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Parotitis/Sialadentitis
- Painful swelling of the parotid one or both parotid glands
Cause
-
Viral infection
- Historically the number one cause was the mumps
- Parainfluenza and Epstein barr are the most common
- HIV
-
Bacterial infection
- Staph Aureus is the most common bacteria
-
Autoimmune disease
- Sjogrens
-
Blockage
- Stone
- Mucus plug
- Dehydration
Clinical Presentation
- Facial swelling
- Facial pain
- Difficulty swallowing
Labs, Studies and Physical Exam Findings
- Clinical diagnosis
Treatment
- Supportive care
- Appropriate antibiotics
Glaucoma
- Increased intraocular pressure leading to damage to the optic nerve.
- Aqueous humor is constantly being produced within the eye. It also is constantly draining out.
-
The four major types of glaucoma include
- Open angle glaucoma which is a the chronic form
- Closed angle glaucoma which is an acute clogging of the drainage of aqueous humor
- Congenital glaucoma
- Secondary glaucoma – caused by systemic diseases, trauma or steroids.
Risk Factors
- Advancing age
- African American
- Family history of glaucoma
- Diabetes
- HTN
- Hypothyroidism
- Long term use of corticosteroids
Clinical presentation
-
Open angle glaucoma
- Insidious, often no symptoms
- Gradual loss of peripheral vision
-
Acute angle closure glaucoma
- Pain
- N/V
- Blurred vision
- Halos around lights
- Photophobia
Labs, Studies and Physical Exam Findings
-
Open angle glaucoma
- Tonometry: IOP > 22
- Bowing of the iris
- Visual field test will show decreased peripheral vision
- Visual acuity should always be tested
-
Fundoscopic exam
- look for vessels bending over the edge of the disc
- cup:disc ratio of >0.5
-
Closed angle glaucoma
- Tonometry: IOP > 22, in an acute phase pressures can be between 40 and 80 mmhg
- Fixed mid dilated pupil
- Red or hazy eye
-
Fundoscopic exam
- look for vessels bending over the edge of the disc
- cup:disc ratio of >0.5
Treatment
-
Medications
-
Prostaglandins to promote drainage
- Latanoprost ( Xalatan)
- Bimatoprost (Lumigan)
-
Beta Blockers to decrease production of aqueous humor
- Timolol
- Betaxolol
-
Alpha Adrenergic agonists to decrease production of aqueous humor and promote drainage
- Apraclonidine (iopidine)
- Brimonidine (Alphagan)
-
Prostaglandins to promote drainage
-
Surgical correction
- Laser trabeculoplasty – open the clogged channels
- Filtering trabeculectomy – removing a piece of the sclera to allow drainage
What is the first line treatment for Glaucoma?
Prostaglandins and beta blockers
