Download - Eye and ear problems
![Page 1: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/1.jpg)
Ear and eye disorders
• Otitis media• Conjunctivitis
![Page 2: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/2.jpg)
![Page 3: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/3.jpg)
Otitis media Inflammation of the middle ear Common in children types
Acute suppurative otitis media Serous otitis media Chronic suppurative otitis media
![Page 4: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/4.jpg)
Acute suppurative otitis media Etiology
Streptococcus pneumoniae Haemophilus influenzae
![Page 5: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/5.jpg)
Acute suppurative otitis media Predisposing factors
Recurrent upper respiratory tract infection Tonsillitis Cleft palate
Route of infection Via eustachian tube Via external ear Haematogenous route (uncommon)
![Page 6: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/6.jpg)
ASOM: Pathogenesis URTI- usually viral origin Edema of the nasopharyngeal end of ET ET blockage Negative pressure in the middle ear Promotes invasion of pyogenic organism Acute suppurative inflammation Tympanic membrane bulges outward and perforates Release of pus in the external ear Followed by resolution If persistence of infection spread of infection with various complications
![Page 7: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/7.jpg)
ASOM: Complications Acute mastoiditis Facial paralysis Labyrinthitis Extradural abscess Meningitis Brain abscess
![Page 8: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/8.jpg)
Acute suppurative otitis media: morphology Gross:
Edematous and congested middle ear mucosa Haemorrhage Middle ear cavity may be filled with pus
Microscopy: Neutrophilic infiltration in the mucosa Osteoclastic destruction of the mastoid bone Fibrosis
![Page 9: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/9.jpg)
Serous otitis media Insidious onset Accumulation of non-purulent effusion in
the middle ear cleft
![Page 10: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/10.jpg)
Chronic suppurative otitis media Chronic infection of the middle ear cleft Common in developing countries
![Page 11: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/11.jpg)
Types of CSOM Tubotympanic- safe or benign type Atticoantral- unsafe or dangerous type
![Page 12: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/12.jpg)
CSOM- tubotympanic type Involves anteroinferior part of middle ear
cleft Central perforation No risk of serious complications
![Page 13: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/13.jpg)
CSOM- atticoantral type Involves posterosuperior part of middle ear
cleft (attic, antrum, posterior tympanum, mastoid
Attic perforation of tympanic membrane Associated with cholesteatoma Risk of serious complications
![Page 14: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/14.jpg)
![Page 15: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/15.jpg)
CSOM Etiology
Sequelae of acute otitis media Causative organisms
Gram negative bacilli proteus species pseudomaonas aeruginosa
![Page 16: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/16.jpg)
CSOM- tubotympanic type: Morphology
Involvement of anteroinferior part of the middle ear cleft with central perforation of tympanic membrane
Aural polyp (granulation tissue) protuding out thru’ perforation
Loss of ossicular bone
![Page 17: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/17.jpg)
CSOM- atticoantral type: morphology Involvement of posteriosuperior part of middle
ear with attic perforation of tympanic membrane
Osteitis Ossicular necrosis Cholesterol granulomas Cholesteatoma- stratified squamous epithelium
with underlying thin fibrous stroma and central keratin debris- tendency to erode bone and surrounding structures
![Page 18: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/18.jpg)
Clinical features‘TT’typeEar discharge- mucoid or mucopurulent Hearing loss- conductive typeCentral Perforation‘AA’ typeEar discharge- foul smellyHearing loss- mostly conductive typeBleeding Attic perforation
![Page 19: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/19.jpg)
![Page 20: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/20.jpg)
Conjunctivitis Inflammation of conjunctiva
RED EYE
![Page 21: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/21.jpg)
Types of Conjunctivitis Based on duration
Acute subacute Chronic
![Page 22: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/22.jpg)
Conjunctivitis: etiology
Infectious causes Bacterial Viral Fungal Chlamydial parasites
Non-infectious Allergic Irritants Autoimmune Toxic Idiopathic
![Page 23: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/23.jpg)
Bacterial conjunctivitis Causative agents:
Staphylococcus aureus (common) Haemophilius aegyptius H. influenzae
clinically manifest as acute purulent or mucopurulent conjunctivitis
Conjunctiva Hyperemia, edema (chemosis) mucopurulent or purulent discharge
![Page 24: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/24.jpg)
Viral conjunctivitis Common causative agents
Adenoviruses Paramyxoviruses Herpes simplex
Watery clear or serous discharge
![Page 25: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/25.jpg)
Trachoma Form of chronic conjunctivitis (>4wks
duration) caused by chlamydia trochomatis serotypes
A,B,C Endemic in many parts of the world Contagious in the acute stages Common in unhygienic and crowded
surroundings One of the leading cause of blindness
![Page 26: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/26.jpg)
Trachoma
WHO classification (FISTO) Trachomatous Follicles – active disease Trachoma Intense- severe disease requiring
urgent treatment Trachomatous Scarring- old inactive disease Trachomatous Opacities- corneal opacities
with visual loss
![Page 27: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/27.jpg)
Trachoma
![Page 28: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/28.jpg)
Tumors of eye: classificationEye lid tumor- Basal cell carcinoma, Sebaceous carcinoma
![Page 29: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/29.jpg)
Contd.Tumors of conjunctiva Benign: Squamous papilloma
Conjunctival nevi Malignant: Squamous cell carcinoma Melanoma
![Page 30: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/30.jpg)
Tumors of uvea(choroid, iris, ciliary body) Benign-uveal nevi Malignant- melanoma
![Page 31: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/31.jpg)
Tumors of retina Retinoblastoma Retinal lymphoma
![Page 32: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/32.jpg)
Tumours of optic nerve Pilocytic astrocytoma Meningioma
![Page 33: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/33.jpg)
Tumours of orbit: Mesenchymal tumoursBenign Lipoma Haemangioma Schwannoma Neurofibroma Osteoma Chondroma
Malignant tumours Angiosarcoma Chondrosarcoma Malignant nerve
sheath tumours
![Page 34: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/34.jpg)
Tumours of lacrimal gland Pleomorphic adenoma
![Page 35: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/35.jpg)
Retinoblastoma Commonest intraocular malignancy Children Hereditary sporadic
![Page 36: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/36.jpg)
Retinoblastoma: morphology Gross:
exophytic or endophytic retinal growth Creamy whitish in colour with areas of
calcification and necrosis
![Page 37: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/37.jpg)
Retinoblastoma : microscopy
Sheets of small round cells with scant cytoplasm and hyperchromatic nucleiFlexner-Wintersteiner rosettesNecrosis
![Page 38: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/38.jpg)
Well differentiated retinoblastoma
![Page 39: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/39.jpg)
metastasis Brain Bone marrow Prognosis poor
![Page 40: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/40.jpg)
![Page 41: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/41.jpg)
Skin
![Page 42: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/42.jpg)
Macroscopic terms Macule- flat circumscribed, 0.5cm Papule- raised, 0.5cm Vesicle-raised, fluid filled, 0.5cm Pustule- pus filled raised lesion Nodule- raised, >0.5cm
![Page 43: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/43.jpg)
Skin diseases Infections Dermatitis Tumors
![Page 44: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/44.jpg)
Skin infections Bacterial Viral fungal
![Page 45: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/45.jpg)
Bacterial infections Furuncle, boil, carbuncle Impetigo
![Page 46: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/46.jpg)
Furuncle/boil/carbuncle Causative organism- staphyoloccoci Hairy areas- face, axilla Furuncle- Focal suppurative inflammation of
the hair follicle Boil - abscess point Carbuncle- Deep suppuration beneath the
subcutaneous fascia and superficial multiple sinuses
![Page 47: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/47.jpg)
Boil and carbuncle
![Page 48: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/48.jpg)
Impetigo Organisms:
Group A beta hemolytic streptococci Staphylococcus aureus
Common infection in children Site: Face, hands Gross examination- Erythematous macule to small
multiple pustules that ruptures and appears as honey coloured crusted lesion
Microscopic examination- subcorneal pustule
![Page 49: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/49.jpg)
Viral infections Verrucae(warts) Cold sores(herpes simplex)
![Page 50: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/50.jpg)
Verrucae (Wart) Caused by Human papilloma virus (HPV) Direct contact or autoinoculation Any age group Self limiting disease Verrucae vulgaris – common type – hands Flat to raised papules with rough surface Microscopy: Papillomatous hyperplasia
![Page 51: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/51.jpg)
Herpes simplex virus infection Commonly known as Cold sores- mucocutaneous
junction Lip, nose Causative agent: HSV1 & HSV2 Acute primary infection- replication of viruses in the
epidermis-> vesicular eruptions Latent infection-Via sensory nerve spread to the sensory
ganglion and remain in dormant phase ( no replication) Recurrent infection- reactivation of latent viruses-
spread to the skin and mucous membrane from the affected ganglion
![Page 52: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/52.jpg)
Superficial fungal infections Dermatophytes Candidiasis
![Page 53: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/53.jpg)
Superficial dermatophytoses Limited to the stratum corneum Reservoirs- soil, animals
![Page 54: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/54.jpg)
Types of dermatophytoses Tinea capitis- Scalp Tinea corporis-Body Tinea cruris- Inguinal region Tinea pedis- foot web space Tinea versicolor- Upper trunk
Microscopic feature- Hyphae and yeast in the stratum corneum
![Page 55: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/55.jpg)
Tinea corporis (ring worm)
Appears as a circular scaly raised area with clearing in the centre
![Page 56: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/56.jpg)
Cutaneous candidiasis Yeast- candida albicans Nail, nail folds, webs of fingers and toes,
perineum of infants- diaper rash Microscopic features-Yeast like forms and
pseudohyphae
![Page 57: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/57.jpg)
Cutaneous candidiasis
![Page 58: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/58.jpg)
Dermatitis Inflammation of the skin secondary to
immune reaction Acute chronic
![Page 59: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/59.jpg)
Acute eczematous dermatitis Acute immune mediated inflammatory
lesion Red papulovesicular oozing lesion
![Page 60: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/60.jpg)
PathogenesisDelayed type of hypersensitivity reaction Exposure to antigen in the epidermis Sensitization of T lymphocytes and production of T
memory cells On repeated exposure to same antigen, T cells
recruitment at the site of antigenic exposure Release of cytokines Recruitment of inflammatory cells Inflammatory response Occurs within 24 hrs
![Page 61: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/61.jpg)
Chronic dermatitis: Seborrheic dermatitis Chronic inflammatory disease Region with high sebaceous glands- scalp,
forehead Fungal infection- malassezia furfur
![Page 62: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/62.jpg)
Clinical appearnance Macules and papules with greasy base Scaling and crusting Dandruff of the scalp
![Page 63: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/63.jpg)
Psoriasis Common chronic inflammatory disease All ages affected Association with- arthritis, myopathy,
enteropathy T cell mediated inflammation Results in proliferation of keratinocytes,
angiogenesis and inflammation
![Page 64: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/64.jpg)
Clinical features Site of affection- elbows, knees, scalp,
lumbosacral areas, intergluteal cleft Scaly plaque- silver white in colour Nail changes-yellow brown discolouration
with pitting
![Page 65: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/65.jpg)
Lichen planus Chronic inflammatory disorder Self limiting disease Cell mediated immune reaction Malignant transformation in chronic
mucosal lesions
![Page 66: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/66.jpg)
Clinical features Itchy lesions Flat topped papule – coalesce – plaque Dark brown color in dark skinned
individual due to loss of melanin pigment Multiple lesions, symmetrical distribution-
extremities- wrist, elbows
![Page 67: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/67.jpg)
![Page 68: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/68.jpg)
Malignant Tumors of skin Squamous cell carcinoma Basal cell carcinoma Melanoma
![Page 69: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/69.jpg)
Squamous cell carcinoma It is the 2nd most common skin malignancy Sun exposed area Men>females Elderly age group
![Page 70: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/70.jpg)
Predisposing factors Sun exposure Chronic ulcers Old burn scars Ionizing radiation Industrial exposure to carcinogens- tar
![Page 71: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/71.jpg)
UV light – DNA damage- cancer development
![Page 72: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/72.jpg)
Squamous cell carcinoma
Cauliflower like growth orUlcerated lesion
![Page 73: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/73.jpg)
Morphology Tumor arising from epidermal epithelium Invades basement membrane and infiltrates
underlying dermis Nests of malignant tumor cells Stratification Keratin pearls in well differentiated tumors Necrosis- poorly differentiated tumors
![Page 74: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/74.jpg)
Squamous cell carcinoma
![Page 75: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/75.jpg)
Basal cell carcinoma Most common skin tumors Sun exposed areas- face Slowly growing tumors Rarely metastasize Locally invasive- rodent ulcers
![Page 76: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/76.jpg)
morphology Ulcerated lesion with pearly white borderMicroscopic examination- Arises from the basal layer of the epidermis or follicular
epithelium Nest of tumor cells resembling basal layer of the epidermis Peripheral palisading Retraction artifact Cells- small, scant cytoplasm, round to oval hyperchromatic
nuclei Mucoid stroma Inflammatory infiltration in the stroma
![Page 77: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/77.jpg)
Basal cell carcinoma
![Page 78: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/78.jpg)
Basal cell carcinoma
![Page 79: Eye and ear problems](https://reader036.vdocument.in/reader036/viewer/2022062401/586fd8d01a28ab18428b571b/html5/thumbnails/79.jpg)
Malignant melanoma