6.1.4. Identifies external pathology and offers appropriate advice to patients not requiring referral.

Question 1

Difference between Anterior & Posterior Blepharitis

Answer 1

• Anterior = inflammation of glands of zeiss or moll; bacterial or serborrhoeic
• Posterior = inflammation of meibomian glands

Question 2

Differences between Staphylococcal & Seborrhoeic Blepharitis

Answer 2

• Staphylococcal = bacterial exotoxins released by bacteria causing inflammatory response or allergic reaction to bacteria themselves
• Seborrheic = disorder of glands of zeis or moll, related to acne rosacea & serborrhoeic dermatitis

Question 3

Symptoms of Anterior Blepharitis

Answer 3

• Chronic
• Worse in mornings
• Redness, irritation, grittiness, watery discharge
• FB sensation, soreness, photophobia
• Itching

Question 4

Signs of Anterior Blepharitis (early)

Answer 4

• Scales - hard & brittle in staphylococcal (collarettes), soft & greasy in serborrhoeic
• Lid hyperaemia, shiny lid
• Lid margin swelling
• Telengectasia (lid margin veins visible)

Question 5

Signs of Anterior Blepharitis (longstanding)

Answer 5

• Foamy tears
• Scarring
• Thickened lid margin
• Corneal staining
• Trichiasis, Madarosis, Poliosis

Question 6

Symptoms of Posterior Blepharitis

Answer 6

• Dryness
• Itchiness
• Redness
• CL intolerance
• Blurred vision due to frothing of tear film (not enough lipids change properties of tear film)

Question 7

Signs of Posterior Blepharitis

Answer 7

• Secretions at meibomian gland orifices
• Foam at tear meniscus
• Plugging of orifices (glands look dilatated)
• Conjunctival hyperaemia
• Evaporative tears
• Secondary signs include: punctate epithelial erosion over lower third of cornea; marginal keratitis; scarring; neovascularisation and pannus; mild papillary conjunctivitis

Question 8

Risk factors of bleph

Answer 8

• Age
• Hormones
• Gender
• Secondary to some skin conditions
• Diabetes
• Makeup
• Down’s syndrome
• Dirty people/hygiene
• CL wearers

Question 9

Difference between Staphylococcal & Demodex (tough one!)

Answer 9

• Generally same symptoms, might be milder in demodex
• Staph has yellower greasy scales at bottom of lashes. Demodex look more cylindrical & white (dandruff cuff)

Question 10

How to treat demodex?

Answer 10

Tea tree oil with eye only solutions as it’s toxic to the eye e.g. Optase solution. Done daily until sxs resolve

Question 11

Common causes of aqueous deficient dry eye:

Answer 11

• Sjogren syndrome (autoimmune)
• Rheumatoid arthritis (inflammatory)
• Lupus (inflammation)
• Sarcoidosis (autoimmune)
• Aging
• Refractive surgery
• Medications - antidepressants, antipsychotics, antihistamines, antihypertensive, anticholinergics, anti-arrhythmic

Question 12

Predisposing factors: (changeable)

Answer 12

• VDU - less blinking!
• Environment - air con, low humidity
• Smoking
• Contact lens wear
• Health issues as listed above
• Medication especially the pill!!

Question 13

Symptoms (bilateral)

Answer 13

• Irritation, FBS, Redness, Gritiness, Burning
• Possibly blurred vision if epithelial disruption or mucous strands
• Sxs worsen with heat, wind or smoke

Question 14

Lid wiper epitheliopathy:

Answer 14

• Thought to indicate friction
• The wiper is a small area that comes into contact with the ocular surface during a blink. If tear film isn’t working as it should or isn’t sufficient enough to lubricate it then friction occurs! This causes the below staining pattern to occur.

Question 15

What are ingredients for Eye drops?

Answer 15

• Mild - Sodium hyaluronate 0.10g, Sodium chloride, EDTA, Boric acid, Borax decahydrate, purified water 100ml
• Moderate - Sodium hyaluronate 0.20g, Glycerine, Povidone, Sodium chloride, Magnesium chloride, Potassium chloride, Calcium chloride, Boric acid, Borax decahydrate, purified water 100ml
• Intensive - Sodium hyaluronate 0.30g, Glycerine, Povidone, Sodium chloride, Magnesium chloride, Potassium chloride, Calcium chloride, Boric acid, Borax decahydrate, purified water 100ml
• Thealoz Duo - Trehalose (3%), hyaluronic acid (*as sodium hyaluronate salt 0.15%), sodium chloride, trometamol, hydrochloric acid and water for injections.

Question 16

When would you use one drop over another?

Answer 16

• Depends on severity of symptoms e.g. if smile stain, then mild probably wont work well whereas someone with a little dryness after a long day will be better off with mild.
• Dry eye gel - for more severe dry eye. More for before bed to work overnight.
• Liposomal drops for evaporative e.g. Optrex Achtimist is really good!
• Hyaluronate holds water so better for aqueous deficient