FOCUSED REVIEW 2020 HEENT EXAM Clinical Medicine I
1. S/S blepharitis, conjunctivitis, entropion, chalazion
Blepharitis: chronic bilateral inflammatory condition of lid margins
● Anterior: involves eyelid skin, eyelids, and associated glands
o Signs and Symptoms (S/S)g g:
Eyes are red-rimmed
Scales and granulations can be seen clinging to lashes.
o Tx: Controlled by cleanliness of lid margins, eyebrows, and scalp
Scales removed daily with hot washcloth and baby shampoo
Acute exacerbations w/: Antistaphylococcal ABX eye ointment:
● Bacitracin or Erythromycin
● Posterior: Meibomian glands and their orifices are inflamed
o S/S:
Lid margins are hyperemic w/ telangiectasias (AKA spider veins).
Lid margin frequently rolled inward to produce mild entropion
Tears may be frothy or abnormally greasy
o Tx: Regular Meibomian gland expression with warm compresses may be sufficient to
control symptoms
Inflammation of conjunctiva and cornea indicates a need for more tx:
● Long term oral ABX therapy:
o Tetracycline
o Doxycycline
o Minocycline
o Erythromycin
● Possibly short-term topical corticosteroid
o Prednisolone
● Topical therapy w/ ABX may be helpful, but short course
o Ciprofloxacin ophthalmic solution twice daily
Conjunctivitis: inflammation of the mucous membrane that lines the surface of eyeball and inner eyelids
● Viral: Adenovirus is most common cause. Bilateral disease.
o S/S:
Copious watery discharge
Marked foreign body sensation
Follicular conjunctivitis
o HSV conjunctivitis: unilateral with lid vesicles
o Enterovirus 70 or coxsackievirus A24: Hemorrhagic conjunctivitis (looks like eye is
bleeding)
o Tx:
HSV: use antiviral agents. Can cause scarring, so you’d sent to ophthalmology.
● Topical ganciclovir 0.15%
● Oral acyclovir
Cold compresses and or artificial tears to reduce discomfort
, Topical sulfonamides (polymyxin B sulfate-trimethoprim) to prevent secondary
infection
Use of topical corticosteroids is DISCOURAGED in acute infections because it
may worsen it (steroids block the inflammatory response, so you’d be blocking
your immune reaction, and making the infection run rapid.)
● Bacterial Conjunctivitis:
o S/S:
Copious purulent discharge
NO BLURRING OF VISION
Mild discomfort
o Tx: Usually self limiting lasting 10-14 days if untreated
Topical sulfonamide (stops growth of bacteria) or oral antibiotic will usually clear
infection in 2-3 days
Except in contact lens wearers: use of topical fluoroquinolones
● Gonococcal Conjunctivitis:
o S/S:
Copious purulent discharge
Ophthalmologic emergency
o Tx:
Ceftriaxone (injectable cephalosporin)
Topical ABX: erythromycin or bacitracin
Rule out other STIs and treat for chlamydial infection (doxycycline/Azithromycin)
● Chlamydial Keratoconjunctivitis: most common infectious cause of blindness worldwide
o S/S: Corneal scarring
Entropion (inward eyelid)
Trichiasis (inward lashes)
o Tx: Azithromycin or doxycycline
● Keratoconjunctivitis Sicca (DRY EYES): hypofunction of lacrimal glands causing loss of aqueous
component of tears
o S/S:
Dryness
Redness
Foreign body sensation
May have no symptoms
Marked conjunctival injection
Mucus strands
Severe cases:
● Persistent marked discomfort with photophobia
● Difficulty moving the eyelids
● Excessive mucus secretion
o Tx:
Artificial tears
Drop preparations with mucomimetic: hydroxypropyl methylcellulose (HPMC) or
Carboxymethylcellulose
, Tenacious mucus: mucolytic agents (topical acetylcysteine) break down the
mucus so it isn’t a glob, it is more broken down/liquified
Entropion: result of degeneration of lid fascia
● Inward turning of the usually lower lid
● Surgery indicated if lashes rub cornea
● Botulinum toxin injections may also be used for temporary correction
Chalazion: Common granulomatous inflammation of the meibomian gland that may follow internal
hordeolum
● S/S: Hard, NON TENDER swelling on the upper or lower lid
o Redness and swelling of the adjacent conjunctiva
2. Tests that distinguish conductive from sensorineural hearing loss.
Weber: checks symmetry of hearing and helps to assess unilateral hearing
● Place tuning fork on apex of skull at midline
● Normal: hear the same in both ears
○ Conduction loss: sound lateralizes toward the affected side
○ Sensorineural loss: sound lateralizes toward the unaffected side
Rinne: checks difference between air and bone conduction (tuning fork against mastoid bone and beside
ear, counting how long until both are not heard (do NOT strike tuning fork between))
● Conductive hearing loss: when only bone conduction is audible or when bone conduction is
GREATER than air conduction in affected ear.
● Sensorineural loss: when air conduction is greater than bone conduction, but ratio is LESS than
2:1
Audiometry: tests hearing at a range of frequencies to determine if hearing loss is normal…???
3. S/S of various forms of conjunctivitis.
● Viral: Adenovirus is most common cause. Bilateral disease.
o S/S:
Copious watery discharge
Marked foreign body sensation
Follicular conjunctivitis
Preauricular lymphadenopathy
● Bacterial:
o S/S:
Copious purulent discharge
NO BLURRING OF VISION
1. S/S blepharitis, conjunctivitis, entropion, chalazion
Blepharitis: chronic bilateral inflammatory condition of lid margins
● Anterior: involves eyelid skin, eyelids, and associated glands
o Signs and Symptoms (S/S)g g:
Eyes are red-rimmed
Scales and granulations can be seen clinging to lashes.
o Tx: Controlled by cleanliness of lid margins, eyebrows, and scalp
Scales removed daily with hot washcloth and baby shampoo
Acute exacerbations w/: Antistaphylococcal ABX eye ointment:
● Bacitracin or Erythromycin
● Posterior: Meibomian glands and their orifices are inflamed
o S/S:
Lid margins are hyperemic w/ telangiectasias (AKA spider veins).
Lid margin frequently rolled inward to produce mild entropion
Tears may be frothy or abnormally greasy
o Tx: Regular Meibomian gland expression with warm compresses may be sufficient to
control symptoms
Inflammation of conjunctiva and cornea indicates a need for more tx:
● Long term oral ABX therapy:
o Tetracycline
o Doxycycline
o Minocycline
o Erythromycin
● Possibly short-term topical corticosteroid
o Prednisolone
● Topical therapy w/ ABX may be helpful, but short course
o Ciprofloxacin ophthalmic solution twice daily
Conjunctivitis: inflammation of the mucous membrane that lines the surface of eyeball and inner eyelids
● Viral: Adenovirus is most common cause. Bilateral disease.
o S/S:
Copious watery discharge
Marked foreign body sensation
Follicular conjunctivitis
o HSV conjunctivitis: unilateral with lid vesicles
o Enterovirus 70 or coxsackievirus A24: Hemorrhagic conjunctivitis (looks like eye is
bleeding)
o Tx:
HSV: use antiviral agents. Can cause scarring, so you’d sent to ophthalmology.
● Topical ganciclovir 0.15%
● Oral acyclovir
Cold compresses and or artificial tears to reduce discomfort
, Topical sulfonamides (polymyxin B sulfate-trimethoprim) to prevent secondary
infection
Use of topical corticosteroids is DISCOURAGED in acute infections because it
may worsen it (steroids block the inflammatory response, so you’d be blocking
your immune reaction, and making the infection run rapid.)
● Bacterial Conjunctivitis:
o S/S:
Copious purulent discharge
NO BLURRING OF VISION
Mild discomfort
o Tx: Usually self limiting lasting 10-14 days if untreated
Topical sulfonamide (stops growth of bacteria) or oral antibiotic will usually clear
infection in 2-3 days
Except in contact lens wearers: use of topical fluoroquinolones
● Gonococcal Conjunctivitis:
o S/S:
Copious purulent discharge
Ophthalmologic emergency
o Tx:
Ceftriaxone (injectable cephalosporin)
Topical ABX: erythromycin or bacitracin
Rule out other STIs and treat for chlamydial infection (doxycycline/Azithromycin)
● Chlamydial Keratoconjunctivitis: most common infectious cause of blindness worldwide
o S/S: Corneal scarring
Entropion (inward eyelid)
Trichiasis (inward lashes)
o Tx: Azithromycin or doxycycline
● Keratoconjunctivitis Sicca (DRY EYES): hypofunction of lacrimal glands causing loss of aqueous
component of tears
o S/S:
Dryness
Redness
Foreign body sensation
May have no symptoms
Marked conjunctival injection
Mucus strands
Severe cases:
● Persistent marked discomfort with photophobia
● Difficulty moving the eyelids
● Excessive mucus secretion
o Tx:
Artificial tears
Drop preparations with mucomimetic: hydroxypropyl methylcellulose (HPMC) or
Carboxymethylcellulose
, Tenacious mucus: mucolytic agents (topical acetylcysteine) break down the
mucus so it isn’t a glob, it is more broken down/liquified
Entropion: result of degeneration of lid fascia
● Inward turning of the usually lower lid
● Surgery indicated if lashes rub cornea
● Botulinum toxin injections may also be used for temporary correction
Chalazion: Common granulomatous inflammation of the meibomian gland that may follow internal
hordeolum
● S/S: Hard, NON TENDER swelling on the upper or lower lid
o Redness and swelling of the adjacent conjunctiva
2. Tests that distinguish conductive from sensorineural hearing loss.
Weber: checks symmetry of hearing and helps to assess unilateral hearing
● Place tuning fork on apex of skull at midline
● Normal: hear the same in both ears
○ Conduction loss: sound lateralizes toward the affected side
○ Sensorineural loss: sound lateralizes toward the unaffected side
Rinne: checks difference between air and bone conduction (tuning fork against mastoid bone and beside
ear, counting how long until both are not heard (do NOT strike tuning fork between))
● Conductive hearing loss: when only bone conduction is audible or when bone conduction is
GREATER than air conduction in affected ear.
● Sensorineural loss: when air conduction is greater than bone conduction, but ratio is LESS than
2:1
Audiometry: tests hearing at a range of frequencies to determine if hearing loss is normal…???
3. S/S of various forms of conjunctivitis.
● Viral: Adenovirus is most common cause. Bilateral disease.
o S/S:
Copious watery discharge
Marked foreign body sensation
Follicular conjunctivitis
Preauricular lymphadenopathy
● Bacterial:
o S/S:
Copious purulent discharge
NO BLURRING OF VISION
