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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

TREATMENT

■ Warm compresses

■ Antibiotic ointment plus PO abx for associated cellulitis

■ May require incision and drainage

■ Ophthalmologic referral

Eyelid Laceration

TREATMENT

■ Simple eyelid lacerations can be repaired with 6-0 or 7-0 nonabsorbable

suture.

■ Involvement of the following requires ophthalmology referral:

■ Lid margin

■ Canalicular system: Laceration medial to the punctum

■ Tarsal plate (dense connective tissue that gives form to the eyelid); may

see ptosis

■ Orbital septum: Fat protruding through lid wound

■ Significant tissue loss

CONJUNCTIVITIS

ETIOLOGY

■ Bacterial conjunctivitis

■ Viral conjunctivitis

■ Allergic conjunctivitis

■ Neonatal conjunctivitis (ophthalmia neonatorum)

■ When unclear, assume bacterial etiology.

SYMPTOMS/EXAM

■ Discharge

■ Clear or watery discharge with allergic process, corneal abrasions, viral

infections

■ Allergies can also produce a stringy white mucus

■ Yellow or purulent more common with bacterial conjunctivitis

■ Preauricular andenopathy

■ Seen with most viral infections, including herpes simplex and aden-

ovirus (pink eye)

■ Membrane

■ Fibrinous membrane over palpebral conjunctiva most commonly seen

with adeno or herpetic viral infections, streptococcal or gonococcal

infections, and chemical burns

Bacterial Conjunctivitis

ETIOLOGY

■ S. aureus,Streptococcus,H. influenza

■ Neisseria gonorrhea

■ Chlamydia

■ Pseudomonas

Opthalmia Neonatorum:

Chemical: 24–48 hours (from

topical silver nitrate)

GC or HSV2: 3–5 days post

delivery (from mom)

Chlamydia: 5–14 days post

delivery (from mom)

Strep and staph: 5 weeks–

5 years