HEENT Flashcards
Leukoplakia Etiology
Inflammatory/Autoimmune
Leukoplakia Presentation
Adherent white patches/plaques on oral mucosa or tongue.
Erythroplakia Presentation
Type of Leukoplakia that presents with erythema
Leukoeruthroplakia Presentation
Type of leukoplakia that is white and speckled
Leukoplakia Treatment
Pre-cancerous. Biopsy. ENT referreal
Oral Hairy Leukoplakia Etiology
epstein-berr virus. Almost exclusively HIV patients.
Oral Hairy Leukoplakia Presentation
Vertically Corrugated white lesions on the lateral side of the tongue.
Oral Squamous Cell Carcinoma Presentations
Ulcers/masses that don’t heal. Can be painful if ulcerated. Dental changes. Exophytic.
Oral Squamous Cell Carcinoma Treatment
ENT for biopsy and surgical resection.
Oral Melanoma Presentation
Painless, bleeding mass. Discolored. Ulceration. Dental changes. ABCDEs.
Oral Melanoma Treatment
ENT for biopsy, CT, endoscopy. Surgical resection and radiation.
Amalgam Tattoo presentation
blue/black macule seen in area adjacent to amalgam dental filling. benign.
Melanosis
common pigmentation change in darker skin types. Appears symmetrically.
Oral Melanotic Macules
Dark benign macules that are symmetric with sharp borders
Mucoceles Etiology
Mild/minor trauma
Mucoceles Presentation
fluid-filled cavities in mucous membranes lining the epithelium. pink/blue soft papule/nodule. gelatinous fluid.
Mucoceles Treatment
Resolves on their own.
Oral Herpes Simplex Virus Etiology
HSV 1
Oral Herpes Simplex Primary Presentation
Herpetic Gingivostomatitis. Painful grouped vesicles on an erythematous base on buccal mucosa. Can have fever.
Oral Herpes Simplex Recurrent Presentation
Prodrome with pain/burning/tingling 24 hours before lesion appears. usually occurs withing keratinized areas.
Oral Herpes Simplex Diagnosis
Clinical. viral culture. Tzanck prep will show multinucleated larger cells.
Oral Herpes Simplex Treatment
Antivirals (acyclovir, valacyclovir, famiclovir) within first three days. Miracle mouthwash, analgesics.
Coxsackie Virus prodrome
fever, malaise, sore throat
Coxsackie virus presentation
Small, painful, aphthae lesions that usually spare the lips and gingiva. Pale papules also present on hands and feet.
Coxsackie Virus Treatment
Supportive. Resolves within 5-6 days.
Oropharyngeal Candidiasis Etiology
Candida Albicans. Opportunistic Infection.
Oropharyngeal Candidiasis Presentation
Sore mouth/throat. Beefy red tongue. Creamy white patches with erythematous mucosa. “Thrush with Brush”
Oropharyngeal Candidiasis Diagnosis
KOH prep shows budding yeast.
Oropharyngeal Candidiasis Treatment
Topical. Nystatin suspension/troche or clotrimazole troche.
Erythema Multiforme Major Etiology
Acute, immune-mediated condition. Induced by HSV or Mycoplasmic pneumonia.
Erythema Multiforme Major Presentation
Target-like lesions on the skin. Diffuse areas of mucosal erythema with erosions/bullae. Also effects genitals and eye.
Erythema Multiforme Major Treatment
Resovles within 2 weeks. Topical corticosteriods for relief. miracle mouthwash, antihistamines. Can use oral glucocorticoids for severe mucosal involvement.
Stevens-Johnson Syndrome Etiology
Medication induced.
SJS Prodrome
Fever, flulike symptoms. conjunctivitis/photophobia.
SJS skin Lesions
Tender erythematous purpuric macules leading to vesicles leading to skin sloughing.
SJS mucosal involvement
Erythema, edema, bullae that rupture. Can also effect genitals and eyes.
SJS treatment
biopsy, discontinue offending med, corticosteroids, hospital admission (hydration and secondary infections: S. aureus and P. aeruginosa).
Pemphigus Vulgaris Etiology
Chronic Auto-immune disorder
Pemphigus Vulgaris Presentation
Flaccid bullae in oropharynx that spread to the scalp/face/axillae. Nikolsky sign.
Nikolsky Sign
gentle application of lateral pressure in uninvolved area causes the superficial layer to slough off. Diagnostic for Pemphigus.
Pemphigus Vulgaris Diagnosis
Nikolsy Sign. 2 biopsies (lesion and perilesional) for direct immunofluorescence.
Pemphigus Vulgaris Treatment
Systemic corticosteroids, immunosuppressants, Topical lidocaine or oralone. Derm referral.
Pemphigoid Etiology
Chronic auto-immune disorder
Pemphigoid prodrome
pruritic eczematous, papular/uticaria-like lesions
Pemphigoid Presentation
Tense bullae that remain intact. erythematous plaques in mucosal membrances.
Pemphigoid Diagnosis
2 biopsies (lesion and perilesional) for direct immunofluorescence.
Pemphigoid Treatment
Topical or oral corticosteriods. Derm referral.
Apthous Ulcers Etiology
Idiopathic. Predisposing factors: infection, HIV, genetic, vitamin/mineral deficiencies.
Apthous Ulcers Presentation
single/multiple oral lesions. Shallow round/oval, painful with grey base and ring of erythema. on buccal and labial mucosa.
Apthous Ulcers Treatment
Resolve within 10-14 days. Topical steroids for symptomatic relief.
Bechet’s Syndromd Etiology
Neutrophilic Inflammatory disease.
Bechet’s Syndrome Presentation
Recurrent oral/genital ulcers. Painful, deep, central yellow necrotic base. Often multiple.
Bechet’s Syndrome Diagnosis
Recurrent oral ulcers >3 times per year with 2 other clinical findings (genital ulcers, eye or skin lesions).
Bechet’s Syndrome Treatment
Refer to Rheumatology
Oral Lichen Planus Etiology
Chronic inflammatory disorder
Oral Lichen Planus presentation
Reticular: Lacy white plaque on buccal mucosa (wickham’s straie)
Erythematous: Painful, red patches due to atrophy.
Erosive: painful erosions and ulcers
Oral Lichen Planus Diagnosis
biopsy and ENT
Oral Lichen Planus Treatment
pain relief, high potency corticosteroids (clobetasol proprionate).
Black Hairy Tongue Etiology
antibiotic use, candida albicans, poor oral hygeine.
Black Hairy Tongue Presentation
Elongated filliform papillae. Yellow/white/brown. Drosal aspect of tongue.
Black hairy tongue Treatmen
better oral hygeine. brush the tongue.
Geographic tongue presentation
Erythematous patches on dorsal tongue with circumferential white borders. Transient. Asymptomatic.
Geographic Tongue Treatment
Reassurance.
Atrophic Glossitis Etiology
Nutritional deficiencies (VB12), dry mouth, celiacs, candida. Inflammatory disorder causing atrophy of the filliform papillae.
Atrophic Glossitis Presentation
smooth, glossy, erythematous tongue. Burning sensation.
Atrophic Glossitis Treatment
Address the underlying condition.
Otitis Externa Etiology
Psuedomonas, S. Epidermis, S. Aureus, aspergillus, candida.
Otitis Externa Causes
Heat and moisture leading to swelling and maceration of the EAC.
Otitis Externa Presntation
Ear pain that worsens with movement of the external ear. pruritc especially with fungal. Decreased conductive hearing. Erythematous and edematous.
Otitis Externa Green Discharge
pseudomonas
Otitis Externa yellow discharge
S. Aureus
Otitis Externa black/white fluffy growth
Fungal
Otitis Externa fungal treatment
clotrimazole 1% BID x 14 days. Acidifying solution (acetic acid). Keep EAC dry.
Otitis Externa Bacterial Treatment
cortisporin otic suspension (polymyxin B, neomycin, hydrocortisone). Keep EAC dry. Resolves within 5-7 days.
Malignant Otitis Externa Etiology
Pseudomonas. Seen with DM and immunocompromised.
Malignant Otitis Externa Presentation
Intense ear pain (out of proportion), otorrhea, red granulation, lymphadenopathy, edema, trismus, elevated inflammatory markers in the blood.
Malignant Otitis Externa Treatment
Admission. IV ciprofloxacin. Debridement.
Acute Otitis Media Etiology
Streptococcus pneumoniae, Haemophilus influenzae, moraxella cararrhalis
AOM Pediatric Presentation
Irritability, decreased apetite, +/- Fever, ear pain, discharge, vomiting, diarrhea, conjunctivitis (H. Influenzae).
AOM Adult Presentation
Otalgio without fever.
AOM exam findings
opaque/reddend, bulging TM. Decreased TM mobility. Conductive hearing loss. Can have blisters. Type B tympanogram.
AOM Antibiotics indicated for…
102.2, or bilateral AOM
>24 months: severe symptoms
AOM antibiotics NOT indicated for…
6-23 months with unilateral and non severe AOM
>24 months with uni/bilateral and non severe AOM
AOM Antibiotic Treatment
Amoxicillin (80-90 mg/kg/day) for 7-10 days.
AOM first line antibiotic Treatment contraindicated
antibiotics in last 30 days, purulent conjunctivitis or recurrent AOM. Instead use Augmentin (amoxicillin and clavulanate).
AOM Treatment with Penicillin Allergery
cefdinir, cefuroxime, cefpodoxine
AOM treatment failure
IM rocephin (ceftriaxone) 50 mg.
Recurrent AOM
more than 3 in the last 6 months or more than 4 in the last 12 months. Treat with ceftriaxone or augmentin. Consider ENT consult.
Chronic Otitis Media Etiology
Recurrent AOM, trauma or cholesteatoma.
Chronic Otitis Media Presentation
Drainage from middle ear for longer than 2 weeks with a painless TM perforation. Conductive hearing loss.
Chronic Otitis Media Treatment
Refer to ENT
Otitis Media with Effusion Etiology
Viral URI, AOM, allergic rhinitis.
OME Presentation
painless, ear fulness and decreased hearing. Amver colored fluid behind TM. Type B tympanogram.
OME Treatment
Watchful waiting. intranasal steroids for allergeris. ENT for T tubes if longer than 3 months.
Eustachian Tube Dysfunction Presentation
Retracted TM. Type C tympanogram. Ear fullness, recurrent OME, hearing loss.
Eustachian Tub Dysfunction Treatment
Steroid nasal spray (afrin/neo-synephrine for ONLY 3 days), allergy management, decongestants, T tubues.
Ear Barotrauma Presentation
Discomfort or drainage with pressure changes. Ear fullness. Hemotympanum.
Ear Barotrauma Treatment
supportive
Labrynthitis Etiology
Viral URI causing acute inflammation/infection of the vestibular system.
Labrynthitis Presentation
Acute onset of vertigo, N/V, balance problems, tinnitus, hearing loss. Positive head thrust (can’t maintain visual fixation). Horizontal nystagmus.
Labrynthitis Treatment
Bed rest, hydration, Meclizine (antivert) 25mg TID for vertigo.
Allergic Rhinitis Etiology
Hyper-responsiveness to allergens. IgE (basophils/mast cells). Increase in histamine, cytokines, leukotrienes, prostaglandins.
Allergic Rhinitis symptoms
Rhinorrhea, sneezing, itchy eyes/nose, congestion, PND (clear), cough.
Allergic Rhinitis Signs
pale/blue boggy nasal mucosa, clear discharge, palpebral conjunctival injection, allergic shiners, denier morgan lines.
Allergic Rhinitis Diagnosis
Skin test or Immunoassays (less risk but more expensive)
Allergic Rhinitis Treatment
Remove allergen, intranasal glucocorticosteroids (flonase), antihistamines, decongestants (sudafed), leukotriene antagonists (singulair), immunotherapy.
First Generation Antihistamines
Chlorpheniramine (chlor-trimeton) or diphenhydramine (benadryl). Can cause dry mouth, sedation and constipation.
Second Generation Antihistamines
Loratadine (claritin), fexoxedadine (allegra), cetrizine (zyrtec). Less sedating, same effect as first generation.
Sympathomimetics
Decongestants. Vasoconstriction decreases edema and secretions. Psuedoephredrine (sudafed). Contraindicated in patients with HTD and cardiac disease.
Immunotherapy
Hypersensitizes IgE. Takes about 6 months to start working.
Perennial Non-allergic (vasomotor) Rhinitis Etiology
Abnormal autonomic response triggered by stress, temperature changes, sexual arousal and blood pressure meds.
Vasomotor Rhinitis Presentation
Congestion and rhinorrhea without itching or sneezing. Nasal mucosa and IgE levels are normal.
Vasomotor Rhinitis Treatment
Avoid triggers, topical steroids, topical antihistamines (azelastine), topical antichollinergics (ipratropium) and first generation oral antihistamine.
Nasal Polyps Etiology
Associated with allergic rhinitis, vasomotor rhinitis, chronic sinusitis and smatter’s triad.
Smatter’s triad
Asthma, nasal polyps and NSAID sensitivity.
Nasal Polyp presentation
pedunculated, non-tender, soft, grey tissue growths.
Nasal polyp Treatment
intranasal glucocorticoids. ENT referral if obstruction occurs.
Rhinitis Medicamentosa Etiology
Tachyphylaxis with overuse of topical decongestants like afrin.
Rhinitis Medicamentosa Presentation
Erythematous mucosa
Rhinitis Medicamentosa Treatment
discontinue the intranasal glucocorticoid.
Common Cold Etiology
Rhinovirus, Parainfluenza and Respiratory Syncytial Viruses in pediatric patients
Common Cold Symptoms
Rhinitis, congestion, sore throat, cough, malaise, +/- fever, HA (mild), Myalgias (mild).
Common Cold Signs
Mucosal edema, congestion, pharyngeal erythema, +/- lymphadenopathy, conunctival injection.
Common Cold Treatment
Rest, Hydrate, NAIDS, anti-tussive, decongestant. 1-2 week duration.
Influenza Etiology
Influenza virus A and B
Influenza Symptoms
Abrupt onset, HA, Fever (100-104), chills, myalgias, malaise, cough, sore throat, conjunctival injection.
Influenza Signs
Flushed, hot, dry skin. Mucosal membrane injection, mild lymphadenopathy.
Influenza Diagnosis
Rapid antigen test, immunofluorescense (A from B), Viral culture (gold standard), Polymerase chain reaction.
Influenza Treatment
Antivirals (within 24-48 hours of onset). Oseltamivir, Zanamivir.
Oseltamivir Dosing
Tamiflu. For influenzae. 70mg BID for 5 days. Can cause delirium, N/V.
Zanamivir Dosing
Relenza. For influenzae. 10mg BID for 5 days. indicated for pregnancy. Can cause bronchospasm.
Pharyngitis/tonsilitis Symptoms
sore throat, fever, HA, malaise, lymphadenopathy, URI symptoms.
Pharyngitis/tonsilitis signs
pharyngeal erythema, tonsilar hypertrophy, purulent exudate, tender/enlarged anterior cervical nodes, palatal petechiae.
Group A strep Presentation
Pharyngeal exudate, cervical lymphadenopathy, fever, lack of a cough.
Group A strep Diagnosis
Rapid antigen detection. Even if negative follow up with a throat culture.
Herpetic Pharyngitis Presentation
ulcerations in the throat.
Herpetic pharyngitis treatment
acyclovir or famcyclovir
Diptheria Presentation
gray membrance in the pharynx with significant bleeding.
Diptheria treatment
antitoxin plus penicillin or erythromyocin.
HIV Presentation
If pharyngitis sxs aren’t improving in 5-7 days or are worsening.
Group A strep Treatment
Penicillin V. 500mg BID-TID for 10 days.
Group A Strep Treatment alternatives
amoxicillin, penicillin G benzathine (IM), cephalexin.
Group A strep treatment with penicillin allergy
macrolides or clindamycin.
Scarlet fever rash
sand papery feeling. complication of strep.
Emergent Acute Pharyngitis disorders
epiglottitis, peritonsilar abscess, submandibular space infection, retropharyngeal space infection.
Epiglottitis Presentation
severity of sore throat is out of proportion to exam findings. stridor, respiratory distress.
Peritonsilar abscess Etiology
Group A strep, S. aureus.
Peritonsilar abscess Symptoms
severe, unilateral sore throat. muffled voice, drooling, trisumus, fever, neck swelling/pain, ipsilateral ear pain, fatigue.
Peritonsilar abscess Signs
swollen, fluctuant tonsil. Uvula deviation towards opposite side. soft palate with palpable fluctuance. Lymphadenopathy.
Peritonsilar abscess diagnosis
CBC, throat culture, Ct with contract to rule out spread to parapharyngeal space.
Pharyngitis/tonsilitis signs
pharyngeal erythema, tonsilar hypertrophy, purulent exudate, tender/enlarged anterior cervical nodes, palatal petechiae.
Group A strep Presentation
Pharyngeal exudate, cervical lymphadenopathy, fever, lack of a cough.
Group A strep Diagnosis
Rapid antigen detection. Even if negative follow up with a throat culture.
Herpetic Pharyngitis Presentation
ulcerations in the throat.
Herpetic pharyngitis treatment
acyclovir or famcyclovir
Diptheria Presentation
gray membrance in the pharynx with significant bleeding.
Diptheria treatment
antitoxin plus penicillin or erythromyocin.
HIV Presentation
If pharyngitis sxs aren’t improving in 5-7 days or are worsening.
Group A strep Treatment
Penicillin V. 500mg BID-TID for 10 days.
Group A Strep Treatment alternatives
amoxicillin, penicillin G benzathine (IM), cephalexin.
Group A strep treatment with penicillin allergy
macrolides or clindamycin.
Scarlet fever rash
sand papery feeling. complication of strep.
Emergent Acute Pharyngitis disorders
epiglottitis, peritonsilar abscess, submandibular space infection, retropharyngeal space infection.
Epiglottitis Presentation
severity of sore throat is out of proportion to exam findings. stridor, respiratory distress, drooling.
Peritonsilar abscess Etiology
Group A strep, S. aureus.
Peritonsilar abscess Symptoms
severe, unilateral sore throat. muffled voice, drooling, trisumus, fever, neck swelling/pain, ipsilateral ear pain, fatigue.
Peritonsilar abscess Signs
swollen, fluctuant tonsil. Uvula deviation towards opposite side. soft palate with palpable fluctuance. Lymphadenopathy.
Peritonsilar abscess diagnosis
CBC, throat culture, CT with contrast to rule out spread to parapharyngeal space.
Peritonsilar abscess treatment
Drainage via aspiration/incision. IV ampicillin-subactan or clindamycin. Oral amoxicillin-clavulanate or clindamycin for 14 days.
Trismus
Spasm of the internal pterygoid muscle so can’t open mouth.
Submandibular space infection (ludwig’s angina) Presentation
elevated oropharyngeal floor, protruding tongue, double chin
Retropharyngeal space infection Presentation
difficulty swallowing/breathing, neck stiffness. can follow intubation or trauma.
Abscess of parapharyngeal space
bulging behind tonsilar pillars
Acute Laryngitis Causes
Viral, bacterial or vocal abuse, trauma, GERD, carcinoma.
Acute Laryngitis Viral
rhinovirus, influenze and parainfluenza
Acute Laryngitis Bacterial
Strep, M. cattarrhalis, H. influenzae, S. Aureus.
Acute Laryngitis Symptoms
Hoarseness, URI symptoms
Acute Laryngitis Signs
Laryngoscopy can reveal erythema, edema, vascular ingorgment, nodules and ulcerations.
Acute Laryngitis Treatment
Address underlying cause, humidification, resolves within 3 weeks.
Acute rhinosinusitis Causes
Usually viral URI followed by a secondary bacterial infection.
Acute rhinosinusitis Viral
rhinovirus, influenza, parainfluenza
Acute rhinosinusitis Bacterial
H. influenzae or S. pneumonia.
Acute rhinosinusitis Symptoms
Congestion, purulent discharge, facial pain, fever, fatigue, cough, HA, ear pressure.
Acute rhinosinusitis treatment 1-9 days
analgesics, irrigation, decongestants.
Acute rhinosinusitis indication for antibiotics
symptoms >10 days or a fever (102) with purulent discharge for 3 days. Or worsening symptoms following a viral URI.
Acute rhinosinusitis antibiotics
Amoxixillin-clavulanate (augmentin) 500mg TID or 875mg BID. for 5-7 days
Acute rhinosinusitis with penicillin allergy
Doxycycline, levofloxacin or moxifloxacin for 5-7 days.
Chronic Rhinosinusitis Presentation
Mucopurulent discharge, congestion, facial pain/pressure and loss of smell (cough for pediatrics) for longer than 12 weeks with treatment.
Chronic Rhinosinusitis Treatment
Saline lavages, intranasal corticosteriods, oral corticosterious/antibiotics, antihistamines, antifungals, sinus surgery.
Infectious Mononucleosis Etiology
Epstein-Barr virus
Mono Prodrome
1-2 weeks with fatigue, fever and malaise.
Mono Presentation
cervical lymphadenopathy, fever, sore throat (resembles strep), malaise, splenomegaly.
Mono diagnosis
CBC, elevated LFT, Monospot (weeks 2-3), antibody testing.
Mono antibody testing
IgM and absence of IgG indicates an acute infection.
Mono Treatment
Supportive. Can last up to 6 months. Sports restrictions for 4 weeks.
Cataracts
Any opacity of the lens, usually age-related.
Cataracts Presentation
gradual, chronic, painless loss of vision. Glare at night. yellow/opalescent lenses.
Cataract Treatment
Refer. Intraocular lens implant has good prognosis.
Glaucoma
Increase in intraocular pression leading to optic nerve damage causing visual field loss.
Closed Angle Glaucoma
Emergency. Crescent shadows. Acute. Painful. Aqueous fluid can’t flow outwards at all.
Glaucoma Presentation
Peripheral vision loss. Increased intraocular pressure. increased cup/disc ratio.
Rhegmatogenus Retinal Detachment
associated with myopia
Tractional Retinal detachment
Associated with diabetes.
Retinal detachment Symptoms
Floaters, photopsias (flashes of light), Acute loss of vision “curtain-like”
Retinal Detachment Signs
decreased vision, raised, whitish retina. posterior vitreous detachment.
Macular Degeneration (ARMD)
number one cause of blindness. Degeneration of the phororeceptors.
ARMD Symptoms
gradual or acute blurred vision, metamorphopsia (wavy lines), central scotoma.
ARMD Signs
Decreased visual acuity, amsler grid distortion. Dry then Wet ARMD.
Dry ARMD
Drussen bodies (dead cells), pigment mottling, geographic atrophy.
Wet ARMD
Subretinal fluid/blood, neovascularization.
ARMD Treatment
Referral. Stop smoking. Vitamins (omega 3, antioxidants, zinc).
Central Retinal Artery Occlusion (CRAO).
Embolic
CRAO symptoms
Acute, painless, total loss of vision.
CRAO signs
no light perception, afferent pupil defect, white retina with cherry red spot.
Central retinal Vein Occlusion (CRVO)
Thrombotic
CRVO Presentation
acute, painless, variable vision loss. Afferent Defect. “blood and thunder”
CRVO Treatment
Referral and aspirin.
Hypertensive Retinopathy Presentation
Usually asymptomatic. Copper wiring (narrowing), sliver wiring (sclerosis), A-V nicking, cotton-wool spots, disc edema.
HTN retinopathy Treatment
Control systemic BP. Referral if severe or any vision loss.
Diabetic retinopathy
number one cause of blindness in people younger than 50.
Non-proliferative DM retinopathy
microaneurysms, cotton-wool spots, venous bleeding
Proliferative DM retinopathy
neovascularization, traction retinal detachment.
Macular edeam with DM retinopathy
graying/opacification, microaneurysms.
DM retinopathy treatment
Sugar control. Ophthalmology dilated exam once a year.
Blepharitis Symptoms
Eyelid inflammation. chronic itching, burning, scratchy. Worse in the AM.
Blepharitis Signs
Erythema, scales, debris, meibomian gland disease, chalazion.
Blehparitis treatment
warm compresses, baby shampoo. antibiotics/steroid topical if severe.
Pingueculum
yellow bump on the sclera associated with aging.
Pterygium
Triangular thickening of the bulbar conjunctiva. Grows from nasal side to the surface of the cornea. Can interfere with vision.
Cellulitis Symptoms
acute onset of pain, swelling, +/- systemic sxs.
Cellulitis Signs
+/- vision decrease, warm erythematous, edema, tenderness. Loss of EOMS with orbital cellulitis.
Cellulitis Treatment
referal. and systemic antibiotics.
Dry eye Sxs
chronic, itching, burning, scratching, tired eyes especially at night.
Dry eye signs
vision fluctuation, poor tear film, punctate epithelial erosions.
Viral conjunctivitis Presentation
Acute, bilateral, itching/burning/soreness, mild-severe injection, watery discharge, URI symptoms, preauricular lymphadenopathy.
Viral conjunctivitis Treatment
Tears, compresses, vasoconstictors.
Bacterial conjunctivitis Presentation
Acute, unilateral, burning, irritation, moderate-severe injection, mucopurulent discharge, adherent lids.
Bacterial conjunctivitis Treatment
topical antibiotics
Allergic Conjunctivitis Presentation
Chronic, bilateral, itching, mild-moderate injection, stringy mucoid discharge, chemosis.
Chemosis
swelling of the conjunctiva
Allergic conjunctivitis treatment
tears, topical antihistamines/mast cell stabilizers
Subconjunctival Hemorrhage Presentation
Acute, asymptomatic diffuse red patch on the sclera. Usually results from trauma. No treatment neccessary.
Episcleritis/Scleritis Etiology
Can be associated with systemic autoimmune diseases.
Epi/scleritis Presentation
Subacute. Feeling of foreign body, pain. Focal injection, inflammation of episclera/scleral tissue, scleritis is a deep bluish hue.
Corneal Abrasion presentation
Acute onset of pain and foreign body sensation. Epiphora. +/- vision.
Epiphora
overflowing tears.
Corneal abrasion diagnosis
epithelial defect seen with flourescein drops and blue light.
Corneal abrasion treatment
lubricants, antibiotics, pain meds, NO anesthetic drops.
Chemical Injury Presentation
Acute pain, burning, decreased vision, red/pink/white eye.
Chemical injury treatment
irrigate and refer.
Corneal Foreign Body Presentation
Acute onset of foreign body sensation. Can sometimes see the foreign body with or without rust rings.
Corneal Foreign Body Treatment
Irrigation or use of cotton-tip applicator to remove the foreign body.
Keratitis/corneal ulcer Etiology
Usually from contact lense abuse. Or use of anesthetic drops with a corneal abrasion.
Keratitis/corneal ulcer Presentation
acute onset of pain, mucous discharge, decreased vision, white infiltrate can have a hypopyon. Treated with topical antibiotics.
Keratitis HSV Presentation
Dendritic pattern. Treated with topical anti-viral. Referral.
Iritis/uveitis Presentation
Acute onset of photophobia, ciliary flush, +/- vision decrease. Hypopyon.
Hyphema Etiology
Blood in the anterior chamber usually due to trauma.
Hyphema Presentation
Acute onset of pain and photophobia, +/- vision, layered heme in anterior chamber.
Hyphema Treatment
Eyeshield and immediate referral.
Angle Closure Glaucoma Etiology
Acute rise in intraocular pressure die to outflow obstruction.
Angle closure glaucoma symptoms
Acute, decreased vision, halos, nausea, pain, feeling of pressure in the eye.
Angle closure glaucoma Signs
Crescent shadow, ciliary flush, decreased vision, steamy cornea.
