ENT & Eyes Flashcards
most common eyelid tumour.
Basal cell carcinoma
They are characteristically described as having a pearly sheen with rolled edges and an ulcerated centre.
They do not metastasise but cause problems via local invasion.
Risk factors
Risk factors include: sun exposure, immunosuppression, and some rare inherited syndromes (e.g. xeroderma pigmentosa and Gorlin Goltz syndrome.)
Blepharitis
sore, itchy eyelid margins with a crusty appearance at the base of the eyelashes. The condition cannot be cured, but it very rarely causes damage to eyesight.
Treatment is aimed at controlling the symptoms with good eyelid hygiene. Warm compresses should be applied twice daily to clean debris from the eyelid margins.
carotid cavernous fistula
abnormal communication between the carotid artery and the cavernous sinus.
Causes
It may be spontaneous or secondary to trauma and presents with pulsatile proptosis, a bruit and severely injected conjunctiva. The cranial nerves that run through the cavernous sinus may be affected.
Complications
of cataract surgery
Endophthalmitis is the most dangerous complication and the first thing any doctor should rule out when presented with a patient complaining of visual symptoms following intraocular surgery. Patients typically present within days of surgery with severe pain, loss of vision and hyperaemia. They should be admitted and seen immediately by an ophthalmologist.
Posterior lens capsule opacification is a relatively common complication of cataract surgery that usually occurs a few weeks following the operation. The typical patient complains of blurry vision as if their cataract has returned, and a white opacity may be visible on observation. The condition can be treated easily with a simple laser procedure which can be carried out as an outpatient.
Risk factors for cataracts include:
Age Smoking Diabetes Alcohol Sunlight exposure Corticosteroid use Trauma Previous eye surgery
Central retinal vein occlusion
sudden painless loss of vision
widespread hyperaemia and haemorrhages, often likened to a ‘stormy sunset’
Central retinal vein occlusion RF
Risk Factors
Old age, hypertension, diabetes mellitus, polycythaemia, and arteriosclerosis are important risk factors
Chronic open angle glaucoma
loss of peripheral fields as well as a central scotoma in advanced disease. Fundoscopy may reveal optic disc cupping, where the cup appears large in relation to the optic disc.
topical beta blocker or prostaglandin analogue.
Beta blockers (e.g. Timolol) – Reduce aqueous production
Prostaglandin analogues (e.g. Latanoprost) – Increase uveoscleral outflow
Carbonic anhydrase inhibitors (e.g. Dorzolamide) – Reduce aqueous production
Sympathomimetics (e.g Brimonidine) – Reduce aqueous production & increase uveoscleral outflow
Miotics (e.g. Pilocarpine) – Increase uveoscleral outflow
red eye,
Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Acute angle-closure glaucoma features
systemically unwell with nausea and headaches.
Pain with lurred vision and haloes around lights.
fixed dilated pupil
Anterior uveitis features
red eye, pain, blurred vision and photophobia.
increased lacrimation from the affected eye.
Differentials of diplopia
Third nerve palsy Fourth nerve palsy Sixth nerve palsy Myasthenia gravis Strabismus MS
Fourth nerve palsy
ye points upwards and inwards and the patient may present with a tilted head to compensate for the palsy.
Sixth nerve palsy
medially deviated at rest, and diplopia worsens when the patient is asked to look horizontally away from the midline.
Endophthalmitis
infection inside the globe and most commonly occurs after surgery
intravitreal vancomycin
Horner’s syndrome
ptosis, meiosis with or without anhydrosis.
Pancoast tumour (affecting sympathetic nerve supply)
Stroke
Carotid artery dissection (Red flag: neck pain)
hypertensive retinopathy
Grade I – Vascular attenuation (or narrowing of the retinal arteries)
Grade II – Above + AV nipping
Grade III – Above + retinal haemorrhages, hard exudates and cotton wool spots
Grade IV – Above + optic nerve oedema
Ocular side effects of steroid
Steroids have several ocular side effects. These include:
Raised intraocular pressure
Glaucoma
Accelerated cataract formation
Worsening of some types of viral and bacterial corneal ulcers through its immunosuppressive effects
Onchocerciasis
Itchy eyes Ocular Pain Photophobia Blurred vission Glaucoma Night blindness Progression to blindness
Oral ivermectin
Some of the important causes of optic disc pallor are listed below:
Glaucoma due to raised intraocular pressure
Retinitis pigmentosa
Choroiditis
Central retinal artery occlusion
Multiple sclerosis
Leber’s optic atrophy (or Leber’s hereditary optic neuropathy)
Syphilis
Preseptal cellulitis refers to infection of tissue not spreading past the orbital septum.
swollen eyelid, mild fever and erythema surrounding the orbit.intravenous empirical antibiotics. If there is doubt over the diagnosis, treat it as orbital cellulitis.
Orbital cellulitis
Painful eye movements
Diplopia
Visual impairment
feverish child with a swollen eyelid, reduced eye mobility, painful eye movements, and diplopia in some - reduced visual acuity, ‘red desaturation’ and a relative afferent pupillary defect.
Patients should be admitted for immediate CT scan, ENT review and urgent intravenous antibiotics.
