: Symptoms

Feeling of fullness/wetness in ear
Gradual hearing loss
Can lead to tissue maceration
- itching, pain, inflammation, infection

Water-Clogged Ears: Treatment

Isopropyl alcohol
Acetic acid (vinegar)

Misc. Ear Problems

Contact dermatitis
- earrings and eardrops
Seborrhea, psoriasis
- skin cells plugging things up
- need same meds used on skin in eardrop formula
Hearing loss
Dizzines
Tinnitus

Teething

No fever, V/D, nasal congestion, rash
Symptoms:
- sleep disturbance, irritability, drooling
Treatment:
- frozen pacifiers/washclothes
- Ibuprofen (baby Tylenol), APAP
NO lidocaine
NO benzocaine
- can bind hemoglobin and cause blue lips
- Methemoglobinemia
  - blue lips, SOB, fatigue, confusion, tachycardia
  - minutes to hours onset, 1st or several times after use

Apthous Stomatitis: Etiology

Canker Sore
unknown
Things to consider: smoking, stress, diet
Precipitating factors: stress, trauma
Smoking cessation
Allergies
Hormonal change
Genetics
Malnutrition
HIV/AIDS

Apthous Stomatitis: Symptoms

ulceration on nonkeratinized mucosa
lasts 5-14 days
heal spontaneously with no scarring
painful

Apthous Stomatitis: Treatment

* No cure, only relief * Nonpharmacological * increase iron, folate, Vit B12, avoid spicy/acidic food, apply ice * NO HEAT, can spread infection * Pharmacolgic * Oral debriding/wound cleaning agents * carbamide peroxide, H2O2, sodium bicarb, perborates * Topical anesthetics * not benzocaine * butacaine * Oral Protectants * Orabase (mix with steroid and put it on), Zilactin * Oral rinses * Listerine to hasten healing * Saline/baking soda to soothe * Analgesic

Aphtous Stomatitis: When to refer

* Lesions with underlying pathology * Lesions there for more than 2 weeks * frequently reoccuring * systemic illness

Leukoplakia

* white, flaky patches on tounge * tobacco users * referral, risk of oral cancer

Herpes Simplex Labialis/Virus: Trigger, Etiology

* Etiology * lips/bordering mouth area * painful/reoccurant lesion * self-limiting, heals w/o scarring, 5-14 days * Trigger * hides in trigeminal ganglion * reactivated by UV, stress, fatigue, cold, windburn

HSV: Symptoms

* Prodrome (warning sign) * tingly, burning, numbness * vesiculopapular eruption * Other symptoms: * fever, pain, bleeding, swollen lymph nodes, malaise

HSV: Treatment

* Avoid triggers * Keep lesions clean * Topical to prevent infection and relieve dryness * DO NOT USE NEOSPORIN (for bacteria, not virus) * Docosanol (Abreva) * prevents viral replication * shortens course * Acyclovir * Don't use good drugs if don't need them * Can cause antibiotic resistance * Refer if \>14 days, increased frequency, compromised immune, infection

Xerostomia: Etiology

* AKA: Dry mouth * Sjorgens, DM, depression, Chron's * Radiation * Medication

Xerostomia: Symptoms

* From increased talking, swallowing, * stomatitis (inflammation of mouth) * burning tounge * halitosis * loss of apetitie * dental decay

Xerostomia: Treatment

* Good dental care * Avoiding: * tobacco, alcohol, antihistamines, CNS stimulants, sugary/acidic food * xylitol is okay * Artifical saliva * Flouride * pilocarpine, cevimeline (prescription)