HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESTREATMENT
■ Ophthalmology consult
■ Oral acyclovir, famciclovir, or valacyclovir.
■ Topical broad-spectrum antibiotic ointment to rash
■ Steroids for iritis—leave it up to the ophthalmologist.
Dacryocystitis
An acute infection/cellulitis of lacrimal sac due to nasolacrimal duct obstruc-
tion. Seen most commonly in infants and adults > 40 years. (See Figure
14.37—be able to identify on pictorial.)
ETIOLOGY
S. aureus,S. epidermidis,Streptococcussp., and H. influenzae.
SYMPTOMS/EXAM
■ Epiphora (excessive tearing)
■ Unilateral pain, erythema, swelling over lacrimal sac
■ Purulent discharge at the puncta
TREATMENT
■ Broad-spectrum oral and topical antibiotics
■ Warm compresses
■ Good analgesics
■ Gentle massage of lacrimal sac
■ Ophthalmologic referral for surgical drainage
Preseptal (Periorbital) Cellulitis
ETIOLOGY
■ Infection of superficial tissues anterior to the orbital septum (fascia between
eyelids and orbit)
■ More common than orbital cellulitis
Herpes zoster is difficult to
distinguish from herpes
simplex on slit lamp
(pseudodendritic vs dendritic
keratitis). A good rule of
thumb: Herpes zoster has
dermatomal skin involvement
and is seen in age > 60 years.
Herpes simplex is typically
seen in young adults.Never prescribe topical ocular
steroids without an
ophthamology consult.FIGURE 14.37. Dacrocystitis. Be able to identify on pictorial.
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency
Medicine, 2nd ed. New York: McGraw-Hill, 2002:41.)