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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ Most common oral mucosal disease in North America

■ Thought to be noncontagious

SYMPTOMS/EXAM

■ Painful ulcerations on the nonkeratinized mucosa of the mouth lasting

weeks to months

■ Varies from minor to major to herpetiform

■ Typically see multiple ulcers

■ Palatal or posterior oropharyngeal ulcers suggest hand-foot-and-mouth dis-

ease (coxsackievirus).

■ Consider Tzanck smear (for herpes), viral culture, ESR, CBC, KOH prep.

DIFFERENTIAL

■ Hand-foot-and-mouth disease

■ Candidiasis

■ Herpes simplex

■ Behçet disease

■ Reiter syndrome

■ Syphilis

TREATMENT

■ Supportive care

■ Topical agents for analgesia and hygiene rinses (see the section Acute

Necrotizing Ulcerative Gingivitus)

■ Corticosteroids are first-line therapy (elixir or topical gel, PO if severe).

■ Discharge with outpatient follow-up.

EYELID DISORDERS

External Hordeolum

ETIOLOGY

Acute (staphylococcal in 90–95%) infection/abscess of the oil gland associated

with the follicle of a cilium (eyelash) (see Figure 14.27)

SYMPTOMS/EXAM

Pain, erythema, focal swelling, and tenderness of the eyelid

TREATMENT

■ Warm compresses

■ Antibiotic ointment

■ May require incision and drainage

■ Ophthalmologic referral

Internal Hordeolum: Chalazion

ETIOLOGY

■ Chronic inflammation (obstruction) of the meibomian gland (see Figure 14.28)

■ Clogged gland expands →lipogranulomatous foreign body reaction.

Visual acuity is the vital sign of

the eye.