Eye, Ear, and Throat Disorders

Question 1

Sinusitis

Answer 1

 Undrained collection of pus occurs in sinuses
 Frequently proceeded by insult to sinuses (i.e., viral URI, nasal instrumentation)
 Common pathogens – strep. pneumoniae (most common bacterial), H. influenzae, and Moraxella catarrhalis
 Manifestations – headache worst when head dependent, pressure behind eyes, stuffy nose
 Diagnostics – frequently a clinical diagnosis; CT scan if required
 Treatment – empiric antibiotics with Augmentin 500/125 mg PO TID or 875/125 mg BID

Question 2

Conjunctivitis (general)

Answer 2

 Inflammation of the conjunctiva caused by bacteria, viruses, or allergies
 No matter what the cause there is high risk of bacterial infection secondary to the fragile conjunctiva
 Bacterial pathogens – Staphylococcus, S. pneumoniae, and H. influenze
 Viral pathogens (most common) – adenovirus and herpes simplex
 Manifestations – itching, foreign body sensation, “gritty eye”, conjunctival erythema and injection, ocular discharge; almost never painful

Question 3

Conjunctivitis - viral

Answer 3

 Watery discharge
 Symptomatic treatment – artificial tears, topical antihistamines, cold compresses
 Discontinue contact use

Question 4

Conjunctivitis - bacterial

Answer 4

 Purulent discharge
 Gonococcal/chlamydial = PROFUSE purulent discharge
 Treatment – gentamycin or ciprofloxacin 1-2 gtt x 1 week
 Refer to ophthalmology if gonococcal/chlamydial
 Discontinue contact use

Question 5

Corneal abrasion

Answer 5

 Manifestations – throbbing pain that intensifies over 12-24 hours, sensation of foreign body, erythema, tearing
 Diagnosis – clinical, fluorescein stain, CT or MRI if high velocity injury or retained foreign body
 Treatment – topical NSAID drops (diclofenac or ketorolac), topical antibiotics (bacitracin or Cipro), tetanus if penetrating injury, only 1 day of oral opiates if needed, refer to ophthalmology if no improvement in 48 hours or initial presentation is severe
 Do not order corticosteroid drops, eye patching, or continue use of topical anesthetic

Question 6

Chronic (aka wide or open-angle) glaucoma

Answer 6

 Cause – GRADUAL rise in pressure
 Symptoms – PAINLESS, gradual loss of peripheral vision, usually asymptomatic
 Exam findings – elevated intraocular pressure (normal 10-20 mmHg)
 Treatment – medications to reduce pressure by either improving flow or reducing production of humour; prostaglandin analogs are first line (ex: latanoprost (Xalatan); refer to ophthalmology

Question 7

Acute (aka narrow or closed-angle) glaucoma

Answer 7

 Cause – ACUTE pressure elevation
 Symptoms – SEVERE OCULAR PAIN, SUDDEN VISION LOSS, “HALOS” around objects, blurry vision
 Exam – corneal injection, decreased visual acuity, firm globe, severely elevated intraocular pressure (normal 10-20 mmHg)
 Treatment – emergency; systemic carbonic anhydrase inhibitors (ex: Diamox); refer to ophthalmology