Term
Hordeolum (staphylococcus aureus)
Signs and Symptoms |
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Definition
Sx: Localized inflammation
Signs: inflammation of eyelash or small pustule at margin
Swelling and tenderness on internal (meibomain gland or external (sebaceous gland) w/opening
Itching of scaling eyelids; collection of discharge, redness, irritation leading to localized tenderness and pain |
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Term
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Definition
Warm, moist compresses to liquefy glandular secretion
No antibiotics
Steroid injection; intra-lesion
Lid massage to express impacted secretion
Lesions must be surgically incised and removed |
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Term
Hordeolum (Staphylococcus aureus)
Managment |
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Definition
warm, moist compress
Warm, moist compresses to hasten drainage
Antibiotic: topically: Erythomycin opth; for 1 week; systemic doxycycline for recurrent lesion
Steriod: none
Lid scrubs, discard of eye makeup, don’t express |
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Term
Chalazion
Signs and Symptoms |
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Definition
Small bump in eyelid caused by blockage of tiny oil gland
Sx: eyelid tenderness, increased tenderness, painful swelling on eyelid, sensitivity to light
Signs: eyelid confirms diagnosis |
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Term
Blephritis (staphylococcal, Seborrheic, Meibomain glands)
Managment |
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Definition
Bacitracin or e-mycin
Topical corticosteroids (short-term) increase risk: cataract
Meibomain gland: Doxycycline or tetracycline (2-4 wks)
Artificial tears
Contra: tetracycline no in preg, nursing or ped<8yrs
Fluoroquinolone (levofloxacin: persistent s. blepharitis) |
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Term
Blephritis (staphylococcal, Seborrheic, Meibomain glands)
Signs and Symptoms |
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Definition
All types: Burning, itching, eyelid erythema, conjuctival injection (red eye), tear deficiency, tearing, photophobia
Staphylococcal: recurrent, missing eyelid, scales, collarettes (ring like formation around lash), ulceration, eyelid scarring
Seborrheic: dry flakes, oily secretions, dandruff of scalp, eyebrows
Meibomian: eyelash misdirection, fatty deposits, thickening |
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Term
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Definition
Viral (nonherpetic): art. tears, vasoconstrictor/antihistamine (naphazolinephenirmamine)
Viral (herpetic): trilumidine, acyclovir (oral)
Bacterial: (self limited) bacitractin, E-mycin
Bacterial (gonococcal)ceftriaxone 1g IM
Allergic: ketotifen
Contra: avoid steroids |
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Term
| Conjunctivitis (adenovirus, S. aureus, seasonal allergies) |
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Definition
hx: * must document normal vision for dx
viral: one eye then both, herpetic: recurrences or vesicles on skin
Bacterial: assume bacterial in contact lens, STD suspect
Allergic: itching, seasonal dander
Irritant: feels dry tear film deficit, chemicals (meds)
Exam: red eye eyelid sticking crust
viral: rarely itching, herpetic skin vesicles
bacterial: r/o pseud. keratitis in contact wearer
bacterial: gonococcal: rapid onset, purulent
allergic: itching predominant |
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Term
Otitis Externa (bacterial, pseudomonas, fungal (Aspergillus)
Managment |
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Definition
Neomycin/polymyxin B/hydrocortisone, betamethasone (more effective) oral antibiotics if OE or erythema w/o discharge
Fungal: 2% acetic acid, clotrimazole 1%
Eczematous: 2%acetic acid, Burrow solution, steroid cream, antibacterial
Necrotizing: antistaphylococcal, antipseudomonal (quinolones) |
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Term
| Otitis externa (bacterial, pseudomonas, fungal) |
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Definition
Hx: variable: itching, plugging ear, pain, discharge
Exam: red, purulent discharge debris, pain on pinnae, periauricular adentitis, eczema of pinna |
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Term
Otitis Media (S. pneumonia, H. Inflenza, viral)
Managment |
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Definition
Ammoxicillin: children > 2 yrs 5-7 days; 10 day for < 2yr
PCN allergy: Azithomycin, Clarithromycin, Septra
Pain med: NSAID, benzocaine gttss
Recover: 3 months per AFPP. |
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Term
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Definition
Hx: earache, precede or accompany URI, decrase hearing
Exam: fever, decrase mobility, bulging, redness, otorrhea if perforated. Few sx in 1st few months of life |
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Term
Rhinitis, Allergic
Signs and Symptoms |
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Definition
Hx: atopic dermatitis/food allergies, nasal congestion, rhinorrhea, prurius o fnose, sneezing, itching, mouth breath
Exam: pale, boggy nasal mucosa, Rhinorrhea clear, dark circles eyes, postnasal discharge |
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Term
Rhinitis, Allergic
Management |
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Definition
2nd gen antihistamines:cetirizine, loratadine
intranasal corticosteroids: most effective drug class, Nasonex.
Psuedophedrine, Afrin <3 days
Nasal saline flush |
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Term
Acute Sinusitis
signs and sx |
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Definition
ALERT:
Sx predictive of bacterial sinusitis is worsening of symptoms >5–7 days after initial improvement.
other predictive of bacterial sinusitis:
Persistent symptoms for ≥10 days
Persistent purulent nasal discharge
Unilateral upper tooth or facial pain
Unilateral maxillary sinus tenderness
Fever
Pediatric
Sinuses are not fully developed until age 20. Maxillary and ethmoid sinuses, although small, are present from birth.
Peds sx often more subtle. |
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Term
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Definition
First Line
Decongestants,Analgesics,Antibiotics
2nd: Amoxicillin-clavulanat(Augmentin):
When bacterial infection is present, patients recover somewhat more quickly with antibiotics, but the majority will recover with symptomatic treatment alone |
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Term
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Definition
Modified Centor clinical prediction rule for group A strep.
+1 Tonsillar exudates
+1Tender anterior chain cervical adenopathy
+1 Fever by history
+1 Age < 15 years
0 Age 15–45 years
–1 Age > 45 years
–1 Cough (presence of cough almost always excludes diagnosis of group A strep.)
Scoring:
3–4 , positive predictive value of ~80%; treat emprically.
2 points, postitive predictive value of ~50%, rapid strep. antigen + culture; treat if either positive.
1 point, positive predictive value <50%, positive rapid strep. antigen or culture likely false-positive
0 or -1 points, positive predictive value <20%; do not test; close follow-up p.r.n.
Coryza (nasal congestion), hoarseness, cough, diarrhea, conjunctivitis, or viral rash highly suggests viral cause. |
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Term
pharyngitis
Signs and symptoms |
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Definition
Sore throat
Cough, hoarseness, lower respiratory symptoms
Fever
Anorexia
Chills
Malaise
Headache
Contacts with similar symptoms or diagnosed infection
Physical Exam
Enlarged tonsils
Pharyngeal erythema
Tonsillar exudates
Soft palate petechiae
Cervical adenopathy
Fever >102.5°F (>39.1°C)
Scarlet fever rash: Punctate erythematous macules with reddened flexor creases and circumoral pallor (streptococcal pharyngitis)
Gray pseudomembrane found in diphtheria and, occasionally, mononucleosis
Characteristic erythematous-based clear vesicles are found in herpes stomatitis.
Conjunctivitis is found more commonly with adenovirus infections. |
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Term
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Definition
For streptococcal pharyngitis, penicillin is the standard therapy
allergic to penicillin, erythromycin ethylsuccinate
Salt water gargles
Acetaminophen 15–20 mg/kg (pediatric) q4h gives more rapid relief than antibiotic therapy for strep. infection.
Anesthetic lozenges
Cool-mist humidifier |
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Term
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Definition
| Whenever the diagnosis is suspected, immediate hospitalization is required |
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Term
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Definition
There are 2 key aspects to the treatment:
* Maintenance of an adequate airway should be the primary concern Administration of antimicrobial agents
Medication (Drugs)
First Line
•Begin empiric antibiotic promptly after blood and epiglottic cultures are obtained. Use antibiotics guided by cultures thereafter. Duration of antimicrobial: 7–10 days
•Cefotaxime (Claforan) 100–200 mg/kg/d q.8h. IV
•Ceftriaxone (Rocephin) 50–100 mg/kg/d q.12h. IV
• Whenever the diagnosis is suspected, immediate hospitalization is required |
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Term
Peritonsillar abscess
Signs and Symptoms |
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Definition
History
•Extreme sore throat or neck pain
•Odynophagia
•Dysphagia
Physical Exam
•Fever >38°C
•Trismus
•“Hot potato voice” (thickened, muffled voice)
•Drooling and pooling of saliva in the mouth
•Tonsillar exudates seen uncommonly
•Erythematous, edematous tonsil
•Asymmetry of the oropharynx with inferior and medial displacement of the infected tonsil, often with contralateral deviation of the uvula
•Cervical adenopathy |
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Term
Peritonsillar abscess
management |
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Definition
First Line
•Penicillin remains the standard antimicrobial therapy
•For penicillin-allergic patients:
•Erythromycin ethyl succinate 300–400 mg p.o. t.i.d. or
•Same-day surgery is possible in some cases with outpatient management.
•IV rehydration
•Pain control
•Follow up with ENT surgeon, especially if symptoms recur or do not improve |
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Term
Dacryocystitis
Signs and sx |
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Definition
May present as an acute or indolent swelling and erythema of upper eyelid
•Swelling and tenderness greatest in temporal aspect of upper lid under orbital rim:
oS-shaped lid
•Mass may be palpable
•May be associated with:
oExtensive cellulitis
oConjunctival injection and discharge
oIncrease or decrease in tear production
oIpsilateral conjunctival injection and chemosis
oIpsilateral preauricular adenopathy
•Normal visual acuity, slit-lamp, and funduscopic exams
•May cause pressure on the globe or globe displacement:
oVisual distortion may occur.
•Chronic form: Slowly progressive, painless swelling |
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Term
Dacryoadentitis
Management |
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Definition
•Cool compresses to decrease inflammation and nonsteroidal pain medication
•Viral etiology:
oTypically self-limited inflammation
•Bacterial etiology:
oAntibiotics
oOral for mild infection:
Cephalexin
Amoxicillin/clavulanate
Dacryocystitis
•Drainage of infected sac is essential:
oWarm compresses and gentle massage to relieve obstruction
oMay facilitate outflow from obstructed tract with nasal introduction of vaso-constricting agent
oIncision and drainage only in severe cases |
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Term
Orbital Cellulitis
Signs and Symptoms |
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Definition
History
•Malaise and fever
•Most patients with history of sinusitis, dental infection, or history of eye surgery or trauma
•Diffuse unilateral periorbital edema and erythema
•Chemosis (conjunctival swelling)
•Pain with eye movement
•Restricted extraocular mobility
•Diplopia
•Proptosis and globe displacement
•Blurred vision or loss of vision
ALERT:
•Ophthalmoplegia, mental status changes, contralateral cranial nerve palsy, or bilateral orbital cellulitis may herald intracranial involvement.
Physical Exam
•Thorough inspection of the eye and surrounding structures
•Inspection of nasal vaults and sinus palpation for evidence of acute sinusitis
•Ocular motility testing
•Visual acuity testing |
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Term
Orbital Cellulitis
Management |
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Definition
Once diagnosed with orbital cellulitis, the patient should be admitted to a hospital for treatment and careful monitoring of ocular status
•Empiric antibiotic therapy at all ages should provide coverage for pathogens associated with acute sinusitis (S. pneumoniae, H. influenzae, M. catarrhalis, S. pyogenes), as well as for S. aureus and anaerobes.
Issues for Referral
•Ophthalmology and otolaryngology should be consulted early when orbital cellulitis is suspected.
•Infectious disease consultation should be considered if available.
•Neurology or neurosurgery should be consulted if intracranial spread is suspected |
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Term
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Definition
Physical Exam
Jaw range of motion (opening, closing, lateral, protrusive) and masticatory muscle strength |
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Term
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Definition
•Local heat therapy
•Anti-inflammatory medications
•Muscle relaxants
•Analgesics
•Correction of malocclusion with orthodontic appliance
•Stress reduction
•Behavior modification to eliminate tension-relieving oral habits
•Buccal separator orthodontic appliance
•Linearly polarized, near-infrared irradiation
First Line
•NSAIDs: No single drug more efficacious than another
•Botulinumtoxin |
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