Term
| eyelid and lashes turned outward. may be caused by relaxation of orbicularis oculi muscle. MC in elderly. irritation, ocular dryness, tearing. surgical correction if needed, lubricating eye drops for symptom relief |
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Definition
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Term
| eyeid and lashes turned inward. may be caused by spasms of orbicularis oculi muscle. MC in elderly. eyelashes may cause corneal abrasion/ulcerations, erythema, tearing. surgical correction if needed, lubricating eye drops for relief |
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Definition
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Term
| infection of the lacrimal sac. MC S. aureus, also group A beta hymolytis strep, Staph epi, H flu, Strep pneumo. tearing, tenderness, edema, redness to medial canthal (nasal side) of lower lid, can be purulent. treat acute w antibiotics maybe dacryocystrohinostomy, clindamycin, vanco + ceftriaxone. chronic- dacryocystorhinostomy |
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Definition
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Term
| inflammation of both eyelids. common in pts w down syndrome and eczema. anterior involves skin and base of eyelids- infections (s.aureus/s.epi/viruses) or seborrheic. posterior- meibomian gland dysfunciton (associated w rosacea and allergic dermatitis). ere irritation/itching. eyelid burning, erythema, crusting, red-rimming of the eyelid and eyelash flaking. treat anterior w eyelid hygiene- warm compress, scrubbing/washing w baby shampoo +/- antibiotics- Azithromycin solution/ointment (erythromycin or bacitracin). posterior- eyelid hygiene, regular massage of meibomian gland +/- systemic antibiotics in severe/unresponsive cases (tetracyclines/azithromycin) |
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Definition
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Term
| local abscess of eyelid margin. 90-95% S. aureus. external- infection of eyelash follicle or external sebaceous glands near the lid margin. Internal- inflammation/infection of the meibomian gland. focal abscess: painful, warm, swollen red lump on eyelid. manage w warm compresses (mainstay) +/- topical antibiotic ointment (erythromycin, bacitracin) if actively draining +/- incision & drainage if no sponteneous drainage after 48 hours |
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Definition
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Term
| painless granuloma of the internal Meibomian sebaceious gland -> focal eyelid swelling. Chalazions are often larger, firmer, slower growing & less painful than hordeola. nontender eyelid swelling on the conjunctival surface of eyelid -> rubbery nodule manage w eyelid hygiene- warm compresses. antibiotics usually not necessary. injection of corticosteroid or incision + curettage may be necessary in large ones affecting vision |
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Definition
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Term
| pterygium elevated, superficial fleshy, triangular-shaped "growing" fibrovacular mass MC in inner corner/nasal side of eye & extends laterally. associated w inc UV exposure in sunny climates as well as sand, wind and dust exposure. management is observation for most +/- artificial tears. removal only if growth affects vision |
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Definition
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Term
| yellow, elevated nodule on the nasal side of sclera (fat/protein) that does not grow. management is observation in most cases. may be excised for cosmetic reasons or if it becomes inflamed |
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Definition
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Term
| The outer membrane of the eye is disrupted by blunt or penetrating trauma. Ophtho emergency. may have diplopia, ocular pain but may be painless. See misshapened eye w prolapse of ocular tissue from the sclera or corneal opening. visual acuity is markedly reduced. may have enophthalmos (recession of the globe within the orbit) but may have exophthalmos. foreign bodies may be present. severe conjunctival hemorrhage (360deg bulbar). prolapse of the iris through the cornea, pos Seidel's test (parting of fluorescein dyd by a clear stream of aqueous humor from the anterior chmber. obscured red-reflex, teardrop or irregularly-shaped pupil, hyphema (blood in anterior eye chamber). management is rigid eye shield (protects eye from applied pressure, impaled object should be left undisturbed. immediate ophtho consult. iv antibiotics. avoid topical eye solutions and for hyphema (blood in anterior chamber) place at 45deg to keep rbcs from staining the cornea |
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Definition
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Term
| decreased visual activity (trapped orbital tissue). diplopia especially with upward gaze (if there is inferior rectus muscle entrapment). orbital emphysema, eyelid swelling after blowing nose- air from the maxillary sinus. epistaxis. dyesthesias, hyperalgesia or anesthesia to the anteromedial cheek due to stretching of the infraorbial nerve. CT scan test of choice, may show a teardrop sign. initial management is nasal decongestants (decreases pain), avoid blowing nose, corticosteroids (to reduce edema), antibiotics (ex ampicillin/sulbactam or clindamycin). surgical repair in severe cases, pts w enophthalmos or for persistent diplopia |
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Definition
| orbital floor "blowout" fractures |
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Term
| age>50y, caucasians, females, smokers. MC cause of permanent legal blindness & visual loss in the elderly. bilateral blurred or loss of central vision (including detailed & color vision). scotomas (blind spots, shadows), metamorphopsia (straight lines appear bent), micropsia (object seen by the affected eye looks smaller than in the unaffected eye). |
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Definition
macular degeneration
dry (atrophic)- gradual breakdown of the macula -> gradual blurring of central vision. drusen= small, round, yellow-white spots on the outer retina (scattered, diffuse)- accumulation of waste products from the retinal pigment epithelium. manage w amsler grid at home to monitor stability. Zinc, vitamin A, C and E may slow progression
wet (neovascular or exudative): new, abnormal vessels grow under the central retina, which leak and bleed -> retinal scarring. rarer than dry (but progresses more rapidly). diagnosis w fluorescein angiography. manage w intravitreal anti-angiogenics ex Bevacizumab- inhibits vascular endothelial growth factor (VEGF) -> reduces neovascularization. laser photocoagulation. optical tomography done to monitor treatment response |
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Term
MC cause of new, permanent vision loss/blindness in 25-74y (MC due to maculopathy). retinal blood vessel damage -> retinal ischemia, edema. glycosylation (excess sugar attaches to the collagen of the blood vessels) -> capillary wall breakdown.
nonproliferative- microaneurysms -> blot & dot hemorrhages, flam-shaped hemorrhages, cotton wool sports: hard exudates, retinal vein beading (tortuous/dilated veins), closure of retinal capillaries. not associated w vision loss. cotton wool spots (soft exudates)- fluffy gray-white spots - nerve layer microinfarctions. herd exudates: yellow spots w sharp margins often circinate (due to lipid or lipoprotein deposits from leaky blood vessels). blot & dot hemorrhages (bleeding into deep retinal layer). flamer: nerve fiber layer hemorrhage. management: panlaser treatment. strict glucose control.
proliferative- neovascularization: new abnormal blood vessel growth, vitreous hemorrhage. mgmt: VEGF inhibitors (bevacizumab), laser photocoagulation treatment, tight glucose control.
maculopathy- macular edema or exudates, blurred vision, central vision loss. can occur at any stage. maculopathy is due to macular microaneurysm leakage, causing macular edema & damage. mgmt: laser |
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Definition
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Term
| damage to retinal blood vessels from longstanding high blood pressure, 4 grades. I- Arterial narrowing: abnormal light reflexes on dilated tortuous arteriole shos up as colors. copper wiring= moderate, silver-wiring= severe. II- AV nicking- venous compression at the arterial-venous junction by inc arterial pressure. III- flame shaped hemorrhages, cotton wool spots (soft exudates). IV- papilledema (malignant HTN) |
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Definition
| hypertensive retinopathy. management: blood pressure control |
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Term
| phototopsia (flashing lights) w detachment -> floaters -> progressive unilateral vision loss: shadow "curtain coming down" in periphery initially -> loss of central visual field. no pain/redness. funduscopy shows tissue flapping in the vitreous humor. pos shafer's sign (clumping of brown-colored pigment cells in the anterior vitreous humor resembling tobacco dust. mngmt: ophtho emergency, keep patient supine while awaiting consult DO NOT use miotic drops. laser, cryotherapy, ocular surgery. 3 types. diff dx: amaurosis fugax: temporary "curtain" that "lifts up" usually within 1 hr |
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Definition
retinal detachment
3 types:
-rhegmatogenous MC type- retinal tear-> retinal inner sensory layer detaches from choroid plexus. MC predisposing factors are myopia (nearsightedness) & cataracts
-traction- adhesions separate the retina from its base (proliferative DM retinopathy, sickle cell, trauma)
-exudative (serous)- fluid accumulates beneath the retina-> detachment (ex HTN, CRVO, papilledema) |
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Term
| foreign body sensation, tearing, red and painful eye. pain releived w instillation of ophthalmic analgesic drops. fluorescein staining shows ice rink/linear abrasions. mngmt: 1st check visual acuity |
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Definition
ocular foreign body and corneal abrasion
-foreign body removal: remove w sterile irrigation or moistened sterile cotton swab (needle via slit lamp if experienced) avoid sending pts home c topical anesthetics
-corneal abrasions: patching not indicated for small abrasions. may patch the eye in some pts w large abrasions >5mm but do not patch longer than 24 hrs. do not patch the eye in contact lens wearers/pseudomonas. place them on fluoroquinolone eye drops (ciprofloxacin) with close ophtho follow up
-antibiotic drops: for both corneal abrasions and foreign bodies. 24 hr ophtho follow up. topical erythromycin, polymyxin/trimethoprim, sulfacetamide, ciprofloxacin
-rust ring: remove rust ring at 24 hrs usually w rotating burr by an ophthalmoligist |
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Term
| MC adenovirus. swimming pool MC source. MC in children. highly contagious. foreign body sensation, erythema and itching. normal vision. may have accompanying viral symptoms. preauricular lymphadenopathy, copious watery discharge, scanty muscoid discharge. often bilateral. may have punctate staining on slit lamp examination. mngmt: supportive (cool compresses, artificial tears) +/- antihistamines for itching/redness (ex olopatadine) |
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Definition
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Term
| conjunctival erythema (red eyes) cobblestone mucosa appearance to the inner/upper eyelid, itching, tearing, redness, stringing discharge, usually bilateral +/- chemosis (conjunctival swelling). mngmt- topica antihistamines (H1 blockers): olopatadine (patanol- antihistamine/mast cell stabilizer). pheniramine/naphazoline (naphcon A0- antihistamine/decongestant), emedastine. topical NSAID: ketorlac. topical corticosteroids- side effect of long term steroid use -> glaucoma, cataracts, HSV keratitis |
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Definition
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Term
| MC staph aureus, strep pneumo, h. flu. purulent discharge, lid crusting, usually no visual changes (mild pain). absence of ciliary injection. fluorescein staining needed to detect corneal abrasions or keratitis. topical antibiotics: erythrymycin, fluoroquinolones (ex Moxifloxacin), sulfonamides, aminoglycosides. if contact lens wearer, cover pseudomonas (fluoroquinolone or amino glycoside). if chlamydia or gonorrhea +/- admit for IV and topical abx (ophtho emergency) no steroids. gonococcal conjunctivitis: iv ceftriaxone (+/- add topical). chlamydia (azithromycin) |
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Definition
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Term
day 1: silver nitrate (chemical cause)
day 2-5: gonococcal most likely cause
day 5-7: chlamydia most likely cause
day 7-11: HSV is the likely cause. recommended standard prophylaxis is erythromycin ointment, topical tetracycline, silver nitrate or providone-iodine |
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Definition
| ophthalmia neonatorium (neonatal conjunctivitis) |
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Term
| ophtho emergency! every minute counts! irrigation must be started ASAP. alki: worse than acids (liquefactive necrosis), denatures proteins and collagen, causes thrombosis of vessels ex fertilizers, household cleaners, drain cleaners. acid: coagulative necrosis (H+ precipitates protein barrier). ex cleaners, batteries. mngmt" immediate irrigation (greatest impact on prognosis). lactated ringers or normal saline (LR ideal bc at pH of 6-7.5 it is closer to pH of tears (7.1) than NS (pH 4.5-7) and is less irritating. irrigate x 30min or at least 2 liters of fluid. check pH and visual acuity after irrigation. irrigate until pH of eye is 7.0 - 7.3. antibiotics ex Moxifloxacin and cycloplegic agens (0.25% atropine drops), ophtho f/u |
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Definition
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Term
| usually 2ry to sinus infections (ethmoid 90%). S. aureus, S. pneumo, GABHS, H. flu. may be caused by dental/facial infections or bacteremia. MC in children (esp 7-12y). decreased vision, pain with ocular movement, proptosis (bulging eye), eyelid erythema and edema. high resolution CT scan for infection of fat and ocular muscles, MRI. management w IV antibiotics ex Vancomycin, Clindamycin, Cefotaxime, Ampicillin/sulbactam. amoxicillin if preseptal |
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Definition
| orbital (septal) cellulitis |
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Term
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Definition
| infection of the eyelid and periocular tissue. may have ocular pain and swelling but NO visual changes and NO pain with ocular movement |
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Term
| misalignment of the eyes. stable ocular alignment not present until age 2-3months. estropia: convergent strabismus - deviated inward (crossed eyed). exotropia: divergent strabismus (deviated outward). diplopia, scotomas, or amblyopia. hirschberg corneal light reflex testing (often used as screening test). cover-uncover test to determine the angle, cover test, convergence testing. mngmt: patch therapy: normal eye is covered to stimulate and strengthen the affected eye. eyeglasses. corrective surgery if severe or unresponsive to conservative therapy. if not treated before 2 years of age, amblyopia may occur = decreased visual acuity not correctable by refractive means |
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Definition
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Term
| bacterial MC cause, inflammation. pseudomonas or acanthamoeba (contact lens wearers). fungal. exposure keratitis (ex bell palsy). may rapidly progress and be sight-threatening. pain, photophobia, reduced vision, tearing, conjunctival erythema. conjunctival injection, ciliary injection (limbic flush), corneal ulceration/defect on slit lamp exam, purulent or watery discharge. 2 types |
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Definition
keratitis (corneal ulcer/inflammation)
bacterial keratitis: hazy cornea, ulcer, stromal abscess +/- hypopyon. mgmt: fluoroquinolone drops (ex Moxifloxacin, Gatifloxacin). Do not patch eye
HSV Keratitis: dendritic lesions = branching seen with fluorescein staining. Mgmt: topical antivirals: Trifluridine, Vidarabine, Ganciclovir ointment. PO acyclovir |
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Term
| can be caused by systemic inflammatory diseases: may be associated w HLA-B27 spondyloarthropathies, sarcoid, Behcet's. infectious: CMV, toxoplasmosis, syphilis, TB; trauma. if recurrent, suspect some underlying inflammatory disease. PE climiary injection (limbic flush), consensual photophobia +/- visual changes. inflammatory cells & flare within the aqueous humor (cells = WBCs Flare = proteins). 2 types |
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Definition
Uveitis (iritis)
anterior: unilateral ocular pain/redness/photophobia; excessive tearing (no discharge). anterior usually occurs after blunt trauma. mng w topical steroids, scopolamine, topical cycloplegics (ex cyclopentolate or homatropine) used to relieve the pain from spasms of the muscles controlling the pupil
Posterior: blurred/decreased vision, floaters, absent sx of anterior involvement, no pain. mng w systemic corticosteroids |
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Term
| lens opacification (thickening). usually bilateral. risk factors: aging MC >60y. cigarette smoking, corticosteroids, diabetes mellitus, uv light, malnutrition, trauma. congenital: ToRCH syndrome (toxoplasmosis, rubella, CMV HSV). blurred/loss of vision over months - years. PE: absent red reflex, opaque lens. mngmt surgical. differention dx: retinoblastoma (absent red reflex (fundus reflection) +/- white pupil |
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Definition
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Term
| optic nerve (disc) swelling 2rd to inc intracranial pressure (classically bilateral). enlarged blind spot. from idiopathic itracranial HTN (pseudotumor cerebri) or space-occupying lesion (ex cerebral tumor, abscess) or inc CSF production or cerebral edema, severe HTN (malignant, grade IV). headache, nausea/vomiting, vision is usually well preserved but may have changes. diagnose w funduscopy: swollen optic disc w blurred margins. MRI or CT scan of the head 1st to rule out mass effect -> LP (inc CSF) manage w diuretix (ex Acetazolamide ) (dec's production of aqueous humor and CSF) |
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Definition
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Term
| edema of the optic nerve in the orbit- optic neuritis. unilateral. visual deficits range from central scotoma to complete loss of vision. blurred disc-cup. pos marcus gunn. mng w corticosteroids. |
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Definition
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Term
| edema of optic nerve behind the eye- optic neuritis. unilateral. visual deficit ranges from central scotoma - complete loss of vision. fundoscopic exam normal. marcus funn pos. management w corticosteroids. |
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Definition
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Term
| edema of the optic nerve from inc intraocular pressure. acute: unilateral. chronic: bilateral. visual deficits from halos around light to blindness. funduscopic blurred disc-cup. marcus gunn neg. manage by reduce IOP |
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Definition
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Term
| acute inflammatory demyelination of the optic nerve. MC young pts 20-40y. caused by Multiple sclerosis MC or medications: ethambutol, chloramphenicol, autoimmune. clinical manifestations are loss of color vision, visual field defects (ex central scotoma/blind spot), loss of vision over a few days (usually unilateral). associated w ocular pain that is worse w eye movement. marcus-gunn pupil: relative afferent pupillary defect - during swinging-flashlight test from the unaffected eye into the affected eye, the pupils appear to dilate (delayed response of the affected optic nerve). funduscopy shows 2/3 normal disc/cup (retrobulbar neuritis_ or 1/3 + optic disc swelling/blurring (papillitis). MRI also used in some cases. mngmt w IV methylprednisolone followed by oral corticosteroids. vision usually returns w tx |
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Definition
| optic neuritis (optic nerve/CN II inflammation) |
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Term
optic neuritis mc cause or severe retinal disease (CRVO, CRAO, significant retinal detachment). during swinging-flashlight test into the unaffected eye, both pupils constrict.
-during swinging-flashlight test from the unaffected eye into the affected eye, the pupils appear to dilate (due to less than normal constriction). when you shine a ray int he affected pupil it dilates |
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Definition
| marcus gunn pupil (relative afferent pupillary defect) |
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Term
| near-light dissociation. pupil constricts on accommodation but does not react to bright light. causes: neurosyphilis MC, midbrain lesions (ex Parinaud syndrome), diabetic neuropathy |
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Definition
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Term
| if lesion is on optic nerve or retina |
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Definition
| total blindness of ipsilateral eye |
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Term
| if lesion is lateral to the optic chiasm |
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Definition
| ipsilateral nasal hemianopsia |
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Term
| if midline optic chiasm lesion (ex pituitary adenoma) |
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Definition
| bitemporal heteronymous hemianopsia |
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Term
| if lesion at optic tract or in occipital lobe stroke |
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Definition
| contralateral honymous hemianopsia |
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Term
| inc intraocular pressure (IOP) -> optic nerve damage -> dec visual acuity. ophtho emergency! decreased drainage of aqueous humor via trabecular meshwork and canal of schlemm in patients with preexisting narrow angle or large lens - elderly, hyperopes (far-sighted) and asians. leading cause of preventable blindness in US. precipitated by mydriasis (pupillary dilation further closes the angle- ex dim lights, sympathomimetics and anticholinergics). get severe, sudden onset of unilateral ocular pain +/- nausea/vomiting, headach. vision changes: intermittent blurring, halos around lights, peripheral vision loss (tunnel). PE shows conjunctival erythema, "steamy" cornea = corneal epithelial edema or cloudiness, shallow chamber, mid-dilated, fixed, nonreactive pupil, eye feel hard to palpation. diagnose inc intraocular pressure by tonometry (>21 mmHg), cuppic of optic nerve on funduscopy. 2 steps in management- lower IOP + open the angle (cholinergics). 1st line acetazolamide to dec IOP by decing aqueous humor production. topical beta blocker Timolol reduces IOP w/o affecting visual acuity. mitotics/cholinergics (Pilcarpine, Carbachol) ACl- induced papillary constriction, reduces intraocular pressure by increasing aqueous humor drainage. reverses the angle closure )Usually started once IOP is being reduced) S/E visual changes, lens opacity. Alpha-2 agonists: Apraclonidine, Brimonidine) suppress aqueous humor production and inc outflow. peripheral iridotomy is the definitive treatment |
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Definition
| acute narrow angle-closure glaucoma |
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Term
| slow, progressive bilateral peripheral vision loss (compared to unilateral vision in acute glaucoma) 2nd MC cause of blindness in the world (after cataracts). african-americans, age >40y, family history, diabetes mellitus (DM). normal anterior chamber. inc IOP due to reduced aqueous drainage through the trabeculum, which eventually damages the optic nerve. gradual bilateral painless peripheral vision loss (tunnel vision) -> central loss. usually asymptomatic until later in the disease course and vision loss is usually the presenting symptom. PE: cupping of optic discs (inc cup to disc ratio), notching of the disc rim. prostaglandin analogs 1st line (ex latanoprost - greater reduction of IOP, timolol (B-blocker), Brimonidine (z-2 agonists), Acetazolamide (carbonic anhydrase inhibitor - reduction of IOP. laser therapy (Trabeculoplasty) if medical therapy fails. surgical (trabeculostomy last line tx) |
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Definition
| chronic (Open angle) glaucoma |
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Term
| temporary monocular vision loss (lasting minutes) w complete recovery. due to retinal emboli or ischemia. can be seen w TIA, giant cell arteritis, CRAO, SLE and other vasculitic disorders. vision loss described as temporary "curtain" that resolves ("lifts up") usually within 1 hour |
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Definition
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Term
| retinal artery thrombus or embolus. MC 50-80y with atherosclerotic disease. ophtho emergency! acute sudden monocular vision loss often preceded by amaurosis fugax. funduscopy shows pale retina with cherry-red macula (red spot) due to obstruction of retinal blood flow. "box car" appearance of the retinal vessels (segmentation) +/- emboli (20%) No hemorrhage. no treatment has been shown truly effective but should be attempted. decrease IOP to prevent anterior chamber involvement ex Acetazolamide, chamber paracentesis. Revascularization including placing the patient supine and orbital massage |
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Definition
| central retinal artery occlusion (CRAO) |
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Term
| central retinal vein thrombus-> fluid backup in retina -> acute, sudden monocular vision loss. risk factors: HTN, DM, glaucoma, hypercoagulable stages. funduscopy shows extensive retinal hemorrhages ("Blood & thumder" appearance), retinal vein dilation, macular edema, optic disc swelling +/- relative afferent pupillary defect. no known effective tx +/- antiinflammatories, steroids, laser photocoagulation. may resolve spontaneously or progress to permanent vision loss |
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Definition
| central retinal vein occlusion (CRVO) |
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Term
| "swimmer's ear"- excess H2O or local trauma changes the normal acidic pH of the ear, causing bacterial overgrowth. Pseudomonas MC, Proteus, S. aureus, S. epidermis, GABHS, anaerobes (Peptostreptococcus), Aspergillus. 1-2 days of ear pain, pruritis in the ear canal (may have recent activity of swimming), auricular discharge, pressure/fullness. hearing usually preserved. pain on traction of the ear canal/tragus, external auditory canal erythema/edema/debris. Mngmt: protect ear against moisture (drying agents include isopropyl alcohol and acetic acid) topica abx: ciprofloxacin/dexamethasone (ofloxacin safe if there is an associated TM perforation). aminoglycoside combination: Neomycin/Polytrim-B/Hydrocortisone otic (not used if TM perforation is suspected - aminoglycosides are ototoxic). amphotercin B if fungal |
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Definition
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Term
| osteomyelitis at skull base 2ry to Pseudomonas (MC seen in DM and immunocompromised) management: IV antipseudomonal Abx ex Ceftazidime or Piperacillin + Fluoroquinolones or Aminoglycoside |
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Definition
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Term
| inflammation of the mastoid air cells of the temporal bone. usually a complication of prolonged or inadequately treated otitis media. all pts w acute otitis media have some degree of this because the middle ear is connected. get deep ear pain (usually worse at night), fever, mastoid tenderness, may develop cutaneous abscess (fluctuance), complications: hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain abscess. diagnosis is CT scan 1st line. manageemnt is IV antibiotics and middle ear/mastoid drainage hallmark of treatment. ear/mastoid drainage: myringotomy with or without tympanostomy tube placement. tympanocentesis can be performed to obtain a middle ear culture. IV antibiotics: same antibiotics used in acute otitis media. refractory or complicated -> removal |
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Definition
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Term
| infection of middle ear, temporal bone and masoid air cells. MC preceded by viral URI. rapid onset and sign/sx of inflammation. 4 MC organisms: S. pneumo (MC), H. influenza, Moraxella catarrhalis, Strep pyogenes (same organisms seen in Acute sinusitis) peak age 6-18 months. upper respiratory infection causes Eustachian tube edema -> negative pressure -> transudation of fluid and mucus in the middle ear -> 2ry colonization by bacteria and flora. risk factors: eustachian tube (ET) dysfunction, young (ET is narrower, shorter and more horizontal), day care, pacifier/bottle use, parental smoking, not being breastfed. get fever, otalgia (ear pain), ear tugging in infants, conductive hearing loss, stuffiness. If TM performation -> rapid relief of pain and otorrhea (usually heals in 1-2 days). bulging, erythematous tympanic membrane (TM) with effusion. loss of landmarks. decreased tympanic membrane mobility on pneumatic otoscopy. If bullae on TM -> suspect Mycoplasma pneumoniae. manage w antibiotics: amoxicillin/clavulanic acid (augmentin) or Cefaclor. PCN allergic -> erythromycin-Sulfisoxazole, Azithromycin, Trimethoprim/Sulfamethoxazole. severe/recurrent cases: myringotomy (surgical drainage). tympanostomy if recurrent or persistent. with effusion: observation in most cases. In children w recurrent -> iron deficiency anemia workup and CT scan |
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Definition
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Term
| MC pseudomonas, S. aureus. also GNRs (Proteus), anaerobes, Mycoplasma. See Perforated TM and persistent or recurrent purulent otorrhea +/- pain. May have varying degrees of conductive hearing loss +/- cholesteatoma. manage w topical antibiotics 1st line (Oflaxacin or Ciprofloxacin). Avoid water/moisture/topical aminoglycosides in the ear whenever there is a TM rupture. Surgical can do tympanic membrane repair/reconstruction and Mastoidectomy in severe cases |
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Definition
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Term
| often follows viral URI or alleric rhinitis. ear fullness, popping of ears, underwater feeling, intermittent sharp ear pain, disequilibrium, fluctuating conductive hearing loss, tinnitis. Otoscopic findings usually normal +/- fluid behind TM if acute serous otitis media. Manage w decongestants- pseudoephedrine, phenylephrine, oxymetazoline nasal spray, Autoinsufflation (swallowing, yawning, blowing against a slightly-pinched nostril), intranasal corticosteroids. pts may develop acute serous otitis media (non-infected fluid in the middle ear), which may become colonized by bacteria- infectious otitis media if the blockage is prolonged. ET swelling inhibits ET's autoinsufflation ability -> negative pressure |
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Definition
| Eustachian tube dysfunction |
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Term
| rapid pressure change -> inability of ET to equalize pressure -> sx similar to ET dysfunction. ex taking a flight on an airplane (descent), scuba divers or pts on mechanical ventilation. get auricular pain and fullness/hearing loss that persists after the etiologic event. may have bloody discharge if traumatic. tympanic membrane +/- rupture or petechiae. manage w autoinsufflation (swallowing, yawning) and decongestants or antihistamines (dec's ET edema) |
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Definition
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Term
| weber lateralizes to normal ear. normal rinne, AC>BC. difficulty hearing their own voice and deciphering words |
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Definition
| sensorineural loss (inner ear) |
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Term
| weber lateralizes to affected ear, BC>AC rinne. |
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Definition
| conductive loss (ext/middle) |
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Term
| defect in sound (ex obstruction from a foreign body or cerumen impaction), damage to ossicles (otosclerosis, cholesteatoma), mastoiditis, otitis media (cerumen impaction MC cause) |
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Definition
| conductive hearing loss etiologies (external or middle ear disorders) |
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Term
| presbyacusis, chronic loud noise exposure, CNS lesions (ex acoustic neuroma), labyrinthitis, Meniere syndrome (presbyacusis MC cause) |
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Definition
| etiologies of sensorineural hearing loss (inner ear disorders) |
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Term
| external auditory canal wax impaction. may lead to conductive hearing loss, ear fullness. manage w cerumen softening (hydrogen peroxide 3%, carbamide peroxide (Debrox). and aural toilet- irrigation, curette removal of cerumen, suction. irrigation if no evidence of TM perforation and water must be at body temp to prevent vertigo |
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Definition
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Term
| MC occurs due to penetrating or noise trauma (MC occurs at the pars tensa), otitis media. get acute ear pain, hearing loss, +/- bloody otorrhea +/- tinnitus and vertigo. diagnose w otoscopic examination +/- copnductive hearing loss ( weber lateralization to affected ear, rinne BC>/=AC. mostly heal spontaneously. follow up to ensure resolution +/- surgical repair. avoid water/moisture/topical aminoglycosides in the ear. may lead to cholesteatoma development |
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Definition
| tympanic membrane perforation |
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Term
| abnormal keratinized collection of desquamated squamous epithelium -> mastoid bony erosion. MC due to chronic ET dysfunction: chronic negative pressure inverts part of the tympanic membrane -> granulation tissue that erodes the ossicles over time -> conductive hearing loss. get painless otorreha (brown/yellow discharge w strong odor) +/- develop vertigo/dizziness. otoscope shows granulation tissue (cellular debris) +/- perforation of tympanic membrane. peripheral vertigo, conductive hearing loss (weber lateralization to affected ear, rinne BC>=AC). manage w surgical excision of the debris/cholesteatoma & reconstruction of the ossicles |
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Definition
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Term
| abnormal bony overgrowth of the stapes bone -> conductive hearing loss (blocked conducton). slowly progressive conductive hearing loss, tinnitus. vertigo uncommon. manage w stapedectomy w prosthesis. hearing aid. cochlear implantation if severe |
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Definition
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Term
| MC in children <6y. ear pain, drainage, conductive hearing loss. may be asymptomatic. manage w foreign body removal and assess for tympanic membrane rupture or complications |
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Definition
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Term
| false sense of motion or exaggerated sense of motion. 2 types. nausea and vomiting caused by sensory conflict mediated by the neurotransmitters GABA, acetylcholine, histamine, dopamine and serotonin. antiemetics work primarily by these transmitters. antihistamines 1st line. MOA: blocks emetic response. most antihistamines have anticholinergic properties. ex Meclizine, Cyclizine, Dimenhydrinate, Diphenhydramine (Benadryl). 2. dopamine blockers (phenothiazines)- metoclopramide, prochlorperazine, IV Promethazine MOA: antagonizes dopamine D2 receptors, used to treat severe nausea/vomiting. often given w Benadryl to prevent dystonic reactions. Dopamine inhibition may lead to Parkinsonism symptoms. Anticholinergic property of Benadryl prevents/tx dyskinesias. 3. Anticholinergics: Scopolamine (good for motion sickness and recurrent vertigo) S/E: dry mouth, blurred vision, urinary retention, constipation. 4. benzodiazepines: lorazepam, diazepam used in refractory pts (potentiates GABA) |
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Definition
vertigo
1. peripheral vertigo- labyrinth or vestibular nerve (part of CN VIII)- benign positional vertigo MC- episodic, no hearing loss. Meniere- episodic + hearing loss. vestibular neuritis- continuous vertigo, no hearing loss. labyrinthitis-continuous vertigo + hearing losss. cholesteatoma. get horizontal nystagmus (usually beats away from affected side). fatigable. sudden onset of tinnitus and hearing loss usually associated wtih peripheral compared to central causes
2. central vertigo- brainstem or cerebellar. cerebellopontine tumors, migraine, cerebral vascular disease, multiple sclerosis, vestibular neuroma. vertical nystagmus. nonfatigable (continuous). gait problems more severe, gradual onset, positive CNS signals |
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Term
| caused by displaced otoliths (calcium carbonate particles). MC cause of vertigo. normally, otoliths are attached to the hair cells inside the saccule and utricule (attached to the 3 semicircular canals). head movements cause displaced otolith movement -> vertigo. get sudden, episodic peripheral vertigo provoked w . changes of head positioning. vertigo usually lasts 10-60 seconda. pos dix-hallpike test/nylan barany: patient placed in supi9ne position w head 30deg lower than body. head quickly turned 90deg to one side -> delayed fatigable horizontal nystagmus. if nystagmus is persistent or non-fatigable, assess for a central cause of vertigo. manage w epley maneuver: canalith repositioning mainstay of treatment, usually resolves w time as the otoliths naturally dissolve and the vertigo episodic/brief -> medications usually not needed. medications: antihistamines, anticholinergics, benzodiazepines (ex Lorazepam only short-term) |
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Definition
| benign paroxysmal positional vertigo |
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Term
| the bony and membranous part of the inner ear. consists of cochlea and vestibular system |
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Definition
labyrinth
chochlea- responsible for hearing (converts wave impulses from the middle ear into auditory nerve impulses
vestibular system- 3 semicircular canals originating in the vestibule responsible for balance |
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Term
| inflammation of the vestibular portion of CN8 MC after viral infection. peripheral vertigo (usually continuous), dizziness, N/V., gait disturbances. nystagmus is usually horizontal and rotary (away from the affected side). corticosteroids 1st line. if symptomatic: antihistamines (ex Meclizine), benzodiazepines |
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Definition
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Term
| vestibular neuritis + hearing loss/tinnitus (from cochlear involvement). hearing loss. symptoms usually resolve in weeks. manage w corticosteroids 1st line, if symptomatic: antihistamines (ex Meclizine), benzodiazepines |
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Definition
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Term
| idiopathic distention of the endolymphatic compartment of the inner ear by excess fluid -> increased pressure within the inner ear -> hearing and balance disorders characterized by: 1. episodic vertigo: peripheral lasting minutes-hours. 2. tinnitis 3. ear fullness 4. fluctuating hearing loss (primarily low-tone hearing loss). episodic peripheral vertigo lasting 1-8 hours, horizontal nystagmus, nausea, vomiting. diagnosis: transtympanic electrocochleography most accurate test during an active episode. loss of nystagmus w caloric testing seen. laudiometry (loss of low lones esp). management: symptomatic: antiemetics: antihistamines (ex Meclizine, Prochlorperazine), benzodiazepines (ex Diazepam), anticholinergics (ex Scopolamine). decompression if refractory to meds or severe (ex Tympanostomy tube). labyrinthectomy. Preventative: diuretics (ex Hydrochlorothiazide) reduces endolymphatic pressure. avoidance of salt/caffeine/chocolate/ETOH (because they inc endolymphatic pressure) |
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Definition
| Meniere's disease (idiopathic endolymphatic hydrops). Meniere syndrome is due to an identifiable cause. meniere disease is idiopathic |
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Term
| cranial nerve VIII/8 schwannoma- benign tumor of schwann cells, which produce myelin sheath. unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise. tinnitus, headache, facial numbness, continuous disequilibrium/vertigo (unsteadiness while walking). diagnosis w MRI, CT scan, usually unilateral. if bilateral, suspect neurofibromatosis type II. manage w surgery or focused radiation therapy depending on age, tumor location, size etc |
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Definition
| acoustic (vestibular CN VIII neuroma) |
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Term
1-4 weeks. maxillary>ethmoid>frontal>sphenoid
caused by same organisms as acute otitis media- S. pneumo. H. flu, GABHS, M. catarrhalis. often occurs w concurrent rhinitis or follows viral URI, dental infections. URI leads to edema, which blocks drainage of the sinuses -> fluid buildup -> baxterial colonization. get sinus pain/pressure that's worse w bending down and leading forward. maxillary MC- cheek pain/pressure may radiate to upper incisors. frontal: CN VI palsy. Ethmoid: tenderness to the high lateral wall of the nose. sphenoid: mild head pressure. get headach, malaise, purulent sputum or nasal discharge, fever, nasal congestion. physical exam: sinus tenderness on palpation, opacification with transillumination. clinical diagnosis is primary clinical. sympotms should be present >1 week. CT scan is diagnostic test of choice. sinus radiographs: water's view. management: symptomatic therapy- decongestants, antihistamines, mucolytics, intranasal corticosteroids, analgesics, nasal lavage. indicated if symptoms <7 days or used as adjunctive treatment. antibiotics: symnptoms should be present for >10-14 days or earlier if facial swelling, febrile etc. amoxicillin drug of choice x 10-14 days. 2nd line: doxycycline, trimethoprim-sulfamethoxazole (bactrim). fluoroquinolones or amoxicillin/clavulanic acid used if recent antibiotic use/refractory cases |
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Definition
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Term
symptoms >/= 12 consecutive weeks. bacterial: S. aureus MC, pseudomonas, anaerobes. other: Wegner's (necrotic). fungal: aspergillus MC, murcormycosis 2nd most common
-management deprends on etiology. mucormycosis: fungi (mucor, rhizopus, absidia, cunninghamella) invade the sinuses and may enter the CNS. often affects the orbits, sinuses, lungs and CNS. seen in ummunocomprimised patients (ex DM post transplant, chemotherapy, HIV). Mucormycosis mnay be associated w black eschar on palate, face. get sinus pain/pressure, headache, malaise, purulent sputum or nasal discharge, fever, nasal congestion. Manage w IV amphotericin B 1st line. Posaconazole. May need surgical debridement |
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Definition
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Term
| allergic MC type overall- IgE-mediated mast cell histamine release. infectious- rhinovirus MC infectious cause (common cold). GABHS & strep less common. vasomotor- nonallergic/noninfectious dilation of the blood vessels (ex. temperature change). clinical manifestations- sneezing, nasal congestion/itching, clear rhinorrhea. eyes, ears, nose and throat may be involved. allergic associated with nasal polyps & tends to be worse in the morning. allergic: pale/violaceous, boggy turbinates, nasal polyps with cobblestone mucosa of the conjunctiva. Viral: erythematous turbinates. manage w avoidance and environmental control, exposure reduction. intranasal corticosteroids if allergic. oral antihistamines: decreases itching, sneezing, pruritis & rhinorrhea (little effect on congestion), nonsedating: Cetirizine, Fexofenadine, Lortadine. minimally sedating: desloratadine. sedating: Brompheniramine, chlorpheniramine, hydroxyzine, diphenhydramine. Decongestants: MOA: improve congestion (little effect on rhinorrhea, sneezing pruritus) intranasal: oxymetazoline, phenylephrine, naphazoline. oral: pseudoephedrine. intranasal decongestants: used >3-5 days may cause rhinitis medicxamentosa (rebound congestion). intranasal steroids: most effective med for allergic rhinitis (especially with nasal polyps). mast cell stabilizers can be used in allergic rhinitis. anticholinergics may help for rhinorrhea |
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Definition
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Term
| allergic rhinitis MC etiology. may be seen w cystic fibrosis. samter's triad: asthma + nasal polyps + aspirin/NSAID sensitivity/allergy. most are incidental findings but if large, they can cause obstruction or anosmia (decreased smell). see signs of allergic rhinitis: pale/violaceous, boggy turbinates, cobblestone mucosa of the conjunctiva. nasal masses w inspection of the nose. mngment: intranasal corticosteroids are the treatment of choice. surgical removval may be needed in some cases only if medical therapy is unsuccessful |
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Definition
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Term
anterior MC. risk factors: nasal trauma (nose picking, blowing nose forcefully), low humidity in a hot environment (dries nasal mucosa), rhinitis, ETOH, antiplatelet. Kiesselbach's plexus MC site of bleeding in anterior.
posterior: hypertension and atherosclerosis MC risk factors. palatine artery MC site for posterior (may cause bleeding in both nares and posterior pharynx). manage w direct pressure- 1st line therapy for most cases. pressure applied atleast 10-15 min w the pt in the seated position leaning forward to reduce vessel pressure. topical decongestants/vasoconstrictors: may be adjunctive therapy with direct pressure. Phenylephrine, Oxymetazoline nasal (Afrin), cocaine. cautious use in patients w HTN. cauterization: ex silver nitrate if the above measures failed and the bleeding site can be seen. nasal packibng: if direct pressure and vasoconstrictors are unsuccessful or in severe bleeding. may consider antibiotic (Cephalexin or Clindamycin) to prevent toxic shock syndrome if packed. Adjunct therapy: avoid exercise for a few days, avoid spicy foods (they cause vasodilation). bacitracin and humidifiers helpful to moisten the nasal mucosa. septal hematoma associated w loss of cartilage if the hematoma is not removed |
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Definition
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Term
| most commonly seen in children. asymptomatic. mucopurulent nasal discharge, foul odor, epistaxis, nasal obstruction (mouth breathing). diagnosis w direct visualization (head light and otoscope). rigid or flexible fiberoptic endoscopy. radiographs not usually needed (+/- helpful if button batteries are suspected and not visualized). mngmt: foreign body removal via positive pressure technique: having the patient blow his or her nose while occluding the nostril opposite of the foreign body. oral positive pressure: parent blows into the mouth while occluding the unaffected nostril (used in smaller children). or instrument removal |
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Definition
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Term
| Viral MC overall cause- Adenovirus, rhinovirus, enterovirus, epstein-barr virus, respiratory syncytial virus, Influenza A&B, herpes zoster virus. bacteria: Group A beta hemolytic streptococcus (GABHS/S.pyogenes) MC bacterial cause. get sore throat, pain or swallowing or with phonation. other symptoms based on the etiology. management is symptomatic: fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs. antibiotics if S. pyogenes: Penicillin, Amoxicillin. PCN allergy: erythroycin or clindamycin |
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Definition
| acute pharyngitis/tonsillitis |
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Term
| caused by Group A beta hynolytic strep aka Strep pyogenes. get sore throat. 1 point each for: fever>38C/100.4F, pharyngotonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough. 0-1-> no antibiotic or throat culture needed, <10% for strep but 5-15y throat cultures should be sent in all cases. 2-3-> throat culture, 2 pts 15% change of strep pos 32% if 3 pts. 4-5-> give antibiotics (56% chance). <15y add 1 pt, >44y subtract 1 pt (more effective for ruling out strep throat than diagnosing). diagnose w rapid antigen detection test (95% specific but only 55-90% sensitive, if neg obtain a throat cx. throat cx is definitive diagnosis/gold standard. normal course of illness is 3-5 days. shortened by 48 hrs w treatment, therefore treatment is given mostly to prevent complications (ex rheumatic fever). Penicillin G or VK 1st line- amoxicillin, amoxicillin/clavulanic acid (Augmentin). Macrolides if PCN allergic. toehr alternatives- Clindamycin, Cephalosporins. complications- Rheumatic fever (preventable w antibiotics), glomerulonephritis (not preventable w antibiotics), peritonsillar abscess, cellulitis |
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Definition
| streptococcal pharyngitis (strep throat) |
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Term
tonsillitis -> cellulitis -> abscess formation
-MC strep pyogenes (GABHS), staph aureus, polymicrobial (including anaerobes)
-get dysphagia, pharyngitis, muffled "hot potato voice", difficulty handling oral secretions, trismus, uvula deviation to contralateral side, tonsillitis, anterior cervical lymphadenopathy. CT scan is 1st line test to differentiate fro cellulitis. manage w antibiotics + aspiration or I & D (incision and drainage)- ampicillin/sulbactam (Unasyn); clindamycin; penicillin G plus Metronidazole. Tonsillectomy indications: recurrent strep infections, recurrent peritonsillar infections, chronic tonsillitis |
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Definition
| peritonsillar abscess (quinsy) |
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Term
| inflammation of the larynx. infectious MC cause or trauma (vocal abuse- singers, screaming). viral infection MC- adenovirus, rhinovirus, influenza, respiratory syncytial virus, parainfluenza. bacterial causes include M. catarrhalis and Mycoplama pneumoniae. clinical manifestations- hoarseness hallmark, aphonia, pharyngitis, rhinitis, cough. mngmt- supportive: vocal rest, warm saline gargles, anesthetics, lozenges, increased fluid intake |
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Definition
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Term
| caused by candida albicans. candida is part of the normal flora but can become pathogenic due to local or systemic immunosuppressed states (ex HIV, chemotherapy, use of steroid inhalers w/o spacer, antibiotic use, diabetics, denture use, etc). clinical manifestations- mouth or throat pain. diagnosis: clinical-white curd-like plaques (+/- leave behind erythema/bleeds if scraped). potassium hydroxide (KOH) smear shows budding yeast/pseudohyphae. manage w nystatin liquid tx of choice, clotrimazole troches, oral fluconazole |
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Definition
| oral candidiasis (thrush) |
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Term
| percancerous hyperkeratosis due to chronic irritation (ex tobacco, cigarette smoking, ETOH, dentures). up to 6% show dysplasia or squamous cell carcinoma. diagnosis of exclusion. painless white patchy lesion that cannot be scraped off (in comparison to candida which is painful and can be scraped off). mngmt w cryotherapy, laser ablation, biopsy to assess for cancer risk |
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Definition
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Term
| precancerous lesions similar to leukoplakia but with an erythematous appearance. 90% is either dysplastic or evident of squamous cell carcinoma |
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Definition
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Term
| caused by Epstein-Barr virus (Human herpesvirs-4). MC in immunocompromised (HIV, post transplant, chronic steroid, chemotherapy). painless, white plque along the lateral tongue borders or buccal mucosa +/- smooth, or irregular "hairy" or "feathery" lesions w prominent folds or projections (appearance may change daily). CANNOT be scraped off. mngmt is no specific treatment bc it may spontaneously resolve. or antiretroviral tx, ablation. |
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Definition
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Term
| unknown cause but may be associated w human herpes virus 6. small round or oval painful ulcers (yellow, white or grey centers) w erythematous halos. MC on buccal or labial mucosa (nonkeratinized mucosa). mngmt is topical analgesics, topical oral steroids (ex Triamcinolone in orabase, Fluocinonide), vitamin B& C. Cimetidine may be used in some pts w recurrent ulcers |
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Definition
| aphthous ulcers (canker sore, ulcerative stomatitis) |
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Term
| MC in Wharton's duct (submandibular gland duct) also stensen's duct (parotid gland duct), get postprandial salivary gland pain & swelling. conservative mngmt: sialogogues (ex tart, hard candies, lemon drops, Xylitol-containing gum or candy to increase salivary flow), increase fluid intake, gland massage. avoid anticholinergic drugs if possible (anticholinergics decrease salivation). extracorporeal lithotripsy, intraoral stone removal if no response to conservative therapy |
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Definition
| sialolithiasis (salivary gland stones) |
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Term
| bacterial infection of parotid or submandibular salivary glands +/- occur with dehydration, chronic illness. S. aureus MC or mixed aerobic/anaerobic infections. get acute pain, swelling and erythema near the gland especially with meals. tenderness at the duct opening +/- pus if the duct is massaged. local pain, dysphagia, trismus (reduced opening of the jaw due to spasms of the muscles of mastication). may develop fever and chills if severe. diagnosis w CT scan to assess for associated abscess/extent of tissue involvement. management w sialogogues ex tart hard candies or lemon drops used to increase salivary flow. antibiotics: antistaphylococcus (Dicloxacillin or Nafcillin) plus Metronidazole or Clindamycin if severe |
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Definition
| acute bacterial sialadenitis (suppurative sialadenitis) |
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Term
| idiopathic cell-mediated autoimmune respons (inc in pts w HCV infection). get lacy leukoplakia of the oral mucosa commonly (Wickham striae). manage w local or systemic corticosteroids |
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Definition
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Term
| primary manifestation of HSV-1 in children. MC occurs between 6 months - 5 years. get sudden onset of fever, anorexia -> gingivitis (gum swelling, friable/bleeding gums), vesicles on the oral mucosa, tongue and lips -> grey/yellow lesions. management is usually self-limiting. acyclovir in severe cases |
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Definition
| acute herpetic gingivostomatitis |
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Term
| primary manifestation of HSV-1 in adults. clinical manifestations are fever, malaise, headache, sore throat. PE shows vesicles that rupture -> ulcerative lesions w grayish exudates in the posterior pharyngeal mucosa. mngmt is oral hygeiene - lesions usually resolve within 7-14 days |
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Definition
| acute herpetic pharyngotonsillitis |
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Term
| cellulitis of the sublingual and submaxillary spaces in the neck. MC secondary to dental infections (anaerobic infections). get swelling and erythema of the upper neck and chin w pus on the floor of the mouth. CT is diagnostic test of choice. antibiotics: ampicillin/sulbactam (unasyn) or penicillin plus metronidazole or clindamycin |
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Definition
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