PANCE Blueprint EENT (9%)

Disorders of the Eye (PEARLS)

The NCCPA™ EENT PANCE and PANRE Content Blueprint covers 24 topics under the category diseases of the eye

Blepharitis Eyelid changes: crusting, scaling, red-rimming of eyelid and eyelash flaking along with dry eyes and associated seborrhea and rosacea
Blowout fracture (ReelDx) History of blunt trauma, eyelid swelling, decreased visual acuity, enophthalmos (sunken eye), anesthesia/paresthesia in the gums, upper lips and cheek due to damage to the infraorbital nerve
Cataract Blurred vision over months or years, halos around lights. Clouding of the Lens (versus clouding of cornea = glaucoma)
Chalazion A chalazion is a painless (non-infectious) granuloma of the internal meibomian sebaceous gland, painless "cold" lid nodule, versus hordeolum, which is a painful infectious "hot" nodule
Conjunctivitis (ReelDx) Viral: copious watery discharge, scant mucoid discharge

Bacterial:  Pt will present with purulent (yellow) discharge, crusting, usually worse in the morning

Allergic: red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid

Gonococcal: copious purulent discharge, in a patient who is not responding to conventional treatment

Chlamydial - Giemsa stain - inclusion body, scant mucopurulent discharge

Corneal abrasion (ReelDx) Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection, fluorescein dye - increased absorption in devoid area, antibiotic eye ointment, NO PATCHING!
Corneal ulcer  Contact lense wearers, caused by deep infection in the cornea by bacteria, viruses or fungi, Fluorescein stain - round "ulceration" versus "dendritic" pattern like herpes
Dacryoadenitis Dacryoadenitis is inflammation of the nasolacrimal duct or the nasolacrimal gland (supratemporal)

Dacryocystitis is infectious obstruction of nasolacrimal duct (inferomedial region)

Ectropion Ectropion (eversion of the eyelid) occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation
Entropion Entropion (inversion of an eyelid) is most commonly caused by age-related tissue relaxation, surgical correction is definitive
Ocular Foreign body Metallic foreign bodies may leave a rust ring, irrigation, immediate surgical removal by an ophthalmologist
Glaucoma Open angle glaucoma - peripheral to central, gradual visual loss (versus macular degeneration which is central loss)

Acute angle closure glaucoma - classic triad: injected conjunctiva, cloudy or “steamy” cornea, and fixed dilated pupil, this is an ophthalmic emergency.

Hordeolum (ReelDx) Painful, warm (hot), swollen red lump on the eyelid (different from a chalazion which is painless) Think “H” for Hot = Hordeolum
Hyphema (ReelDx) Collection of blood inside the front part of the eye (called the anterior chamber, between the cornea and the iris). The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye
Macular degeneration Gradual central field loss, The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss, Dry macular degeneration (85% of cases): Atrophic changes with age – slow gradual breakdown of the macula, with Dry = DRUSEN = yellow retinal deposits.
Optic neuritis (ReelDx) Acute inflammation and demyelination of the optic nerve leads to acute monocular vision loss and pain in the affected eye, Multiple sclerosis is the most common cause
Orbital cellulitis Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection
Papilledema Optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks
Pterygium (ReelDx) Elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of the eye)
Retinal detachment Flashers, floaters, asymmetric red reflex, described as a curtain or dark cloud coming across the field of vision, Keep patient supine (lying face upward)
Retinal vascular occlusion Sudden, painless, unilateral, and usually severe vision loss (Amaurosis fugax), ruptured plaque from same sided (ipsilateral) carotid artery. Look for the cherry red spot
Retinopathy Most common cause of new, permanent vision loss and/or blindness in 25-74 year old, most common is diabetic retinopathy, Cotton wool spots, hard exudates, blot and dot hemorrhages, neovascularization, flame hemorrhages, A/V "nicking"
Strabismus (ReelDx) Strabismus is defined as any form of ocular misalignment, The cover/uncover test is used to diagnose strabismus, Exotropia: out-turning of eyes, Esotropia: in-turning of eyes
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