NR511 Dunphy Ch 8 with solutions

dry eye condition in which there are insufficient tears to lubricate and nourish the eye Occurs as a result of 1) mechanical abnormalities that interfere with spread or maintenace of tears over the eyeball surface 2) lacrimal gland malfunction 3) mucin deficiency Feeling of "Sand in the eyes" Dry eye Differential diagnosis for Dry eye Conjunctivitis Blepharitis Contact lens complications Exopthalmos Ectropion Bell's palsy Medicamentosa Sjögren's syndrome Age related changes Hormonal changes Systemic vitamin A deficiency Drug action Excessive tearing (Epiphora) 1) Often a case of paradoxical tearing in response to dry eye 2) secondary to irritant 3) allergy infection, trauma, pain, or structural abnormalities Differential diagnosis of epiohora Allergens Dry eye syndrome Viral or bacterial conjunctivitis Blocked lacrimal duct Ectropion Trauma (e.g., foreign body or corneal abrasion) Environmental pollutants Glaucoma eye pain Discomfort in the eyes. (ROS Eyes) The most important thing for the clinician to know in case if eye pain is when you refer the patient to opthalmoligist Differential diagnosis of eye pain Referred pain (trauma, headache, sinusitis, temporomandibular disorders (TMD), herpes zoster opthalmicus, postherpetic neuralgia, tumors, stroke, trigeminal neuralgia) Eyelid disorders (hordeoleum, trauma, blepharitis) Conjunctivitis, corneal abrasions, ulcerations, foreign body, ultraviolet light overexposure, overuse of contact lenses, computer use Pain with swelling (orbital cellulitis) Pain with eye movement (scleritis, episcleritis) Deep pain (uveitis, glaucoma) Conditions requiring immediate referral to an Opthalmologist •patient complains of severe and sudden loss or sudden severe nontraumatic eye pain Physical exam reveals • corneal ulceration • suspected herpes zoster opthalmicus • hazy cornea • irregular pupil • elevation of fundus on fundoscopic exam • papilledema • limbal flush • muscle paresis Management issues • conditions requiring steroid therapy • patient not improving with conservative therapy Red Eye A non uniform redness if the conjunctiva from hyperemia Red eye common conditions Viral conjunctivitis (pink eye) Bacteria Allergies Chemical irritants Inadequate sleep Overuse of contact lenses Environmental irritants Excessive rubbing Differential diagnosis of red eye • conjunctivitis • hordeolum • glaucoma • iritis • corneal abrasions • dry eyes, keratitis sicca • subconjunctival hemorrhage floaters Those that appear gradually and become less noticeable are usually benign Those that appear suddenly, especially, if bilateral, may warrant further evaluation Photospia or flashing lights Patient should be evaluated immediately for retinal tear or detachment Visualization of floaters Due to contraction of the vitreous humor, common sequela of the aging process. May also result from tear-film debris or from material in the vitreous Differential diagnosis of impaired vision • refractive errors • cataracts • glaucoma • diabetic retinopathy • macular degeneration • retina detachment • vitreous hemorrhage • Central retinal artery or vein occlusion Ear pain (otalgia) Often caused by infection Dental abscesses Sinus infection Temporomandibular joint (TMJ) disease Mastoiditis Differential diagnosis of ear pain Otitis externa Acute otitis media Otitis media with effusion Eustachian tube dysfunction Barotrauma Ceruminosis Dental disease TMJ dysfunction Perforated tympanic membrane Sinus disease Cervical lymphadenopathy Impaired hearing Decreased ability or complete inability to hear Differential diagnosis of hearing loss Presbycusis Noise exposure Ototoxic drugs Eustachian tube dysfunction Cerumen impaction Chronic middle ear infection, effusion Otosclerosis Tympanosclerosis Cholesteatoma Trauma Congenital disorders