6.1.11. Understands the treatment of a range of common ocular conditions Flashcards
Indicators Demonstrates a basic understanding of the treatment regimens of cataract, AMD, glaucoma, diabetic eye disease and minor anterior eye problems Can discuss the treatment options for two of the above condition
Dry eye disease
DEWS - Dry eye is a multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play aetiological roles.
Education and environmental/dietary modifications e.g.
Omega 3 (veg/nuts) & omega 6 (fish)
Avoid air conditioning
Stop smoking
Lowering VDU height, reduce screen time, blink more
Lid therapy – blepharitis management
Tear supplements - 3-4x daily/often as needed if preservative free
- Carbomer gel (usually 0.2%) - common first line in formalities and is used to increase tear film thickness, e.g. clinitas eye gel
- Hypromellose - mild dry eye, usually 0.3%, used more frequently (every 30mins till symptoms resolve then less freq)
- Sodium hyaluronate - tear replacement to increase viscosity and provide lubrication e.g. hycosan (original blue 0.1%, extra red 0.2%) – ADDE
- Lipid based drops to replace/enhance lipid layer to prevent evaporation of the aqueous layer in EDE e.g. Systane balance
- Combo drops e.g. thealoz duo (SH & trehalose) EDDE
Others
Blephex – in office lid hygiene
Steroids if severe inflammation e.g. FML
Antibiotics if severe blepharitis
Punctal plugs – improve retention in ADDE
Therapeutic CL for protection
Blepharitis
- Posterior - dry warm compress 10 minutes twice daily, eyelid bag >40 degrees to melt meibum
- Anterior - wet warm compress to loosen collarettes and crusts for anterior bleph
- Lid massage (mixed/posterior) – melt the meibum and encourage blockage out
- Lid cleansing to remove deposits and bacteria from lid margin - gel e.g. TTO/blephasol or wipes e.g. Blephademodex/blephaclean
- Avoid cosmetics directly on lid margin
- Once symptoms resolve can reduce measures to minimum of twice weekly
- Other options
- Chloramphenicol ointment bds, rubbing onto lid margin with finger
- Demodex if over 70 and/or CD
- Weekly in office treatments with 50% TTO to kill mites
- Nightly treatment with 5% TTO/products with terpinene-4-ol to prevent mating/migration
Initial management followed by referral if three months of treatment does not produce sufficient response
Allergic Conjunctivitis: SAC & PAC
Avoid allergen, cold compress, avoid eye rubbing to prevent degranulation of mast cells
Ocular lubricants to be used 3-4x daily for symptomatic relief i.e. viscotears
- Topical AH to relieve itching i.e. antazoline sulphate 0.5% tds
- Topical MCS i.e. sodium cromoglicate 2% qds
- Oral antihistamine i.e. loratadine od
Allergic Conjunctivitis: VKC
Cold compress when acute
Ocular lubricants symptomatic relief ^
Topical MCS e.g. sodium cromo 2% qds
Refer to HES urgently if active limbal or corneal involvement
Allergic Conjunctivitis: AKC
Cold compress
Lid hygiene for associated blepharitis
Avoid known allergens
Local pharmacy for loratadine od
Topical MCS i.e. sodium cromo 2% qds
Urgent referral if active limbal or corneal involvement
Allergic Conjunctivitis: Acute allergic
Most resolve spontaneously within a few hours
Avoid eye rubbing
Cool compress for symptomatic relief
Identify allergen and avoid future contact
Ocular lubrication for symptomatic relief
If recurrent, prophylactic topical MCS e.g. sodium cromo 2% as POM
Bacterial conjunctivitis
- Self-limiting 5-7 days without treatment
- Bathe eyelids with cooled boiled water
- Advice on contagious nature of condition
- Topical antibiotic may improve short-term outcome:
Drops 0.5%, dose: - 1 drop every 2 hours for 48 hours
- Then, every 4 hours during waking hours
- Eye drops may be supplemented with ointment at night
- Treatment course should last 5 days
- Ointment 1% dose
- qds for 2 days
- bds for 5 days
- CL wearer – quinolone i.e. levofloxacin (PoM)
Viral conjunctivitis
Self-limiting 1-2 weeks
Cold compress
Generally caused by adenovirus
Anti-viral agents are generally ineffective
Artificial tears may relieve symptoms
Sub conjunctival haemorrhage
Refer for BP check if necessary
Reassurance, condition usually clears within 5-10 days
Cold compress may reduce discomfort
Ocular lubrication if irritation is present
Episcleritis
Self-limiting in 7-10days
Cold compress
If severe discomfort, ocular lubricants for 1-2wks
PoM if IP if px is particularly symptomatic e.g. FML
Corneal abrasion
Rule out multiple parts, incl. double lid eversion
Loose FBs irrigated with saline
FB on conjunctiva removed with sterile cotton bud
Assess depth & carry out seidel test
Remove FB under topical anaesthetic
Topical antibiotic, chloramphenicol 0.5% 4x daily for 5 days if likelihood of infection
CL wearer – quinolone
Hordeolum
- External (stye) – associated gland of zeiss/moll - tender inflamed swelling of lid margin, may point anteriorly through skin
- Internal – acute bacterial infection of MG - tender inflamed swelling within tarsal plate – more painful than a stye, may point anteriorly through skin or posteriorly through conj
- Most resolve spontaneously or discharge, following by resolution in case of external
- Hot compress
- AB ointment in case of copious mucopurulent discharge – chloramphenicol 1% tds for 1 week (fusidic acid if allergic/bf/pregnant)
- Rare – refer routinely for incision in cases than do not discharge (more common in internal)
Chalazion
- Most result on conservative management – hot compress, lid massage (B2 – no referral)
- Regular lid hygiene for bleph – most likely posterior
- Routine refer if: persistent, recurrent, causing significant astigmatism, cosmetically unacceptable
Cataract: Referral
If cataract significantly reducing vision/affecting px’s quality of life – routine referral via SCI gateway after discussing with the patient
Glasgow & great Clyde – all two stop
- Assessment of VA, biometry & keratometry
- Surgery separate day
Ayrshire – one or two stop
- Two stop if more complicated px i.e. general anaesthetic, iris clamps etc
- One stop – patient counselling is very important
Cataract Surgery – explaining to a px
One eye at a time
Outpatient – day case
Local anaesthetic only
Need to lie flat 15-20 minutes and face partially covered with a sheet
