Conditions of the eye

Question 1

Describe the presentation of eyestrain / eyestrain headache.

Answer 1

• results from extended use of eyes

SSX:

• headache (normally bilateral tension type, pressing / tightening quality)
• tightness temporal / occipital regions
• pain in neck, shoulders & back
• sore & tired eyes
• watery, dry, burning or itchy eyes
• blurred or tired vision
• maybe photophobia

Treatment:
- reduce cause of eyestrain, potential referral for vision check

Question 2

Describe the condition of acute conjunctivitis

Answer 2

• inflammation / irritation of the conjunctiva of the eye.
• can be viral, bacterial or allergic.

SSX:

• starts unilateral and progresses bilateral (except allergic)
• pink /red eye
• conjunctival oedema & maybe eyelid oedema
• discharge

Viral:

• usually recent URTI or caught from someone else
• palpable pre-auricular nodes
• watery discharge

Bacterial:

• staph, strep or caught from someone else
• mucopurulent discharge
• mucoid debris in inferior cornix
• crusting along eyelash base
• eyelids can get ‘stuck’ together

Allergic:

• bilalteral SSX
• itching hallmark symptom
• rhinitis
• red & oedematous eyelids
• no lymphadenopathy

Treatment:

• viral: self limiting 7-10 days. cool compresses & tear substitutes to relieve symptoms.
• bacterial: self limiting 7-10 days. topical antibiotics can help.
• allergic - eliminate allergen, cool compresses & tear substitutes to relieve symptoms. topical antihistamines to limit itching, mast cell stabilisers to limit inflammation.

Question 3

Describe the presentation of a herdoleum

Answer 3

Herdoleum = stye
* caused by a blocked eyelash follice, causes stasis of gland secretions and secondary infection (usually staph)

SSX:

• eyelid inflammation, oedema and pain
• tender nodule / yellowish pustule at base of eyelash
• may press against cornea, causing tearing and blurring of vision

Treatment:

• self limiting 2 days - 2 weeks
• can assist spontaneous rupture by applying hot compresses & massaging gently

Question 4

Describe the presentation of a chalazion

Answer 4

• firm & painless eyelid nodule caused by obstruction of a meibomian gland resulting in granulomatous lesion

SSX:

• acute swelling of eyelid progresses to chalazion
• nonerythmatous, nontender, nonfluctuant
• injection of palpebral conjunctiva a secondary finding

Treatment:

• self limiting within months
• hot compresses and massage to melt lipids and promote drainage
• maintain eyelid hygiene

Question 5

Describe the presentation of a senile cataract

Answer 5

• chronic age related condition where degeneration causes opacity of the lens

SSX:

• painless & develops over years
• decreased visual acuity
• reduced lens opacity, and visible cataracts on retina or retina obscured

Question 6

Describe the presentation of acute angle closure (AAC) glaucoma

Answer 6

• caused by narrowing of the anterior chamber of the eye (between iris and cornea) which obstructs flow of aqueous fluid through eye, causing fluid to build up in posterior chamber between iris and lens

SSX:

• severe eye pain and decreased vision serious SSX requiring immediate medical emergency referral
• red eye
• medical emergency - immediate referral*