HEENT Flashcards
Otitis externa defintion, MCC, sx, dx, tx
▪︎inflammation of the external auditory canal (EAC)
MCC: Pseudomonas aeruginosa (associated w/ swimming
S/SXS: ear pain worse at night, otorrhea, intense itching, conductive hearing loss
PE: tenderness on palpation of tragus, pain w/ ear canal traction (pulling up & back), crusting
DX: clinical ⇢ otoscope exam
▪︎erythematous/edematous EAC
▪︎otorrhea or debris
▪︎TM may be red but should not bulge
onservative: avoid swimming, keep ears dry, avoid cotton swabs & scratching ear canal
ABX drops + steroids:
▪︎Ciprodex (ciprofloxacin/dexamethasone)
▪︎Neomycin/polymyxin B/hydrocortisone
Malignant Otitis Externa defintion, sx, dx, tx
MOE: severe variant of acute otitis externa; necrotizing inflammation of EAC
MCC: P. aeruginosa
S/SXS: severe, persistent ear &/or jaw pain, conductive hearing loss, red/swollen EAC, otorrhea
Otoscope: granulation tissue at cartilage-bone junction of EAC
Extension ⇢ headache & fever (CNS), facial (VII) nerve
palsy (skull base osteomyelitis)
dx
CT w/ contrast ⇢ bone erosion, soft tissue involvement, intracranial extension, abscess
MRI: better for soft tissue/intracranial
TX: ADMIT + ABX x6-8wks
ABX: ciprofloxacin + one of the following:
▪︎ceftazidime, piperacillin/tazobactam, cefepime
Acute Otitis Media definition, MCC, sx, dx, tx
AOM: middle ear infection commonly following viral URI
▪︎highest incidence 6-24mo, most often combined bacterial/viral
RF: second-hand smoke, daycare, bottles/pacifiers, supine feeds
MCC: S. pneumoniae, H. flu, M. catarrhalis, GABS (older kids)
Viral: RSV, parainfluenza, influenza, rhinovirus
S/SXS: otalgia/earache (throbbing pain), conductive hearing loss, fever
Infants: ear tugging, irritability, refusal to feed
TM rupture ⇢ pain relief, otorrhea
Otoscope exam:
▪︎bulging/erythematous TM, loss of landmarks
▪︎opacification, loss of light reflex
▪︎⇣ TM mobility (pneumatic otoscopy)
DX: clinical ⇢ otoscope exam
TX: amoxicillin or amoxicillin/clavulanate
▪︎PCN allergy: azithromycin or clarithromycin
Mastoiditis definition, MCC, sx, dx, tx
inflammation of the mastoid air cells; MC in children <2yo
Organisms: S. pneumoniae, H. flu, M. catarrhalis, S. aureus, S. pyogenes
S/SXS: begin days to weeks after onset of AOM
▪︎fever, otalgia, mastoid tenderness, erythema, & edema
▪︎external ear displaced forward
Otoscope: +/- AOM findings
DX: mostly clinical
Complicated/toxic-appearing:
▪︎CT scan of temporal bone w/ contrast
TX: IV ceftriaxone for ≥2wks
Early infection: myringotomy & tympanostomy tube insertion to facilitate drainage
Severe/refractory: mastoidectomy
Barotrauma definition, MCC, sx, dx, tx
Ear barotrauma: injury caused by rapid change in ambient pressure w/o adequate equalization of the pressure between the middle/inner ear & external environment
▪MCC: flying & diving
S/SXS: acute onset of symptoms
» Middle ear: ear pain, conductive hearing loss, TM rupture
» Inner ear: persistent vertigo/ataxia, sensorineural hearing
loss, tinnitus, N/V
DX: clinical
Possible supportive findings
▪︎otoscope: hemotympanum, ruptured TM
TX: supportive, most heal spontaneously
TM Perforation sx, dx, tx
TM perforation: breach in membrane between middle ear & ear canal
Etiology: infection, barotrauma (scuba diving, blast injuries), mechanical trauma (cotton swabs)
S/SXS: pain, hearing loss, tinnitus, otorrhea
DX: clinical ⇢ otoscope exam
TX: most heal spontaneously, f/u to ensure resolution
▪︎persists ≥2mo ⇢ surgery
External Ear Trauma, Hematoma: definition, sx, dx, tx
Auricular hematoma: a collection of blood within the cartilaginous auricle
Mechanism: direct blows to the ear (e.g., boxing, wrestling, rugby)
▪︎S/SXS: tender, tense, fluctuant collection of blood; erythema or ecchymosis
Cauliflower ear: permanent deformity d/t fibrocartilage overgrowth that occurs when an auricular hematoma is not fully drained, recurs, or is left untreated
dx
Auricular hematoma: clinical DX
Head trauma: temporal bone CT w/o contrast
tx:
Auricular hematoma: prompt evacuation of the clot
▪︎cephalexin 500mg TID x5d to prevent infection
Acute Laryngitis definition, MCC, sx, dx, tx
Acute inflammation of the mucosa of the larynx
Etiologies:
*viral URI MC – adenovirus, rhinovirus, influenza, RSV, parainfluenza
*bacterial: M. catarrhalis, mycoplasma
*vocal strain, irritants (acid – GERD), polyps, laryngeal cancer
sx
Hoarseness, aphonia; dry or scratchy throat
+/- URI sxs (rhinorrhea, cough, sore throat)
dx: clinical
tx: supportive; hydration, humidification, vocal rest, warm saline gargles, anesthetics
Acute Pharyngitis/Tonsillitis causes, sx, dx, tx
Etiologies: usually viral; adenovirus MC
sx
Sore throat, pain
Viral: cough, hoarseness, coryza, conjunctivitis, diarrhea
dx: clinical
tx: Symptomatic therapy – fluids, warm saline gargles, topical anesthetics
Streptococcal Pharyngitis “strep throat”: MCC, sx, dx, tx
Group A streptococcus (S. pyogenes)
sx
Dysphagia, fever
Not usually associated w/ sxs of viral infection
PE:
*pharyngeal edema or exudate, tonsillar exudate &/or petechiae
*anterior cervical LAD
dx:
Centor Criteria:
(1) absence of cough
(2) exudates
(3) fever (>100.4F)
(4) cervical LAD
3/4 🡪 rapid antigen detection test
(+): treat strep
(-): throat culture: gold standard
tx: Penicillin first line
Rhinosinusitis acute vs chronic
Acute rhinosinusitis (ARS): symptomatic inflammation of the nasal cavity & paranasal sinuses lasting <4wks
» Acute viral rhinosinusitis (AVRS): MC type, rhinovirus, influenza, & parainfluenza viruses
» Acute bacterial rhinosinusitis (ABRS): S. pneumo, H. influenzae, M. catarrhalis; often follows viral URI
sx
ARS S/SXS: nasal congestion, rhinorrhea, purulent nasal, discharge, facial pain/pressure worse leaning forward, fever, atigue, cough, hyposmia/anosmia, HA, ear pressure/fullness, ➁ nasal obstruction/congestion
halitosis (bad breath)
PE: TTP over affected sinuses, mucosal edema, narrowing of the middle meatus, inferior turbinate hypertrophy
dx: clinical, CT when needed
tx: usually self-limiting
Chronic rhinosinusitis (CRS): inflammatory condition involving paranasal sinuses & nasal passage linings lasting ≥12wks
Invasive fungal sinusitis: immunocompromised*
sx
➀ anterior/posterior nasal mucopurulent drainage
➁ nasal obstruction/congestion
➂ facial pain
➃ hyposmia/anosmia
dx
CRS DX: 2/4 cardinal SXS + evidence of inflammation
▪︎1+ findings on nasal endoscopy &/or CT:
➀ purulent mucus/edema in middle meatus/ethmoid
➁ polys in nasal cavity/middle meatus
➂ mucosal thickening or paranasal sinus opacification
tx: amoxicillin or Augmentin
Rhinitis definition, sx, dx, tx
Rhinitis: irritation & swelling of nasal mucous membrane
▪︎Allergic Rhinitis: type I hypersensitivity reaction (IgE)
▪︎Vasomotor Rhinitis: nonallergic, ⇡ blood flow to nasal mucosa
S/SXS: recurrent episodes of sneezing, congestion, rhinorrhea, & postnasal drip; itchy nose/throat
▪︎pale, boggy nasal mucosa w/ hypertrophic turbinates
▪︎cobblestone appearance of posterior pharyngeal wall
▪︎allergic shiners: dark discoloration under eyes
▪︎allergic salute: habit of wiping nose upwards
» allergic nasal crease: transverse crease from upwards wiping
dx: allergy testing
tx: X: intranasal steroids (e.g., fluticasone, mometasone)
Epistaxis posterior vs anterior
posterior
location: Woodruffs plexus
sx: hematemesis from swallowing
tx: Posterior: posterior nasal packing (e.g., balloon catheter)
anterior
location: Kiesselbach’s venous plexus or sphenopalatine artery
sx: small volume
MCC nose picking
tx: Anterior: apply direct pressure at least x10-15min, head tilted forward
Blepharitis definition, MCC, sx, dx, tx
▪︎inflammation w/ scaling of eyelid margins
▪︎MCC: staphylococci
S/SXS: red, swollen eyelids w/ crusting/scaling on eyelid margin & eyelashes
▪︎eye irritation (e.g., pain, itching, FB sensation, watering)
dx: clinical
TX: eyelid hygiene (e.g., warm compress, washing w/ baby shampoo, avoid contacts/makeup)
Severe/refractory: topical ABX
▪︎bacitracin, erythromycin, polymyxin B
Anterior vs posterior blepharitis
Anterior: inflammation of the anterior eyelid margins involving skin, eyelashes, & follicles
Posterior: inflammation of the posterior eyelid margins associated w/ meibomian gland dysfunction
Orbital Floor “Blowout” Fracture defintion, locations, sx, dx, tx
▪︎fractures to the orbital floor as a result of blunt trauma; may lead ⇢ trapping of eye structures
▪︎orbital floor: zygomatic, palatine, maxillary bones
sx
Eyes: ⇣ visual acuity, orbital emphysema
▪︎diplopia esp. w/ upward gaze
*inferior rectus muscle entrapment
Facial: epistaxis, dysesthesias
▪︎hyperalgesia or anesthesia to the anteromedial cheek
*d/t stretching of the infraorbital nerve
dx
CT scan – localizes the fracture
*Teardrop sign: inferior herniation of the orbital fat inferiorly
tx
*nasal decongestants (decreases pain)
*avoid blowing nose or sneezing
*corticosteroids
*abx (ampicillin-sulbactam or clindamycin)
viral conjunctivitis MCC, sx, dx, tx
▪︎MC form of infectious conjunctivitis, mostly adults
▪︎MCC: adenoviruses (highly contagious)
Transmission: direct contact
▪︎contamination via water (e.g., swimming pools)
S/SXS: often starts unilateral ⇢ bilateral
▪︎conjunctival injection; clear, watery discharge
▪︎⇡ lacrimation (epiphora), itchy eyes, preauricular LAD
Dx: clinical
tx: self limiting
Bacterial Conjunctivitis MCC, sx, dx, tx
▪︎MC form of conjunctivitis in children
▪︎MCC (adults): S. aureus
▪︎MCC (children): S. pneumoniae & H. influenzae
▪︎contact lens wearers: Pseudomonas, M. catarrhalis
S/SXS: typically unilateral
▪︎conjunctival injection; thick, mucopurulent discharge
▪︎crusting, difficulty opening eyes in the morning (stuck shut)
dx: clinical
TX: symptomatic + ABX drops
▪︎macrolides (e.g., erythromycin), trimethoprim/polymyxin B
▪︎aminoglycosides (e.g., tobramycin)
▪︎contact lens: ciprofloxacin
Allergic Conjunctivitis MCC, sx, dx, tx
▪︎IgE-mediated hypersensitivity reaction (type I)
S/SXS: bilateral itching**
▪︎conjunctival injection, watery or stringy discharge
▪︎chemosis (conjunctival edema)
dx: clinical
TX: avoid exposure to known allergens, eye hygiene
▪︎topical naphazoline/pheniramine
▪︎H1 antagonist (e.g., azelastine)
Corneal Abrasion defintion, sx, dx, tx
Corneal abrasion: scrape/scratch injury on corneal epithelium; MC eye injury
S/SXS: FB sensation, eye pain, watering, blurred vision, photophobia (pain w/ exposure to bright light), erythema
DX: fluorescein staining
TX: removal of any retained FB, NSAIDs for pain
▪︎ABX drops ⇢ erythromycin
» contact lens: ciprofloxacin (anti-pseudomonal)
▪︎patching for abrasions >5mm (≤24h)
Corneal Ulcer definition, sx, dx, tx
▪︎serious infection involving multiple layers of the cornea
RF: contact lens wearers (Pseudomonas), incomplete lid closure (Bell’s palsy), trauma
S/SXS: eye pain, conjunctival injection, FB sensation, photophobia, lacrimation
PE: round or irregular ulcer w/ white, hazy base
DX: slit-lamp w/ fluorescein staining
▪︎corneal infiltrate w/ ⇡ fluorescein uptake
TX: topical FQs (e.g., ciprofloxacin), cycloplegic drops (e.g., cyclopentolate) for pain, emergent ophthalmology referral
▪︎NO PATCHING**
Dacryocystitis acute vs chronic defintion, sx, dx, tx
acute or chronic inflammation of the lacrimal sac
▪︎acute: streptococci, staphylococci
▪︎chronic: pneumococci, H. influenzae, Pseudomonas
S/SXS (acute): erythema, edema, warmth, & pain below the medial canthus of the eye, watering, purulent discharge
S/SXS (chronic): persistent watering, mucopurulent discharge, no signs of acute inflammation*
DX: clinical, pus culture
DCG (dacryocystography): contrast imaging of lacrimal sac & nasolacrimal duct
X (acute): warm compress, NSAIDs, I&D (abscess)
▪︎ABX (e.g., clindamycin, Augmentin, vancomycin)
▪︎DCR (dacryocystorhinostomy)
TX (chronic): DCR to prevent reoccurrence, ABX
Dacryoadenitis acute vs chronic definition, sx, dx, tx
▪︎acute or chronic inflammation of lacrimal gland
» dacryo-A-denitis is Above eye
▪︎acute: viral (e.g., mumps, EBV), bacterial (e.g., S. aureus)
▪︎chronic: inflammatory/granulomatous MCC (e.g.,
sarcoidosis, granulomatosis w/ polyangiitis),
autoimmune (e.g., Sjogren, Graves’ disease), neoplastic
S/SXS (acute): rapid onset unilateral painful swelling/erythema over lacrimal gland (lateral upper eyelid)
S/SXS (chronic): insidious onset unilateral or bilateral painless swelling over lacrimal gland
DX: eye swabs if discharge
CT: rule out orbital cellulitis (acute) or malignancy (chronic)
TX (acute): viral is usually self-limiting, broad-spectrum ABX for bacterial
TX (chronic): treat underlying disease
Nasal Foreign Body sx, dx, tx
sx
*persistent foul-smelling purulent unilateral nasal discharge in a young child
*absence of other respiratory sxs
dx
Visualization through PE
Sometimes 🡪 rigid or flexible fiberoptic endoscopy
Plain radiographs (button batteries, magnets)
tx
Removal w/ nasal speculum & Hartmann nasal forceps
*oxymetazoline prior to removal – shirks mucous membrane
Ocular Foreign Body definition, sx, dx, tx
Any object embedded in or adhering to the conjunctiva or cornea
sx
Metallic FB 🡪 rust ring
Trapped under lid 🡪 corneal abrasions (worsen w/ blinking)
dx
*slit-lamp exam w/ fluorescein staining w/ cobalt light illumination
Globe penetration 🡪 x-ray or CT
tx
*first 🡪 install topical anesthetic
*then 🡪 removal attempt w/ irrigation
*can attempt to remove w/ swab after visual
Intraocular FB 🡪 immediate surgical removal by ophthalmologist
*systemic & topical abx indicated
Rust ring 🡪 treat as corneal abrasion
*ring will resorb gradually on its own
Angle-Closure Glaucoma defintion, sx, dx, tx
Angle-closure glaucoma: closure of the anterior angle chamber at the junction of the iris & cornea (iridocorneal angle) physically blocks drainage of aqueous, elevating IOP which damages the optic nerve
➀ Acute angle-closure glaucoma (AACG): sudden angle obstruction causes rapid, acutely-symptomatic, vision-threatening
IOP elevation
Acute angle-closure glaucoma (AACG):
▪︎S/SXS: sudden onset severe, unilateral ocular pain, blurry vision, halos around lights, HA, N/V
▪︎PE: unilateral conjunctival erythema, cloudy cornea, mid-dilated fixed pupil, eye hard on palpation
dx
▪︎tonometry: ⇡ IOP >30mmHg
▪︎slit-lamp/gonioscopy: narrowing/closure of
iridocorneal angle
tx
TX (acute): emergency ophthalmology consult, place patient supine
➀ Topical drops:
▪︎pilocarpine (cholinergic/miotic) +
▪︎apraclonidine (⍺2 agonist) +
▪︎timolol (BB) plus
➁ PO acetazolamide (CAI)
Definitive: laser peripheral iridotomy (LPI) within 24-48h after attack resolution
Labyrinthitis, Vestibular Neuritis definition, sx, dx, tx
Vestibular Neuritis: inflammation of the vestibular portion of CN 8
Labyrinthitis: inflammation of the vestibular & cochlear portion of CN 8
*Etiologies: idiopathic – may be associated w/ viral or post-viral inflammation
sx
Vestibular sxs (both): continuous peripheral vertigo, dizziness, N/V, gait disturbances
*nystagmus – usually horizontal & rotary
Cochlear sxs (labyrinthitis only): unilateral hearing loss, tinnitus
dx: clinical
tx: Glucocorticoids first line
Optic Neuritis (Optic Nerve/CN II Inflammation) defintion, sx, dx, tx
acute inflammatory demyelination of the optic nerve
sx
*painful loss of vision
*decrease in color vision (desaturation)
*visual field defects (scotoma – blind spot) over hrs-days
*unilateral
PE:
*ocular pain worse w/ eye movement
*Marcus-Gunn pupil: eye dilates when light enters
dx
Fundoscopy: optic disc swelling/blurring (papillitis)
tx
IV methylprednisolone
Orbital Cellulitis defintion, sx, dx, tx
Infection of the orbit (fat & ocular muscles) posterior to the orbital system
Polymicrobial: S. aureus, streptococci, GABHS, H. flu
sx
*ocular pain esp. w/ eye movements
*ophthalmoplegia (extraocular muscle weakness)
*proptosis (bulging)
*eyelid edema & erythema
dx: clinical
CT – confirmatory
tx: ADMIT + IV abx (vancomycin + ceftriaxone/cefotaxim
Peritonsillar Abscess definition, sx, dx, tx
Abscess between the palatine tonsil & the pharyngeal muscles resulting from a complication of tonsillitis or pharyngitis – MC in adolescent & young adults 15-30yrs
Dysphagia, severe unilateral pharyngitis, high fever
Muffled “hot potato” voice, drooling, trismus
PE:
*swollen or fluctuant tonsil causing uvula deviation to the contralateral side
*bulging of the posterior soft palate
*anterior cervical LAD
dx
Primarily clinical; U/S
CT imaging of choice to differentiate between abscess and cellulitis
tx
Drainage (aspiration or I&D) + abx
*drainage: needle aspiration preferred
*abx: PO Augmentin, clindamycin
Tonsillectomy – reserved for pts who fail to respond to drainage, complications, recurrent, or severe
Retropharyngeal Abscess definition, sx, dx, tx
*deep neck space infection located behind the posterior pharyngeal wall
*MC in children 2-4yrs
sx
Neck:
*torticollis (unwilling to move the neck secondary to pain & spasms)
*neck stiffness esp. w/ extension
*fever, drooling, dysphagia, odynophagia, chest pain, trismus
*muffled “hot potato” voice
PE:
*midline or unilateral posterior pharyngeal wall edema (MC)
*anterior cervical LAD, lateral neck mass or swelling
dx
Lateral neck x-ray: *low suspicion
*increased prevertebral space >50% of the width of adjacent vertebral body
CT w/ contrast *preferred if high suspicion
tx
*surgical incision & drainage w/ abx for large & mature abscesses in the OR
-ampicillin-sulbactam or clindamycin
*abscess <2.5cm2 may be observed for 24-48hrs w/ antibiotic therapy
Retinal Detachment non-Rhegmatogenous vs Rhegmatogenous
Rhegmatogenous (MC): retinal tears cause fluid to seep into
subretinal space
▪︎RF: prior eye surgery, posterior vitreous detachment, myopia
Non-Rhegmatogenous:
➀ Tractional: formation of vitreoretinal bands
▪︎RF: proliferative diabetic retinopathy, sickle cell
➁ Exudative: subretinal fluid accumulation
▪︎RF: HTN, central serous retinopathy
Retinal Detachment sx, dx, tx
Prodromal: floaters, flashes of light (photopsia)
S/SXS: sudden onset unilateral, painless visual loss, “curtain coming down”
⊕relative afferent pupillary defect (RAPD), also called Marcus Gunn pupil
» defect in consensual light reflex i.e., affected eye constricts less
Fundoscopy: retinal tear (dark red), detached tissue floats freely/moves w/ eye movements
⊕Shafer’s sign: pigment cells in vitreous
tx
TX: keep patient supine w/ head turned towards side of detachment, emergency ophthalmology consult
▪︎laser photocoagulation, cryoretinopexy
Central Retinal Artery Occlusion (CRAO) definition, MCC, sx, dx, tx
CRAO: retinal artery thrombus or embolus causing ischemia
▪︎onset >60yo, more common in males
MCC: embolus resulting from carotid artery atherosclerosis
▪︎cardiogenic emboli (e.g., AFIB), temporal arteritis (rare)
S/SXS: sudden onset unilateral, painless vision loss; may be preceded by amaurosis fugax
⊕RAPD
Fundoscopy: pale, opaque fundus (retina) w/ cherry-red spot (fovea/macula); attenuated arteries (boxcar appearance)
TX: ⇣ IOP; immediate TX indicated if onset within 24h*
▪︎ocular massage, anterior chamber paracentesis
▪︎ocular hypotensive drugs (timolol 0.5%, acetazolamide)
▪︎catheterization, thrombolytics
**irreversible retinal damage after 90m
Central Retinal Vein Occlusion (CRVO) definition, sx, dx, tx
CRVO: non-ischemic (venous stasis retinopathy) or ischemic (hemorrhagic retinopathy) vein occlusion causing ischemia
▪︎onset >80yo, exact cause known
SXS: sudden onset unilateral, painless vision loss; ⊕RAPD
Fundoscopy: blood & thunder retina (i.e., dilated, tortuous veins; hemorrhages; cotton wool spots)
▪︎macular edema, papilledema (optic disc swelling)
DX: fluorescein angiography (differentiates ischemic vs non-ischemic)
▪︎optical coherence tomography: determines degree of macular edema & its response to TX
TX: panretinal photocoagulation (minimizes neovascularization)
Macular edema: intravitreal anti-VEGF injection
Epstein-Barr Virus (Mononucleosis) – HHV4 definition, sx, dx, tx
Infection due to EBV characterized by fever, LAD, & tonsillar pharyngitis
PATHO: EBV infects B cells
Transmission: saliva (known as the kissing disease) esp. ages 15-25
sx
*fever, LAD (esp. posterior cervical)
*tonsillar pharyngitis (may be exudative)
+/- petechiae on hard palate
+/- fatigue, HA, malaise
PE:
*splenomegaly
*rash – seen in ~5% esp. if given ampicillin
dx
Heterophile antibody (Monospot)
Rapid viral capsid antigen test; ↑ LFTs
Peripheral smear: lymphocytosis >5% w/ >10% atypical lymphocytes
tx
Supportive
- rest
- analgesics (acetaminophen, NSAIDs)
- antipyretics
Steroids ONLY if:
- airway obstruction d/t LAD
- hemolytic anemia
- severe thrombocytopenia
AVOID TRAUMA & CONTACT SPORTS 3-4WKS IF SPLENOMEGALY TO PREVENT RUPTURE
Subperichondrial Hematoma (Cauliflower Ear) defintion, sx, dx, tx
*blunt trauma to the pinna may cause a subperichondrial hematoma & accumulation of large amounts of blood between the perichondrium & cartilage
*this can interrupt the blood supply to the cartilage & render all or part of the pinna a shapeless, reddish-purple mass
*avascular necrosis of the cartilage may follow
*characteristic “cauliflower ear” of wrestlers/boxers
dx
Cauliflower ear: clinical appearance + hx of blunt trauma to the auricle
tx
Cauliflower ear:
*immediate referral for I&D by an ENT specialist
*PO abx effective against staph (cephalexin 500mg TID) x5d
Hyphema defintion, sx, dx, tx
Collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris); blood may cover most or all of iris/pupil, blocking vision partially or completely; usually painful.
▪︎MCC: trauma
S/SXS: visible blood in front of eye, photophobia, pain, blurry/clouded vision
dx: clinical
tx: monitor IOP, limit activity, eye shield
▪︎cycloplegic drops (cyclopentolate, scopolamine)
▪︎steroid drops (prednisolone, dexamethasone)
Papilledema definition, sx, dx, tx
Optic nerve (disc) swelling 2° to ⇡ ICP (usually bilateral)
S/SXS: HA, N/V
*vision is often preserved
Fundoscopy: swollen optic disc w/ blurred margins
DX: MRI/CT (r/o mass effect) ⇢ LP (⇡ CSF pressure)
TX: acetazolamide, treat the underlying cause
Macular Degeneration dry vs wet: definition, sx, dx, tx
MC cause of permanent legal blindness & vision loss in older adults (esp. >75)
Types:
*dry (atrophic): MC type; progressive (over decades)
*wet (neovascular or exudative): more aggressive (within months)
sx
Bilateral, progressive central vision loss (including detailed & colored vision)
*central scotomas
*metamorphopsia (strait lines appear bent)
*micropsia (objects seem smaller in affected eye)
Wet occurs more rapidly & is more severe
dx
Fundoscopic exam:
- dry: drusen bodies – small, round, yellow-white spots on the outer retina (represent local deposits of extracellular material)
- wet: new, abnormal vessels that can cause retinal hemorrhaging & scarring
Fluorescein staining, Amsler grid
tx
Dry:
*zinc + antioxidant vitamins (C, E) may slow progression but do not reverse changes
*amsler grid at home to monitor stability
Wet:
*intravitreal VEGF inhibitors (bevacizumab) ↓ new, abnormal vessel formation
*laser photocoagulation
