Ectropion

Patient is 92-year-old lady who is brought in by her son, to help identify why she has had this chronic runny nose and postnasal drip for the last few years. She has been seeing Dr. for this for many years, and he states that there is not a whole lot he can do for it, but it is really impacting her life. She is constantly blowing her nose and thinking she is sick and does not want to participate in activities or be around people because she feels she is sick all the time. She currently complains of clear nasal discharge, postnasal drip, frequent nose blowing, and frequent throat clearing that seems to occur every day. She does not have any seasonal variation. She denies any troubles of sinus infection, nasal polys, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad colds, or frequent tonsillitis. Her nasal symptoms are severe. She has been using fluticasone nasal spray daily as well as cetirizine 10 mg to help with this and it does not seem to help at all.

She denies any frequent ear infection, dizziness, or lightheadedness.

She does have some eye itching, redness, tearing and eyelid irritation a lot of a time.

She denies any history of wheezing or lung problems. She denies any frequent coughing spells. She has never had any allergic skin problems or been evaluated for allergies before.

ASSESSMENT:
1. Senile rhinitis.
2. Possible mixed rhinitis with allergic rhinitis and vasomotor rhinitis.
3. Allergic conjunctivitis.
4. Ectropion.

PLAN:
1. At this time, I feel that most of patient’s trouble is atrophied nasal turbinates in her nasal mucosa which is causing her nose to constantly drip and run back down her throat. I would like her to try using Atrovent nasal spray three times daily as well as an air nasal gel to help lubricate the nose as much as possible and see if this nasal spray can benefit her more than the cetrizine and fluticasone combination for allergies. I do not want her taking fluticasone due to its drying effect and possible interaction with her balance too. I did prescribe her Optivar azelastine eye drops to use one drop each eye twice daily to see if this will help with her tearing, redness, and irritation in her eyes. She is exhibiting significant amount of ectropion and her eyes may be drying because her eyelids are not closing accurately any more.
2. We will follow up in two weeks to insure that she is having any benefit from this and we will further pursue what else we can do to have her the best quality back as possible.

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