NURS 5335 family 2 Study Guide EENT Family Nursing II
n n n n n n n n n n
Modules 1&2 Completed 2023-2024
n n n
Eye:
Blepharitis:n(Hollier,n ppn465-466)
• Definition:n inflammationnof ninfe ctionnof nthe neye lidsn associatednwithnbacterialn infe ction,ndryne
yes,nand/ornrosace a.nOftennanchronicnproble mnwithnintermitte ntnexace rbations. n Blepharitisnisnc
ategorizedn accordingntonpredominantn anatomicn location:nanteriorn(lessncommon,nwithninflam
mationnatnthe nbase nofnthe neye lashe s) nornposteriorn(inflammationnof nthe ninne rnportionnof nthe ne
yelid,natnthe nMeibomiann glands).
• Pathophysiology
o Nonulce rative nformnassociatednwithnse borrhe an Occasionallynsee nninn
those nwithntrisomyn 21
Tendsntonaffe ctnpe ople nwithnpsoriasis,nse borrhe a, necze ma,nalle rgies,n&
n lice n infestations
Contributingnfactors:nexposure ntonche micalnornenvironmentalnirritants,n
use nof neye nmakeupnandncontactn lense snon Ulce rative nform
Involve snthe nlashnfollicle nandnthe nMe ibomiannglandsn ofnthe neye lidn
Maynbe npustulesnatnthe nbase nof nthe nhairnfolliclesnthatnmaynbe ncrust
andnbleedn n Lashesnbe come nthinnandnbreakneasilyn n Risknfactors:
o Dryneyes
o Frequentnhordeolan(stye) nornchalazionnonFacialnornscalpnseborrhe anon
Immunocompromisednstate no nAcne nrosace anonDiabetesnme llitusn onI
sotretinoin
• Differential n diagnosis:
o Sebaceousncell,nbasalnce ll,nornsquamousncellncarcinoman onChalazion
o Lice ninfestation
• Diagnosticn testingn needed:
o Usuallynnone;nan clinicalndiagnosisn onSlitnlampnexaminationncannhe lpn
distinguishnbetweennanteriorn&nposteriornblepharitisnonCulturesnforn
recurrentnanteriornble pharitisnwithnsevere n inflammationnof nlacknof n
response ntontherapy
• TreatmentnonPharmacologic:
, Topicalnmedications:
n
• Antibiotics:
o Azithromycinnophthalmicnsolutionn 1%non
Erythromycinnointmentn onBacitracinnoint
mentnonQuinolone n ointments
• Glucocorticoids:n forn acute n exacerbations
• Cyclosporine n0.05%neye ndrops Oralnmedications: Antibiotics:
o nTetracycline n250mgnPOnQIDnonDoxycycline n100mgnPOnBIDno
Azithromycinn500mgnonndayn1,nthenn250mgnx n4ndaysn(Z-pack)
nFornsevere ncasesnorncasesnthatndonnotnrespondntone yelidnhygiene,nantibioticnointm
entnisnappropriate
Forninfectionsnresistantntontopicalntre atment,nconside rnoralntetracycline ntherap
n
ynfornseveralnweeks
Topicalnglucocorticoidsncannincrease nglaucomanandncataractnrisk;ntherefore,
theynshouldnnotnbe nusednfornprolongedn(chronic)ntherapy.no
Nonpharmacologic:
Cleanneyelidnmarginsn2-4x/daynwithnbabynshampoon,ndepe ndingnonnseverity
Warm,n moistn compressesn severaln times/days
Lidnmassage ntone mptynMe ibomiannglandsn;nbestntime ntonpe rformnisnimme
diatelynafternwarmncompresse s
Remove ncontactnlense sn&ndisinfe ct!
Thermalnpulsationnsystemsnprovide nhe atn&ngentle npressure nonnthe neye lidntonre l
ease nobstructionn innthe nMe ibomiann gland
• Follow-up:
o None n usuallyn neededn forn simple n cases
o Mayn re-evaluate n withinn 2n weeksn ifn corticosteroidn isn prescribed
• Referral:
o Ophthalmologistn forn severe n infections
o Ophthalmologistnfornprese ntationsnthatn donnotnimprove n afterntre atme ntno nPat
ientnwithnunilateralnornothernunusualnsymptomsnshouldnbe nevaluatednfornthe npo
ssibilitynofnsebaceousnce llnmalignancy
Hordeolum/Chalazionn(knownhowntondifferentiate nbetweennthe ntwo)n–
n the n differencen betweennthe n2n isn thatn then Hordeolumnisntendernwithnpusnpresent,nwhile nthe nChalazionn isnfirm
n andnnontender.n Also,nthe nhordeolumn isn causedn byninfectionnwhile nthen chalazionn resultsnfromn annoninfectio
usnMeibomiannglandnocclusion.
• Definition
o Hordeolumn(eye ndisordernpp)nstye n–
nannacutely npre senting, ne rythe matous, ntende rn lumpn within n the n eye lid
, o
n Externalnhordeolum:ninflammation/infection nofnthe neyelidnmarginnaffectingnth
e nhairnfolliclesnof nthe neyelashes
Internaln hordeolum:n inflammation/infection n of n the n Meibomiann glands
Chalazionn(Hollier,nppn468-469)n–
n benign, n chronicn lipogranulomatous n inflammation nof n the n eyelid n caused n byn blockage n of n the n Meibomian n gland.
nAngranulomatousninfe ctionnof nanMeibomianngland,npresentingninnthe nformnof npainl
essnswellingntonthe neye lid.
nInitiallynmaynbe ntende rn&nerythe matousnbefore nevolvingnintonannontende rnlumpn
Blepharitisnisnfrequentlyn associatednwithnchalazia
• Pathophysiology
o Hordeolumn-
nbecome ninfected nby n S. naure us. n Thisn infe ction n causes n painn andn swe llingn atnthe n base n of nt
he neyelashnwithnlocalizednabsce ssnformation.no nChalazionn–
n are ncaused n by n inflammation n andn obstruction n of n se bace ous n glands n of n the n eyelids. n Whi
le ninfectionncanncause nthe ninflammationnornobstructionnthatnle adsntonthisncondition, nthe
nlesion nitself n isn ann inflammatory n lesion.
• Risknfactorsno nInternalnhordeolumn(stye) ncannbecome nchronicnandndeve lopnintonan chalazionno n
Anynconditionnthatnmaynimpede dnflownthroughnthe nMe ibomianngland;nthisnglandnproducesnthe
n outern layern of n tearn film.
o Ocularndemodicosisn(mite nspecies nthatnreside sninnlashnfollicle nornMeibomianngland) n o
Rosacea
• Differential ndiagnosisnonHordeolum
o Tumor
, o Blepharitisnon Embedde dnforeignnbody
Diagnostic
n testingnneedednon None n usuallynneede d
• TreatmentnonPharmacologic
UsuallynNOTnnecessary
Ifnsecondarilyninfected,nconsidernsulfacetamide, nerythromycinnornanothern to
picalnophthalmicnantibiotic
n See n complete n listn inn Conjunctivitis n diagnosis
Antibioticsnare nnotnindicatednbecause nanchalazionnisnangranulomatousncondition.
o Nonpharmacologic
nWarm,nmoistncompressesnnonnaffe ctednlidnarean3x/day:nclearsnthe nMe ibomiann
ductsnof nstagnantnoils
IntralesionalnsteroidninjectionnLi
dnmassage
Lidnscrubs
Spontaneousn resolutionn mayn occur
• Follow-up
o 2-4nweeksnif nsmallnandnuncomplicatedno
If ninfected;ndependsnonnseverity
• Referral
o Ophthalmologistnifnnonresponse ntontre atme ntnaftern6nweeks
o Optionsninclude nintralesionalnsteroidninje ction,ntotalnexcision,nornbotulinumnne urotoxin
n type n A n injection
Conjunctivitisn(knownhowntondifferentiate nbetweennbacterial,nviral,nandnallergic)n(Hollier,nppn469-472).
• Definition
o Anninflammationnornirritationnofnthe nconjunctiva.n Maynhave ninfe ctiousnornnoninfe ctious
n cause;n infectious n forms n are n highly n contagious.
n n n n n n n n n n
Modules 1&2 Completed 2023-2024
n n n
Eye:
Blepharitis:n(Hollier,n ppn465-466)
• Definition:n inflammationnof ninfe ctionnof nthe neye lidsn associatednwithnbacterialn infe ction,ndryne
yes,nand/ornrosace a.nOftennanchronicnproble mnwithnintermitte ntnexace rbations. n Blepharitisnisnc
ategorizedn accordingntonpredominantn anatomicn location:nanteriorn(lessncommon,nwithninflam
mationnatnthe nbase nofnthe neye lashe s) nornposteriorn(inflammationnof nthe ninne rnportionnof nthe ne
yelid,natnthe nMeibomiann glands).
• Pathophysiology
o Nonulce rative nformnassociatednwithnse borrhe an Occasionallynsee nninn
those nwithntrisomyn 21
Tendsntonaffe ctnpe ople nwithnpsoriasis,nse borrhe a, necze ma,nalle rgies,n&
n lice n infestations
Contributingnfactors:nexposure ntonche micalnornenvironmentalnirritants,n
use nof neye nmakeupnandncontactn lense snon Ulce rative nform
Involve snthe nlashnfollicle nandnthe nMe ibomiannglandsn ofnthe neye lidn
Maynbe npustulesnatnthe nbase nof nthe nhairnfolliclesnthatnmaynbe ncrust
andnbleedn n Lashesnbe come nthinnandnbreakneasilyn n Risknfactors:
o Dryneyes
o Frequentnhordeolan(stye) nornchalazionnonFacialnornscalpnseborrhe anon
Immunocompromisednstate no nAcne nrosace anonDiabetesnme llitusn onI
sotretinoin
• Differential n diagnosis:
o Sebaceousncell,nbasalnce ll,nornsquamousncellncarcinoman onChalazion
o Lice ninfestation
• Diagnosticn testingn needed:
o Usuallynnone;nan clinicalndiagnosisn onSlitnlampnexaminationncannhe lpn
distinguishnbetweennanteriorn&nposteriornblepharitisnonCulturesnforn
recurrentnanteriornble pharitisnwithnsevere n inflammationnof nlacknof n
response ntontherapy
• TreatmentnonPharmacologic:
, Topicalnmedications:
n
• Antibiotics:
o Azithromycinnophthalmicnsolutionn 1%non
Erythromycinnointmentn onBacitracinnoint
mentnonQuinolone n ointments
• Glucocorticoids:n forn acute n exacerbations
• Cyclosporine n0.05%neye ndrops Oralnmedications: Antibiotics:
o nTetracycline n250mgnPOnQIDnonDoxycycline n100mgnPOnBIDno
Azithromycinn500mgnonndayn1,nthenn250mgnx n4ndaysn(Z-pack)
nFornsevere ncasesnorncasesnthatndonnotnrespondntone yelidnhygiene,nantibioticnointm
entnisnappropriate
Forninfectionsnresistantntontopicalntre atment,nconside rnoralntetracycline ntherap
n
ynfornseveralnweeks
Topicalnglucocorticoidsncannincrease nglaucomanandncataractnrisk;ntherefore,
theynshouldnnotnbe nusednfornprolongedn(chronic)ntherapy.no
Nonpharmacologic:
Cleanneyelidnmarginsn2-4x/daynwithnbabynshampoon,ndepe ndingnonnseverity
Warm,n moistn compressesn severaln times/days
Lidnmassage ntone mptynMe ibomiannglandsn;nbestntime ntonpe rformnisnimme
diatelynafternwarmncompresse s
Remove ncontactnlense sn&ndisinfe ct!
Thermalnpulsationnsystemsnprovide nhe atn&ngentle npressure nonnthe neye lidntonre l
ease nobstructionn innthe nMe ibomiann gland
• Follow-up:
o None n usuallyn neededn forn simple n cases
o Mayn re-evaluate n withinn 2n weeksn ifn corticosteroidn isn prescribed
• Referral:
o Ophthalmologistn forn severe n infections
o Ophthalmologistnfornprese ntationsnthatn donnotnimprove n afterntre atme ntno nPat
ientnwithnunilateralnornothernunusualnsymptomsnshouldnbe nevaluatednfornthe npo
ssibilitynofnsebaceousnce llnmalignancy
Hordeolum/Chalazionn(knownhowntondifferentiate nbetweennthe ntwo)n–
n the n differencen betweennthe n2n isn thatn then Hordeolumnisntendernwithnpusnpresent,nwhile nthe nChalazionn isnfirm
n andnnontender.n Also,nthe nhordeolumn isn causedn byninfectionnwhile nthen chalazionn resultsnfromn annoninfectio
usnMeibomiannglandnocclusion.
• Definition
o Hordeolumn(eye ndisordernpp)nstye n–
nannacutely npre senting, ne rythe matous, ntende rn lumpn within n the n eye lid
, o
n Externalnhordeolum:ninflammation/infection nofnthe neyelidnmarginnaffectingnth
e nhairnfolliclesnof nthe neyelashes
Internaln hordeolum:n inflammation/infection n of n the n Meibomiann glands
Chalazionn(Hollier,nppn468-469)n–
n benign, n chronicn lipogranulomatous n inflammation nof n the n eyelid n caused n byn blockage n of n the n Meibomian n gland.
nAngranulomatousninfe ctionnof nanMeibomianngland,npresentingninnthe nformnof npainl
essnswellingntonthe neye lid.
nInitiallynmaynbe ntende rn&nerythe matousnbefore nevolvingnintonannontende rnlumpn
Blepharitisnisnfrequentlyn associatednwithnchalazia
• Pathophysiology
o Hordeolumn-
nbecome ninfected nby n S. naure us. n Thisn infe ction n causes n painn andn swe llingn atnthe n base n of nt
he neyelashnwithnlocalizednabsce ssnformation.no nChalazionn–
n are ncaused n by n inflammation n andn obstruction n of n se bace ous n glands n of n the n eyelids. n Whi
le ninfectionncanncause nthe ninflammationnornobstructionnthatnle adsntonthisncondition, nthe
nlesion nitself n isn ann inflammatory n lesion.
• Risknfactorsno nInternalnhordeolumn(stye) ncannbecome nchronicnandndeve lopnintonan chalazionno n
Anynconditionnthatnmaynimpede dnflownthroughnthe nMe ibomianngland;nthisnglandnproducesnthe
n outern layern of n tearn film.
o Ocularndemodicosisn(mite nspecies nthatnreside sninnlashnfollicle nornMeibomianngland) n o
Rosacea
• Differential ndiagnosisnonHordeolum
o Tumor
, o Blepharitisnon Embedde dnforeignnbody
Diagnostic
n testingnneedednon None n usuallynneede d
• TreatmentnonPharmacologic
UsuallynNOTnnecessary
Ifnsecondarilyninfected,nconsidernsulfacetamide, nerythromycinnornanothern to
picalnophthalmicnantibiotic
n See n complete n listn inn Conjunctivitis n diagnosis
Antibioticsnare nnotnindicatednbecause nanchalazionnisnangranulomatousncondition.
o Nonpharmacologic
nWarm,nmoistncompressesnnonnaffe ctednlidnarean3x/day:nclearsnthe nMe ibomiann
ductsnof nstagnantnoils
IntralesionalnsteroidninjectionnLi
dnmassage
Lidnscrubs
Spontaneousn resolutionn mayn occur
• Follow-up
o 2-4nweeksnif nsmallnandnuncomplicatedno
If ninfected;ndependsnonnseverity
• Referral
o Ophthalmologistnifnnonresponse ntontre atme ntnaftern6nweeks
o Optionsninclude nintralesionalnsteroidninje ction,ntotalnexcision,nornbotulinumnne urotoxin
n type n A n injection
Conjunctivitisn(knownhowntondifferentiate nbetweennbacterial,nviral,nandnallergic)n(Hollier,nppn469-472).
• Definition
o Anninflammationnornirritationnofnthe nconjunctiva.n Maynhave ninfe ctiousnornnoninfe ctious
n cause;n infectious n forms n are n highly n contagious.
