Blepharitis, Hordeolum: Diagnosis & Management

Blepharitis and Conjunctivities

• Blepharitis: Typical chief complaint includes "red, swollen, itchy eyelids with crusting on eyelashes upon waking." Symptoms include red, swollen, or tender eyelids, crusting/scaling along eyelid margins (especially upon waking), flaky skin at lash line, itchy, dry, or burning eyes, gritty or foreign body sensation, frequent eye irritation or redness.

• Conjunctivitis: Typical chief complaint includes "irritated, red eyes with thick discharge." Symptoms include purulent or mucopurulent discharge, eye redness and irritation, eyelid matting (especially upon waking), and unilateral onset that may spread to other eye(s).

Blepharitis Management

• Non-pharmacological: Warm compresses (5-10 minutes, 2-4 times daily), gentle lid scrubs (diluted baby shampoo or specialized lid scrubs), regular cleaning of eyelid margins to remove crusts and debris, patient education on hygiene and adherence to prescribed regimen.

• Pharmacological: Topical antibiotic ointments (e.g., erythromycin, bacitracin) may be used, especially in chronic or infected cases. Corticosteroid eye drops/ointments could be considered for short-term relief of inflammation.

Hordeolum (Stye) Management

• Management: Apply warm compresses (5-10 minutes, 3-4 times daily). Gently cleanse the affected eyelid to remove crusting and debris. Avoid squeezing the lesion. Patient education on managing the condition at home and avoiding squeezing the stye helps to improve compliance and prevent recurrence.

• Evidence-based treatment: Topical antibiotics (e.g., erythromycin or bacitracin) are preferred for external infections. Oral antibiotics may be used for more severe or recurrent cases, especially if cellulitis is suspected or the patient has a history of recurrent styes. Important Note: The text indicates that systemic antibiotics and steroids are not generally indicated.

Conjunctivitis Types

• Types: Allergic, bacterial, and viral conjunctivitis.

Bacterial Conjunctivitis Causative Agent

• Most common cause (adults): Staphylococcus aureus.

Otitis Media Management

• Non-pharmacological Mgt: Regular cleaning with saline or antiseptic, warm compresses for swelling and drainage, avoiding irritants, removing earrings if present and switching to hypoallergenic jewelry once the infection resolves. Note: Mild infections may be managed with topical mupirocin or bacitracin. Moderate infections may be managed with keflex.

• Pharmacological Mgt: Use first-line antibiotics for bacterial otitis media (amoxicillin). If amoxicillin fails, alternative antibiotics (e.g., augmentin, cefdinir) are used. Pain management with Tylenol or Advil, or topical ear drops (if tympanic membrane is intact).

• Referral: Severe pain, worsening symptoms after 48-72 hours of treatment, persistent hearing loss, and difficulty balancing or dizziness may warrant referral. Also, signs of complications like facial paralysis, mastoid tenderness, or eardrum perforation should prompt referral.

Otitis Media Subject & Object Data

• Subjective Data: Ear pain (often throbbing and worse when lying down), fever and irritability (especially in children), muffled hearing or fullness in the ear, fluid drainage if the tympanic membrane ruptures, recent upper respiratory infection symptoms like cough or nasal congestion.

• Objective Data: Exam of the MOUTH, eyes, and nose, assess for mucosal erythema or nasal congestion (indicating concurrent upper respiratory infection or dehydration- suggested by dry mucous membranes). Check for lymph node tenderness. Otoscopic exam findings (redness, bulging/distortion of tympanic membrane, presence of pus or fluid behind TM, decreased mobility). Hearing assessment assessment (possible hearing loss).

Rhinitis Types and Management

• Allergic Rhinitis: Allergic rhinitis is triggered by allergen exposure (e.g., pollen, dust, mold, pet dander). Symptoms include sneezing, runny nose, itchy nose and eyes, and clear nasal discharge, swollen nasal turbinates. Management includes allergen avoidance, nasal irrigations, and use of antihistamines and/or nasal corticosteroids.

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• Viral Rhinitis: Viral rhinitis is often caused by viruses (e.g., rhinovirus, coronavirus, influenza). Symptoms include nasal congestion, sneezing, clear or slightly mucopurulent nasal discharge, sore throat, fatigue, and malaise. Treatment is symptomatic and supportive (rest, hydration, and pain relief). Viral is highly contagious.

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• Bacterial Rhinitis: Bacterial rhinitis is less common and is caused by bacterial infections. Symptoms include nasal congestion, purulent yellow-green nasal discharge, mild to moderate facial discomfort, and generally limited to the nasal passages. Treatment usually involves antibiotics (e.g., augmentin, amoxicillin-clavulanate). Not contagious except in severe cases; then secondary cases may emerge.

• Non-allergic Rhinitis: Non-allergic rhinitis is caused by factors aside from allergies (e.g., irritant exposure, weather changes, smoke), and it is not contagious. Symptoms can vary from mild congestion to severe discomfort, often triggered by repeated exposure to irritants. Management often involves the avoidance of environmental triggers.

Epistaxis Management

• Non-Pharmacological: Pinch the soft anterior part of the nose, sit upright, and lean forward. Apply ice packs to the nasal bridge to constrict blood vessels.

• Pharmacological: First-line options include nasal saline sprays for hydration, and topical vasoconstrictors like oxymetazoline for bleeding control. More severe cases might require cauterization or nasal packing. Referral to a doctor specialized in acute bleed control, if needed.

Pharyngitis Management

• Viral: Analgesics (e.g., Tylenol, Advil), cough suppressants, throat lozenges/sprays (containing mild anesthetics), and supportive care.

• Bacterial: First-line antibiotics (e.g., penicillin VK). Alternative antibiotics for penicillin allergies (e.g., Keflex, clindamycin, zithromax). Analgesics and antipyretics (e.g., Tylenol, Advil) for fever and pain.

• Referral warranted: persistent symptoms beyond a certain period, development of unexpected complications (like high fever, difficulty swallowing, neck swelling, or respiratory distress). These complications are important to look out for during treatment.

Infectious Mononucleosis (Mono)

• Subjective Data: Severe and persistent fatigue, sore throat (often severe, with difficulty swallowing), low-to-moderate fever, swollen glands (frequently posterior cervical lymphadenopathy), and malaise/body aches are common subjective symptoms.

• Objective Data: Enlarged spleen and/or liver might be observed during physical examination. A detailed physical assessment is important.

Aphthous Ulcers

• Cause: The exact cause is widely accepted as unknown; possible factors include stress, trauma from physical, chemical, or local agents; deficiencies (B12, folic acid, iron); and hypersensitivities (e.g., gluten-sensitive enteropathy).

• Management: Good oral hygiene. Avoid spicy, acidic, or abrasive foods. Ensure hydration. Saltwater rinses may help. Topical anesthetics (e.g., Benzocaine gel) or anti-inflammatory treatments (e.g., topical corticosteroids in severe cases) might be used. Prevention of secondary infections with antiseptic mouthwashes.

Test your knowledge on diagnosing and managing blepharitis and hordeolum. Topics include symptoms, non-pharmacological interventions such as warm compresses, pharmacological treatments, and patient education on medication use and hordeolum management.