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1. EYES
1. Conjunctivitis
 Most common eye disease
 May be acute or chronic
 Most cases caused :
1- bacterial (gonococcal and chlamydial )
2-viral infection
 Other causes : allergy and chemical irritants

2. 2. Bacterial Conjunctivitis
A. Gonococcal Conjunctivitis
 Acquired through contact with infected genital
secretions.
 Manifested by a copious purulent discharge
 Involvement of corneal leads to perforation
 Dx confirmed by stained smear and culture of the
discharge.

3. Treatment
 Topical antibiotic :erythromycin or bacitracin
 Single IM dose of ceftriaxone ,1g ,is effective
 When the cornea is involved , a 5-day of parenteral
ceftriaxone ,1-2g daily ,is required.

4. 3. Viral Conjunctivitis
 Adenovirus is the most common cause
 Associated with :pharyngitis, fever, malaise and
preauricular adenopathy.
 Characterized by :red palpebral conjunctiva and
copious watery discharge
 Treatment : local sulfonamide therapy , hot
compresses

5. Allergic Conjunctivitis
 No pain , vision changes
 Marked pruritus
 Bilateral watery eyes
 Treatment :antihistamine or steroid drops

6. Herpes Zoster Ophthalmicus
 Frequently involves the ophthamic division the
trigeminal nerve.
 Eruptions preceded by :malaise, fever, headache and
burning and itching in the peri-orbital region.
 Rash ccc v vesicular pustular
crusting

9. Ocular manifestations:
 Conjunctivitis
 Keratitis
 Episcleritis
 Anterior uveitis
 Elevated intraocular pressure
 Treatment :high dose oral acyclovir

10. Uveitis
• Inflammation of the iris , ciliary body and /or choroid
• Characterized by : pain , miosis, photophobia
• Diagnosis made by slit lamp examination
• Flare & cells seen in aqueous humor
• Seen in IBD, sarcoidosis
• Treatment underlying disease

11. Glaucoma
• A group of diseases that can damage the eye’s optic
nerve and result in vision loss and blindness
• 2 types :
1. Angle –closure glaucoma
2.Open-angle glaucoma

12. Angle closure glaucoma
• Severe pain
• Decreased peripheral vision
• Presence of halos around lights
• Fixed mid-dilated pupil
• Tonometry reveals elevated intraocular pressure
• Treatment : IV mannitol , acetazolamide, laser
iridotomy for cure

13. Cataract
• Lens opacity
• Blurred vision ,progressive over months or years
• No pain or redness
• Treatment :surgery

14. Macular degeneration
• Age-related
• Painless loss of visual acuity
• Dx by altered pigmentation in macula
• No Tx , but patient often retains adequate peripheral
vision

16. Retinal detachment
• Blurred vision in one eye becoming w0rse ( “ a curtain
came down over my eyes”)
• No pain or redness
• Detachment seen by ophthalmoscopy
• Tx = urgent surgical reattachment

17. OTITIS EXTERNA
• Presents with otalgia
• Pruritus
• Purulent discharge
• h/o recent water exposure or mechanical trauma
• Examination reveals : erythema and edema of the ear
canal and pulling on pinna or pushing on tragus cause
pain

18. • Pseudomonas is usual cause
• Treatment:
I. Protection of the ear from additional moisture
II. Otic drops containing a mixture of aminoglycoside
antibiotic and anti-inflammatory corticosteroid( eg.
Neomycin sulfate , polymyxin B , and
hydrocortisone

19. Malignant External otitis
• Persistent external otitis in the diabetic
• Caused by pseudomonas aeruginosa
• May evolve into osteomyelitis of the skull base
• Presents with persistent foul aural discharg,
granulations in the ear canal ,deep otalgia, progressive
cranial nerves palsies
• CT confirmed the dx by demonstrating of osseous
erosion

20. Treatment
• Medical : antipseudominal antibiotic often for several
months
• Surgical debridement

21. Acute Otitis Media
• Bacterial infection of the mucosally lined air-
containing spaces of the temporal bone.
• Precipitated by a viral upper respiratory tract infection.
• Most common in infant and children
• Most common pathogens : streptococcus pneumonia,
haemophilus influenzae and streptococcus pyogenes

22.  Patient presents with otalgia, aural pressure, decreased
hearing and fever.
 Typical findings : erythema and decreased mobility of
the tympanic membrane.
 Treatment:
 First –choice antibiotic either amoxicillin or
erythromycin.
 Amoxicillin-clavulanate useful alternative

23. Vertigo Syndromes
A. Benign positional vertigo
• Sudden,episodic vertigo with head movement lasting
for seconds.
• Treatment : hallpike maneuver
B. Viral labyrinthitis
• Prececed by viral respiratory illness
• Vertigo lasting days to weeks
• Treatment : meclizine

24. Meniere’s disease
• Dilation of membrane labyrinth due to excess
endolymph
• Characterized by classic triad :hearing loss, tinnitus
and episodic vertigo lasting several hours.
• Treatment : thiazide, anticholinergic or surgery

25. Acoustic neuroma
• CN VIII schwannoma commonly affects vestibular
portion but can also affect cochlea.
• Patient presents with : vertigo, sudden deafness and
tinnitus.
• Dx = MRI of cerebellopontine angle
• Tx = local radiation or surgical erection

26. EPISTAXIS
• Bleeding from Kiesselbach’s plexus, a vascular plexus
on the anterior nasal septum.
• Predisposing factors :
a.Nasal trauma (nose picking, foreign bodies, forceful
nose blowing)
b.Rhinitis, drying of the nasal mucosa ,deviation of the
nasal septum, alcohol , bone spurs, antiplatelet
medication.

27. Treatment = direct pressure, topical nasal constriction
(phenylephrine 0.125-1% solution), consider anterior
nasal packing if unable to stop.

28. SINUSITIS
• Result of impaired mucociliary clearance and
obstruction of the osteomeatal complex. Edematous
mucosa causes obstruction of the sinus drainage
tract, resulting in the accumulation of mucous
secretion in the sinus cavity that becomes
secondarily infected by bacteria.

29. A . Acute sinusitis
• Patient presents with : purulent rhinorrhea, headache,
pain on sinus palpation,fever, halitosis.
• Most common pathogens : S. pneumoniae, H.
influenzae, Moraxella catarrhalis.
• Tx : Bactrim , amoxicillin, decongestants

30. B. Chronic sinusitis
• Same clinical presentation as for acute.
• Lasts longer > 3 months
• Common pathogens : Bacteroides, Staph. Aureus,
Pseudomonas , Streptococcus spp.
• Dx = CT scan showing inflammatory changes or bone
destruction.
• Tx = surgical correction of obstruction , nasal steroids
• Complication : meningitis, abscess formation,orbital
infection,osteomyelitis

31. PHARYNGITIS
A. Group A Strep throat
• High fever
• Severe throat pain w/o cough
• Edematous tonsils with white or yellow exudate
• Unilateral cervical adenopathy

32.  Diagnosis
I. H&P 50 % accurate
II. Rapid antigen test
III. Throat swab culture is gold standard
• Tx: penicillin to prevent acute rheumatic fever

33.  Membranous ( diphtherial )
I. High fever
II. Dysphagia
III. Drooling can cause respiratory failure
 Dx : pathognomonic gray membrane on tonsils
extending into throat
 Tx : Antitoxin

34. • Fungal (candida)
I. Dysphagia
II. Sore throat with white ,cheesy patches in
oropharynx (oral thrush)seen in AIDS and small
children
III. Dx : clinical or endoscopy
IV. Tx : nystatin ,clotrimazole

35.  Adenovirus
I. Fever
II. Red eye
III. Sore throat
IV. Dx : clinical
V. Tx : supportive

36.  Herpangina ( coxsackie A)
I. Fever
II. Pharyngitis
III. Body ache
IV. Tender vesicles along tonsils, uvula and soft palate
V. Dx : clinical
VI. Tx : supportive