PANCE Blueprint EENT (7%)

Corneal disorders (PEARLS)

NCCPA™ PANCE Eyes, Ears, Nose, and Throat Content Blueprint eye disorders ⇒ corneal disorders

Cataract Clouding of the lens in the eye leading to a decrease in vision, affecting one or both eyes

Blurred vision over months or years, halos around lights. Clouding of the Lens (versus clouding of cornea = glaucoma)

Tx: Surgical removal is definitive

Corneal ulcer Corneal ulcers, also known as ulcerative keratitis, is an inflammatory or infective disease of the cornea leading to disruption of the epithelial layer and the corneal stroma

Contact lens wearers, caused by deep infection in the cornea by bacteria, viruses or fungi

  • White spot on the surface of the cornea that stains with fluorescein: round "ulceration" versus "dendritic" pattern like herpes
  • In developing countries, children with vitamin A deficiency are at high risk for developing corneal ulcers.

Tx: Immediate referral - if an immediate referral is not possible, it is reasonable to start topical ophthalmic antibiotics without delay

Keratitis and infectious corneal disorders Keratitis is a condition in which the cornea becomes inflamed and is often marked by pain, impaired eyesight, photophobia, and red eye

  • Infectious keratitis can be caused by bacteria, viruses, fungi, or parasites
  • Viral infection of the cornea is often caused by the herpes simplex virus which causes a dendritic ulcer with fluorescein stain
  • Bacterial infectious keratitis - improper contact lens wear is the largest risk factor and commonly presents with a corneal opacity or infiltrate (typically a round white spot)

Treat herpes keratitis with topical antiviral

  • Bacterial keratitis requires urgent ophthalmological referral and prompt initiation of topical bactericidal antibiotics (ideally after obtaining cultures)
Pterygium (ReelDx) Elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in the inner corner/nasal side of the eye)

  • Pterygium is associated with increased sun exposure and climates where there is wind, sand, and dust

Tx: Only surgically remove when vision is affected

Conjunctivitis (ReelDx + Lecture) (Prev Lesson)
(Next Lesson) Cataract (Lecture)
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