Eye disorders
Conjunctivitis
- Viral: preauricular adenopathy
- bacterial: topical abx
- allergic: triggered, itching, bilateral
- Newborn ppx: erythromycin (MC: chlamydia)
- G/C conjunctivitis: vision threatening
Corneal disorders
Cataracts
- lens opacification
Corneal ulcer - infection of corneal tissue: MC bacterial
- risks: contact lens use, foreign body, chemical injury
- Tx: topical abx
Infectious
Keratitis
- HSV keratitis: immunocompromised, dendrites w/ fluorescein stain, unilateral ocular pain, oral acyclovir
Pterygium vs Pinguecula - risks: UV / dust exposure
- pterygium: triangular, crosses edge of iris
- resection only if visual impairment
Inflammatory disorders
Iritis
Scleritis - “white” part of eye
- Sx: severe, boring pain
- MC: autoimmune, rarely infectious (lyme, syphilis)
- Tx: NSAIDs, steroids/immunomodulators
Uveitis - inflammation of iris/choroid/ciliary muscle
- eye pain, photophobia, pupillary constriciton (miosis)
- slit lamp: WBCs, flare
- MC: autoimmune
- Tx: topical steroids
Lacrimal disorders
Dacryoadenitis
- inflammation of superotemporal lacrimal gland
- acute: Viral/bacterial, can ascend from conjunctivitis
- chronic: Sjogren’s, sarcoidosis, Crohn’s
Dacryocystitis - infection of lacrimal sac (medial canthus)
- tearing, erythema, warmth, purulence of inferior medial canthus
- Tx: warm compresses + oral abx
Dacryostenosis - obstructed nasolacrimal duct
- epiphoria (tear overflow)
- MC: congenital
- Tx: massage, stenting
Keratoconjunctivitis sicca (KCS) - chronic dry eyes
- inadequate tear production, Sjögrens
- schirmer test: measures tear production (decreased in KCS)
- Tx: lubricating eye drops
Lid disorders
Blepharitis
- eyelid margin inflammation: sebhorreic, infectious, rosacea
- Anterior: eyelid margin
- Posterior: interior meibomian glands
- Tx: warm compresses, eyelid scrubs
Chalazion - typically non-tender
- blockage of internal meibomian glad
- Tx: warm compresses
Ectropion - eyelashes out, droopy, excessive tearing
Entropion - eyelashes in, foreign body sensation, corneal damage
Hordeolum
Neuro-ophthalmologic disorders
Nystagmus
Optic neuritis
- MS (female, middle aged)
- unilateral vision loss, scotoma (black spot in vision), aferrent pupillary defect, painful EOMs, optic disc swelling
Papilledema - increased ICP (bilateral optic disc swelling)
- Sx: headaches, pulsatile tinnitus, CNVI palsy
Orbital disorders
Orbital cellulitis
- emergency!
- painful EOMs, proptosis
- secondary to sinus infection
- IV abx, admit
Periorbital (preseptal) cellulitis - no painful EOMs, no proptosis,
- Tx: augmentin
Orbital Rim Fracture - painful/impaired EOMs
Retinal disorders
Macular degeneration
- dry: progressive, MC, drusen
- wet: neovascularization, rapid vision loss
- Sx: bilateral progressive central vision loss, “wavy lines”
- amsler grid monitoring
Retinal detachment - risk factors: myopia, catarct surgery, age
- Sx:
Retinopathy - Diabetic
- Hypertension
Retinal vascular occlusion - Central retinal vein occlusion: painless monocular vision loss
- Central retinal artery occlusion: cherry red spot
Retinoblastoma
- “white” reflex, lack of red reflex
- MC: ~18mo, fundoscopy,
Vision abnormalities
Amaurosis fugax
- transient monocular vision loss (<1hr)
- TIA, GCA, central retinal artery occlusion
Glaucoma - acute angle closure
- non-reactive pupil, increased IOP, pain, vision loss, N/V
- timolol drops, iridotomy
- chronic/open angle
- most common, peripheral vision loss, enlarged optic cup
- Tx:
Presbyopia
- age related vision loss
Opia
| Feature | Amblyopia | Strabismus |
|---|---|---|
| Definition | ↓ visual acuity from abnormal visual development | Misalignment of eyes (esotropia, exotropia, etc.) |
| Primary problem | Brain suppression of one eye | Extraocular muscle / alignment issue |
| Eye alignment | Usually normal appearance | Abnormal (one eye deviates) |
| Vision | Decreased (often unilateral) | May be normal initially |
| Red reflex | Normal | Normal |
| Relationship | Can be caused by strabismus | Risk factor for amblyopia |
| Treatment | Patching good eye, atropine drops | Glasses, patching, surgery |
Ear
External ear
Cerumen impaction
Otitis externa
- bacterial: ciprodex
- fungal: aural toilet, fungal drops
- eczema: topical steroid drops/ointment
Inner ear
Acoustic neuroma
- benign
- unilateral SNHL, vertigo, tinnitus
- diagnosis: MRI
- Management: monitor, stereotactic radiation, or excision
Dysfunction of eustachian tubes
Labyrinthitis / vestibular neuritis - hearing and vertigo = labrynthitis
- vertigo only = vestibular
- HINTS+ peripheral
- Tx: oral steroids
Vertigo
BPPV
Middle ear
Cholesteatoma
- middle ear skin cyst
- presents with drainage, sometimes conductive hearing loss (can erode ossicles)
- surgery
Otitis media - adult
- unilateral middle ear effusion, no contributing history: nasopharyngeal mass until proven otherwise
- myringotomy
- children
- OME -> watch and wait
- AOM
Otosclerosis
Tympanic membrane perforation
Basilar Skull Fracture:
- Traumatic hemotympanum
- Battle’s sign
- Racoon eyes
Hearing impairment
Weber Test
- conductive hearing loss lateralizes to PROBLEM ear
- sensorineural hearing loss lateralizes to the GOOD ear
Rinne Test - bone > air : conductive loss
Conductive (outer/middle ear)
(screening: tuning fork, diagnose: audiogram)
- fluid, cerumen, TM perforation, cholesteatoma
Sensorineural (inner ear)
(screening: tuning fork, diagnose: audiogram) - presbycusis (age related hearing loss)
- medications
- trauma
- vestibular neuroma
- idiopathic (high dose oral steroid)
Other abnormalities of the ear
Mastoiditis
Meniere disease
- fluctuating low frequency SNHL
- unilateral humming tinnitus
- vertigo
- Dx: audiogram, vestibular testing, MRI
- Tx: low sodium diet, diuretics, lifestyle changes
Tinnitus - most common cause: hearing loss
- other: medications (ototoxic abx, salicyclates, NSAIDs)
Foreign bodies of the eyes, ears, nose, and throat
Trauma of the eyes, ears, nose, and throat
Barotrauma of the ear
Blowout fracture
Corneal abrasion
Globe rupture
Hyphema
Neoplasms
Benign
Malignant
Nose/sinus disorders
Epistaxis
Nasal polyps
Rhinitis
Sinusitis
Oropharyngeal disorders
Infectious/inflammatory disorders
Angioedema
Aphthous ulcers
Candidiasis
- scrapable white plaque
- recent abx, oral/inhaled steroids
- +odynophagia = systemic antifungals
Deep neck infection
Dental abscess
Dental caries
Epiglottitis
Gingivitis
Laryngitis
Peritonsillar abscess
Pharyngitis
Salivary disorders
Parotitis
Sialadenitis
Other oropharyngeal disorders
Leukoplakia
- doesnt scrape
- monitor