ENT

Question 1

What is orbital cellulitis?

Answer 1

usually secondary to sinus infection (ethmoid 90%)

S. aureus, S pneumo, GABHS, H. flu

may be caused by dental/facial infections or bacteremia

MC occurs in children (esp 7 - 12 yo)

Question 2

Clinical Manifestations of Orbital Cellulitis

Answer 2

decreased vision

pain with ocular movement

proptosis (bulging eye)

eyelid erythema & edema

Question 3

Diagnosis and Management of Orbital Cellulitis

Answer 3

Dx: High resolution CT Scan (infection of the fat & ocular muscles). MRI

Management: IV Abx

ex. vancomycin, clindamycin, cefotaxime, augmentin

AMOXICILLIN if preseptal

Question 4

Preseptal Cellulitis vs. Orbital Cellulitis

Answer 4

preseptal cellulitis is infection of the eyelid and periocular tissue. can have ocular pain & swelling but NO visual changes and NO pain with ocular movement

Question 5

What is strabismus?

Answer 5

misalignment of the eyes. stable ocular alignment not prsent until age 2 - 3 months

esotropia: convergent strabismus – deviated inward (cross-eyed)

exotropia: divergent strabismus – deviated outward

Question 6

Clinical Manifestations of Strabismus

Answer 6

diplopia, scotomas, amblyopia (lazy eye)

Question 7

Diagnosis and Management of Strabismus

Answer 7

Hirschberg corneal light reflex testing (ofen a screening test)

cover-unconver test to determine the angle of strabismusm, cover test, convergence testing

Management:

• 1. Patch therapy: normal eye is covered to stimulate & strengthen the affected eye. eyeglasses*
• 2. Corrective surgery: if severe or unresponsive to conservative therapy–if not treated before 2 yo, amblyopia may occur = decreased visual acuity not correctable by refractive means*

Question 8

What is the most common cause of viral conjunctivitis?

Answer 8

adenovirus

swimming pool MC source

Question 9

Physical Exam findings for viral conjunctivitis

Answer 9

PREAURICULAR LYMPHADENOPATHY
copious watery discharge

scanty mucoid discharge

often bilateral

may have PUNCTATE STAINING on slit lamp exam

Question 10

Treatment of Viral Conjunctivitis

Answer 10

supportive

cool compresses and artificial tears

+ antihistamines for itching/redness (olopatadine)

Question 11

Allergic Conjunctivitis findings and management

Answer 11

conjunctival erythema (red eyes) and may have other allergic Sx (rhinorrhea)

“cobblestone mucosa” appearance to the inner/upper eyelid, itching, tearing, redness, stringy discharge, usually bilateral

+ chemosis (conjunctival swelling)

Treatment: topical antihistamine (H₁) blockers Olopatadine

Question 12

what are the MC causes of bacterial conjunctivitis?

Answer 12

Staph aureus

Strep pneumoniae

transmitted by direct contact and autoinoculation

Question 13

Clinical findings and Managment of Bacterial Conjunctivitis?

Answer 13

PURULENT DISCHARGE, LID CRUSTING

usually no visual changes

Management: topical antibiotics (erythromycin, flouroquinolones)

if contact lens wearer, need protection against Pseudomonas (FQ or Aminoglycoside)

Question 14

Causes of Neonatal Conjunctivitis

Answer 14

Day 1: silver nitrate (chemical cause)

Day 2-5: Gonococcal

Day 5-7: Chlamydia

Day 7-11: HSV

recommended standard prophylaxis given immediately after birth includes: erythromycin ointment, topical tetracycline, silver nitrate, or providone-iodine

may cause corneal ulceration, opacification, & blindness if it develops & left untreated