Clinical Flashcards
What is blepharitis?
symptoms and mangement
Inflammation of the eyelid margin due to infection or excessive secretions. Without adequate tear lipid layer, tears evaporate, leading to dry eyes.
Symptoms: burning, gritty eyes.
Signs: crusted eyelids, red eyelid margins, scales at base of eyelashes. History of seborrhoeic dermatitis.
Management:
- Eyelid hygiene advice:
- to soften waxy, oily secretions: steam bathing (10-15mins), warm compresses, cleaning with cool boiled water (& baby shampoo) on cotton bud (side to side motion), avoid rubbing inner surface of lid. - Lubricants.
- Topical chloramphenicol.
What is chalazion?
symptoms and mangement
Blocked meibomian gland (accumulation of secretions causes inflammation of the eyelid > cyst) > chronic chalazions will become granulomatous.
Symptoms: dry eyes, uncomfortable lump in eyelid. Signs: Hard lump/s in eyelid (red in acute phase). History of blepharitis or acne roasacea. *Recurrent chalazia may suggest neoplasm: biopsy indicated.
Management:
- Eyelid hygiene advice: warm compresses
- Omega 3 and Flax seeds recommended
- Topical antibiotics
- Surgical excision (when swelling down, left with small lump – excision).
What is entropion?
symptoms and mangement
Inversion of eyelids (eyelashes irritate cornea)
Symptoms: gradual onset red eye, watering, foreign body sensation. Signs: Inverted eyelids, corneal lesions, scarred conjunctiva. History of eyelid surgery or severe conjunctivitis.
Management: surgical correction (can be taped down in short term) + provide lubricant to protect cornea
What is ectropion?
symptoms and mangement
Eversion of the eyelids (> loss of tears)
Symptoms: irritable red eye, watering. (tears not able to drain through normal route). Signs: droopy lower lid, eyelid masses causing distortion of anatomy. History: old age (age-related ectropion), eyelid surgery, CN VII palsy (facial). *Biopsy any masses.
Management: surgical reconstruction
What is BCC?
symptoms and mangement
Most common eyelid neoplasm. Slow growing, metastases rare.
Symptoms: often none (may present due to cosmetic concern). Signs: ‘rodent ulcer’, typically raised pearly edge and central telangiectasia.
Management: cryotherapy for small lesions, excision and reconstruction if large.
What are different refractive errors?
Emmetropia: no refractive error, light is focused on retina.
Astigmatism: Worldwide most common refractive error. Eyeball is rugby ball / egg shaped, light focused in more than one place blurred vision (headaches, eye strain). Usually accompanied by myopia or hyperopia and can cause amblyopia.
Myopia: Short-sighted: light is focused in front of the retina. Causes: eye too long (axial length) for cornea or cornea too curved / steep. Corrected by a concave lens
Hyperopia: Long-sighted: light is focused behind the retina. Causes: eye too short or cornea too flat. Note: emmetropisation (long sighted at birth, allows eye to grow longer). Corrected by a convex lens.
Presbyopia: Lens hardens with age (approximately age 45): less able to accommodate - typically require reading glasses for near vision.
What is dry eyes?
symptoms / management
Reduced tear production (e.g. age-related decline, Sjogren’s syndrome) or increased tear loss (commonly due to blepharitis: increases tear evaporation as the lipid component of tear film usually prevents this evaporation)
Symptoms: irritable, itchy, red eyes.
Signs: Shorter tear break-up time (≤5s) when eye viewed with fluorescein staining (faster evaporation).
May also see irritated regions on cornea (punctate erosions) due to dry areas using fluorescein.
Patient can have watery eyes due to reflex tear production (tear production seems excessive but actually dry eye!). History of known blepharitis, dry mouth.
Management: Lubricants and artificial tears.
What is a subconjunctival haemorrhage?
symptoms / management?
Blood vessel leak, normal conjunctival vessels obscured. Usually idiopathic but may be precipitated by sneeze, cough or conjunctivitis.
Usually asymptomatic, may be some foreign body sensation.
Signs: Superficial bleed with mobile vessels, does not affect cornea. General redness, can’t see individual vessels. History of exertion, trauma, anticoagulants, bleeding disorders, hypertension. Possible mild popping sensation prior to redness, or mild ache.
Management: Self-limiting. If trauma is cause consider ophthalmology referral to ensure no underlying scleral damage / injury. Check blood pressure + coagulation status (INR) for legal reasons. Symptomatic treatment e.g. lubricant drops.
What is conjunctivitis?
Most common causes?
Inflammation of conjunctiva: infectious, allergy, or chemical injury.
Bacterial: mostly staphylococci, streptococci and especially in children H. influenza.
Viral: adenovirus (2 week healing time as opposed to 1) or herpes simplex (keratoconjunctivitis).
Chlamydial: chlamydia trachomatis serotypes DEFGHIJK.
Allergic
Seasonal = spring + summer, perennial = all year (may fluctuate).
Atopic keratoconjunctivitis: chronic + more severe, begins late teenage years, associated with atopic dermatitis
Vernal keratoconjunctivitis: chronic + more severe, affects boys in 1st decade - itching, photophobia, burning, and tearing. The most common signs are giant papillae, superficial keratitis, and conjunctival hyperaemia
Chemical
- Acute presentation e.g. acid or alkali injury.
- Chronic presentation = allergic conjunctivitis – drops are common cause.
Symptoms / management of BACTERIAL conjunctivitis?
Redness, sticky discharge, foreign body sensation, blurred vision.
Acute conjunctivitis can be caused by Neisseria Gonorrhoae: profuse discharge + can perforate cornea.
Management: topical antibiotics e.g. chloramphenicol drops for 5-7 days
Symptoms / management of VIRAL conjunctivitis?
Inflammation typically more acute (more severe): red, watery, light sensitive. Associated features: lid oedema, pre-auricular lymphadenopathy, follicles, keratitis.
Management: supportive measures e.g. lubricant, prophylactic antibiotic drops. If corneal involvement > steroid drops.
Symptoms / management of chlamydial conjunctivitis?
Symptoms/signs: Clinical picture between bacterial and viral: more sticky discharge than bacterial, mucopurulent discharge, corneal involvement, follicles present. History of GUM symptoms (e.g. urethritis / cervicitis, unprotected sexual activity).
Ix: Conjunctival swab for PCR.
Management = systemic: oral azithromycin or doxycycline. Refer to GUM.
Serotypes A, B + C cause trachoma (roughening inner surface of eyelids > pain & breakdown of cornea > eventual blindness. If untreated, repeated trachoma infections can cause permanent blindness where eyelids turn inwards).
Symptoms / management of allergic conjunctivitis?
Symptoms & signs: Redness, itchiness, mucous discharge, light sensitivity. Conjunctival oedema (chemosis) & papillae.
Management: lubricants, anti-histamines, mast cell stabilisers, steroids in acute exacerbations or severe cases. Very good prognosis in vast majority but corneal complications in severe cases.
Symptoms / management of chemical (acute) conjunctivitis?
Symptoms & signs: acute redness, pain, watering, conjunctival / corneal epithelium and stroma trauma and necrosis. Abrasion, stromal inflammation, endothelial loss, limbal stem cell deficiency.
Management: Irrigation with saline until pH 7-7.2.
What is episcleritis?
Management?
Inflammation of the episclera (immediately below conjunctiva). Relatively common.
Acute onset of mild discomfort / gritty eyes – recurrent episodes. Mobile hyperaemic vessels (may have spider vessels).
Management: self-limiting; lubricants for comfort.
