Eyes/Some Ears/HEad and Neck Cancer

a 6-year-old boy complaining of itchy eyes. The mother states that she has noted that he has been tearing and that both of his eyes have been red for the past 4 days. The patient denies any pain but has had a runny nose for the past week. The mother states that he has not had any sick contacts, and he has been home from school for summer vacation. On exam, there is marked redness, tearing, and eyelid edema of both eyes. What is the dx?

allergic conjunctivitis

viral conjunctivitis

bilateral lymphadenopathy, red eye, watery discharge, scant mucoid discharge

causative organism for viral conjunctivitis

adenovirus

tx of viral conjunctivitis

supportive

bacterial conjunctivitis

red eye, purulent discharge, eyes glued shut in AM

causative organisms for bacterial conjunctivitis

staph aureus, strep pneumoniae, H. influenzae

allergic conjunctivitits

red eyes, itching, tearing bilaterally, cobblestoning of mucosa

tx for bacterial conjunctivitis

1st Line: erythromycin ointment

2nd line: FQ (1ST LINE FOR EYE CONTACTS)/ gentamycin/tobramycin, trimethoprim and polymyxin B

tx for bacteria conjunctivitis with contact lens

flouroquinilone like ciproflocacin to cover pseudomonas (pseudomonas is contact lens bacterial conuctivitis)

tx for allergic conjunctivitis

antihistamine like azelastine

A 32-year-old woman comes to your office with a 1-week history of bilateral red eyes associated with tearing and crusting, a sore throat with difficulty swallowing, and a cough that was initially nonproductive but has become productive during the past few days. The patient displays significant fatigue and lethargy, is hoarse, and is having great difficulty performing any of her routine daily chores. PE reveals bilateral conjunctival injection. Her visual acuity is normal. There is significant pharyngeal erythema but no exudate. Cervical lymphadenitis is not present. Examination of the chest reveals a few expiratory crackles bilaterally. what is the dx?

viral conjunctivitis

A 7 year old boy presents to your clinic with thick purulent discharge from her right eye which was significantly worse this morning. Whats the dx?

bacterial conjunctivitis

A 12 year old present to your office with red eyes, itching and tearing bilaterally. He has a past medical history significant for asthma. As you examine the inner eyelid what finding do you expect to see?

cobblestone mucosa

A 17-year-old girl comes to your office with a 1-day history of red eye. She describes not being able to open her right eye in the morning because of crusting and discharge. The right eye feels swollen and uncomfortable, although there is no pain. On examination, she has a significant redness and injection of the right bulbar and palpebral conjunctivae. There is a mucopurulent discharge present. No other abnormalities are present on physical examination. Her visual acuity is normal. whats the dx?

bacterial conjunctivitis

A 12 year-old presents with complaint of both eyes "watering." He also complains of sinus congestion and sneezing for two weeks. On exam vital signs are T-38°C, P-80/minute, and RR-20/minute. The eyes reveal mild conjunctival injection bilaterally, clear watery discharge, and no matting. Pupils are equal, round, and reactive to light and accommodation. The extraocular movements are intact. The funduscopic exam shows normal disc and vessels. The TMs are normal and the canals are clear. The nasal mucosa is boggy, with clear rhinorrhea. What is the most helpful treatment?

cool compress/topical lubrication for viral conjunctivitis

A patient presents complaining of left eye discharge and eyes that were matted shut this morning. The patient denies changes in visual acuity, but states that he is afraid to put his contacts in. On physical examination you note erythematous conjunctivae and mucopurulent discharge of the left eye. The cornea is clear. What is the topical agentfor tx of choice in this patient?

FQ, topical antibiotics (polytrim, oflaxacin)

main cause of viral conjunctivitis

adenovirus

a 45-year-old individual who noticed a bright red patch on the white of one eye upon waking up this morning. The patient reports no pain, vision changes, or recent injury to the eye but feels self-conscious about the appearance. The red patch does not extend to the iris, and there is no discharge or photophobia. The patient has no significant PMHx and is on no medications. On examination, visual acuity is 20/20 in both eyes. Intraocular pressure is within normal limits. Anterior segment examination of the right eye reveals a well-demarcated, bright red area on the nasal conjunctiva. Blood pressure is 120/80, and the left eye examination is unremarkable. Fundoscopic examination of both eyes is normal. what is the dx?

subconjunctival hemorrhage

subconjunctival hemorrhage

sudden onset of a unilateral bright red patch on the sclera due to the rupture of small blood vessels under the conjunctiva

what can a subconjuctival hemorrhage be triggered by?

coughing, sneezing, heavy lifting, vomiting, or even rubbing the eye too hard

what is not associated with subconjunctival hemorrhage?

no pain, vision changes, discharge

RF for subconjunctival hemorrhage

hypertension, diabetes, blood thinning medications, and certain blood clotting disorders

Tx of subconjunctival hemorrhage

reassurance, artificial tears to help with irritation

A 42-year-old woman presents with a red patch in her eye. She is concerned but otherwise asymptomatic. What aspect of the physical examination is most important for confirming a diagnosis of subconjunctival hemorrhage?

Visual acuity testing to test vision (vision shoudl be good)

a 78-year-old man who complains of slowly progressive vision loss over the last several years. He describes his vision as if he is looking through “dirty glass” and reports seeing a white halo around lights. On physical exam, there is a clouding of the lens and no red reflex. What is the dx?

catarcts

cataracts

opacity (cloudy) of the lens that affects the vision and are the leading cause of blindness worldwide

Risk factors for cataracts

Age, DM, smoking/alcohol, sunlight exposure, prolonged drug use

tx for cataracts

anti-glare sunglasses, removal is definitive (surgery replace lens)

What is a primary pathophysiological mechanism in the development of age-related cataracts?

opacity/ clouding of normally clear lens

Three types of cataracts

cortical cataract: peripheral spicules early, vision good initally (ASYMTOMATIC)

nuclear cataract: shift towards myopia color shfit TOWARD YELLOW, HAZY
subcapsular: early trouble readings, Slimmer and WORSE VISION LOSS

presentation of cataracts

painless, gradual vision problems

leading cause of blindness worldwide

cataracts

A 35-year-old woman presents to the clinic complaining of severe pain in her right eye and a noticeable decrease in vision over the past two days. She reports a sensation of something being in her eye (FBS) and increased sensitivity to light. On examination, her visual acuity is 20/200 in the right eye and 20/20 in the left eye. Fluorescein staining of the right eye reveals a branching dendritic ulcer. What is the most likely diagnosis?

What is treatment

Herpes Simplex Keratitis

oral antivirals (acycolvir) 7-10 days

NO TOPICAL STEROIDS

A 34-year-old woman, who is a habitual contact lens wearer, presents with a painful red eye and visual impairment. She reports that she often sleeps with her contact lenses in. Slit-lamp examination reveals a white infiltrate in the cornea with an overlying epithelial defect and stromal involvement. What is the most likely pathogen responsible for her corneal ulcer?

Pseudomonas aeruginosa

a 65-year-old male Hispanic farmworker who is brought to you by his concerned wife. She reports he has had this "thing" on his left eye for years and refuses to seek care. He denies pain or discharge from the affected eye. Physical exam reveals an elevated, superficial, fleshy, triangular-shaped fibrovascular mass in the inner corner/nasal side of the left eye. What is the dx?

pterygium

pterygium

triangular wedge of fibrovascular tissue extending into cornea

pinguecula

yellowish nodule on the conjunctiva (DOESNT GO INTO CORNEA )

symptoms of pterygium

redness, irritation

tx of pterygium

artificial tears or surgery ONLY if vision is affected

A 50-year-old man, who has worked as a lifeguard for over 30 years, presents with a complaint of a slowly progressive growth on his left eye that has begun to affect his vision. On examination, there is a fleshy, triangular-shaped growth of conjunctiva encroaching onto the nasal side of the cornea. What is the most significant risk factor for the development of this condition?

Long-term exposure to ultraviolet (UV) light

uveitis/ (anterior) = _____ posterior=_______

inflamed uveitis

anterior is iritis

posterior is choroid/retina (RARE)

etiology of anterior uveitis

HLA-B27 related diseases(autoimmune), infection, idiopathic

symptoms uveitis

pain, redness, photophobia (BIG), blurred visios, floaters & visual disturbance

complications of uveittis

glaucoma, vision loss

tx iritis (one main phis component)

topical corticosteroids, CYCLOPLEGIC BREAK ADHESIONS FROM IRIS TO LENS ( pupul cant narrow in run -photophobia)

A 40-year-old female presents with a 1-week history of redness, pain, and blurry vision in her left eye. She reports photophobia but denies discharge or itching. On slit-lamp examination, there is ciliary flush, small keratic precipitates on the corneal endothelium, and cells and flare in the anterior chamber. What is the most appropriate next diagnostic step?

Testing for HLA-B27 antigen

A 30-year-old male presents with redness, pain, and photophobia in his left eye for 5 days. He denies discharge or trauma. Slit-lamp examination reveals cells and flare in the anterior chamber, ciliary flush, and posterior synechiae. What is the most appropriate treatment?

Topical corticosteroids and cycloplegic agents for pain

dacryocystitis

infectious obstruction of the nasolacrimal duct

biggest signs and symps of dacryocystitis

overflow of tears or discharge, pain, redness, swelling

tx of dacryocystitis

oral anitbiotics (cephalexin) warm comprsess

A 7-month-old female is brought to your clinic by her mother, who is concerned about persistent swelling at the nasal corner of the child's left eye. The mother reports that the swelling has been present for several weeks and occasionally becomes red and inflamed. If this condition is left untreated, what complications is most likely to develop?

Dacryocystitis

a 56-year-old female complaining of persistent eye dryness, irritation, and a FBS in both eyes for the past three months. She also reports occasional blurry vision that improves with blinking. Her symptoms worsen in air-conditioned environments and after prolonged screen time. She denies any history of recent eye infections or allergies. On examination, her visual acuity is within normal limits. A Schirmer's test reveals tear production of less than 5 mm in 5 minutes. Her tear film breakup time is reduced, and fluorescein staining reveals punctate epithelial erosions. What is the dx?

Keratoconjunctivitis sicca (Dry eye)

Keratoconjunctivitis sicca

dryness of cornea and conjunctiva

SS of Keratoconjunctivitis sicca

dryness, burning, foreign body sensation, blurred vision

cln

tx for keratoconjunctivitis sicca

artificial tears

What treatments is considered most appropriate for managing mild to moderate keratoconjunctivitis sicca?

ARTUFICIAL TEARS (AT) - refresh Topical cyclosporine

a 37-year-old male with crusting, scaling, red-rimming of the eyelid, and eyelash flaking along with dry eyes. The patient has a history of seborrheic dermatitis and rosacea. What is the dx?

blepharitis

blepharitis

inflammation of eyelids

SS blepharitis

crusty eyelids in AM

what is blepharitis associated with?

seborrhea, dry eyes, rosacea, chalazia

tx for blepharitis

warm compress, topical erythromycin, gentamycin, or bacitracin/polymyxin B, baby shampoo (cleaning) (MELT THE BUTTER, oil glands)

A 35-year-old patient presents with red, irritated eyelids and flaky debris at the base of the eyelashes. What diagnostic feature is most indicative of blepharitis?

Eyelid erythema and scaling at the lash base

a 52-year-old male with a foreign-body sensation in the right eye. Over the last 3 weeks, he has had gradually increasing painless swelling around the right lower eyelid. Your examination shows a nontender discrete nodule on the right lower eyelid. There is no evidence of injection or discharge, and her visual acuity is normal. What is the dx?

chalazion

chalazion

noninfectious obstruction of a meibomian gland

SS chalazion

hard, nontender eyelid swelling, often not very red

tx for chalazion

warm/hot compress w digial massage, eyelid hygiene, bactitracin/erthromycin

The best way to differentiate between a Chalazion and a Hordeolum is

red PAIN only in hordeolum

hard and nontender in chalezion

A patient presents with a nontender, painless, nodule involving a meibomian gland. What is the most likely diagnosis?

chalazion

a 73-year-old male who complains of dry eyes coupled with excessive tearing. On exam, you note the conjunctiva appears red, and the right eyelid is turned outward. What is the dx?

ectropion

ectropion

outward turning of the eyelid

SS ectropion

tearing, symptoms of dry eye/ superioir puncuate keratitis,or asymptomatic

tx for ectropion

surgery, artificial tears

a 75-year-old with a foreign body sensation and tearing of his right eye. On physical exam, you note a red, irritated right eye in association with an inverted eyelid. What is the dx?

entropion

entropion

inward turning of eyelid

SS entropion

foreign body sensation, tearing, red eye/, SPK

tx for entropion

surgical correction(definitive), artificial tears (lubricating agents) antibiotic ointments

a 15-year-old male with pain, redness, and swelling of the upper eyelid for the last 3 days. There are no visual changes or photophobia. Examination reveals a tender, erythematous, and outward-pointing edema of the right eyelid. what is the dx?

hordeolum

hordeolum

stye, infection of glands of eyelids

SS hordeolum

painful, warm, swollen red lump on eyelid, tearing, photophobia, foreign body sensation

tx for hordeolum

Warm compresses and topical dicloxacillin or erythromycin

What differentiates between a Chalazion and a Hordeolum?

Hordeolum (Stye): Acute infection of a meibomian gland or Zeis gland, typically painful and located at the eyelid margin

A 20-year-old university student presents with an acutely painful swelling on her upper eyelid diagnosed as a hordeolum. What is the most appropriate initial treatment for this condition?

Warm compresses and lid hygiene

a 46-year-old male with an involuntary, rapid, and repetitive movement of both eyes side to side. what is the dx?

nystagmus

nystagmus

involuntary, rapid, and repetitive movement of the eyes

A patient presents with a 3-day history of vertigo associated with turning over in bed, which lasts for several minutes. There are no other symptoms of the ear. Dix-Hallpike testing shows rotary nystagmus, which diminishes with repeated testing. What is the most likely diagnosis?

positional vertigo (BBPV)

A 5-year-old boy presents with swelling and erythema of his left upper and lower eyelids. His mother reports that he had a mild upper respiratory infection last week. He has been vigorously rubbing his eyelids. What is the most likely underlying cause of his current condition?

Extension from sinusitis

a 62-year-old male who arrives for his follow-up visit for chronic, gradual central vision loss. He describes a phenomenon of wavy or distorted vision that has deteriorated rather quickly. The patient is frustrated because he "just can't drive anymore,” and he is "having difficulty seeing words when he reads.” When looking at a specific region of the Amsler grid, he reports a dark “spot” in the center, with bent lines. On the fundoscopic exam, you note areas of retinal depigmentation along with the presence of yellow retinal deposits. What is the dx?

macular degeneration

macular degeneration

Gradual PAINLESS loss of CENTRAL vision, deterioration of central part of retina (leading cause of legal blindness)

dry macular degeneration

atrophic changes with age - slow, gradual breakdown of the macula, DRUSEN (yellow deposits in eye) VISION IN TACT

wet macular degeneration

New blood vessels growing beneath the retina (neovascularization) leak blood and fluid, damaging the retinal cells. NO VISION

ansler grid

slef monitor for macular degeneration

tx of wet macular degeneration

VEGF inhibittors (stop new small BV from being formed)- avastin, lucentis, montior for reaccurence

tx of dry macular degeneration

more common VITAMINS (AREDs), slow progession from DRY TO WET (cant let get to wet) constant monitoring

what does the macula provide?

central vision

A patient with type 2 diabetes mellitus presents for a yearly eye exam. Ophthalmoscopic exam reveals neovascularization. What is the most likely complication related to this finding?

Vitreous hemorrhage

What is the leading cause of permanent visual loss in a patient over the age of 75?

Macular degeneration

a 65-year-old man complaining of a sudden unilateral vision loss, which he describes as a "curtain or dark cloud lowering over my eye." This was preceded by small moving flashing lights and floaters. what is the dx?

retinal detachment

hallmarks of retinal detachment

Flashes of light, floaters, and painless, sudden vision loss with a curtain-like shadow (fluid seeks behind ratina)