Eye Flashcards
What is conjunctivitis?
What is the commonest cause?
- Inflammation of the conjunctiva –> a thin layer of tissue that covers to inside of the eyelids and the sclera of the eye.
- Is the most common eye problem presenting to primary care.
- Characterised by sore, red eyes associated with a sticky discharge.
- There are three main types –> Bacterial, Viral, Allergic
- Adenovirus commonest cause
What is the general presentation of conjunctivitis?
What are the differences in presentation of viral v bacterial conjuncitivitis?
- Unilateral or bilateral
- Red eyes, blood shot, itchy gritty sensation, discharge from eye
- DOES NOT cause pain, photophobia or reduced visual acuity. Vision may be blurry when eye covered w discharge but when clear discharge acuity should be normal.
Bacterial
Purulent discharge and inflam conjunctiva
Typically worse in morning –> Eyes may be ‘stuck together’ in the morning
-Usually starts in one eye and can spread to other. Highly contagious.
Viral
Serous (clear) discharge
Recent URTI –> often assoc w other symps of viral infection e.g dry cough, sore throat, blocked nose.
Tender preauricular (in front of ears) lymph nodes
Also contagious.
What are the investigations for conjuncitivitis?
What should you ask when Hx taking? (6)
When should you take swabs?
Clinical diagnosis
- Focused Hx –> evidence recent URTI, whether patient uses contact lenses, Hx eye trauma, occupational exposure e.g chemicals, systemic illness, sexual Hx in young patients
- Eye examination check visual acuity, foreign bodies. Pull down lower eye lie to look for follicles/granuloma/discharge
- Examine for lymphadenopathy
- Possible eye swab when purulent discharge or suspicion of STIs or herpes conjunctivitis.
What is the conservative management of conjunctivitis?
When would you advise someone to seek urgent further advice?
- Usually self limiting and resolves w/o Tx w/i 1-2 weeks.
- Advise on good hygiene to avoid spreading (e.g. avoid sharing towels or rubbing eyes and regularly washing hands) and avoiding the use of contact lenses. Cleaning the eyes with cooled boiled water and cotton wool can help clear the discharge. School exclusion not necessary.
-Advise seek urgent medical advice when loss of vision, photophobia, severe eye redness.
What is the medical management of conjunctivitis?
Topical Ab commonly offered when bacterial suspected e.g chloramphenicol drops 1 drop TDS/QDS or when severe given 2-3 hourly, or onitment QDS
- Topical fusidic acid eye drops is alternative e.g if allergic to chlorampheniol–> use in pregnant women. BD.
- Those <1 month w conjunctivitis –> urgent opthalmology review as neonatal conjunctivitis can be associated w gonococcal infection and can cause loss of sight and more severe complications e.g pneumonia.
What is allergic conjunctivitis and how is it treated?
- Caused by contact w allergens –> swelling on conjunctival sac and eye lid w significant watery discharge and itch.
- Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)
- Itch is prominent w possible swelling eyelids.
- May be a history of atopy
- May be seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens)
- 1st line –> topical or systemic antihistamines. E.g loratadine. Reduce symptoms.
- 2nd line –> topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil. Can be used in those w chronic seasonal symptoms. Prevent mast cells from releasing anti histamine.
How would you treat STI related conjunctivitis?
Chlamydia conjunctivitis –> ocular tetracycline ointment and systemic doxycycline 100mg BD 1-2 weeks. Or 1g azithromycin stat.
- Gonococcal w 1.g stat IM ceftriaxone w eye saline wash.
- Herpes simplex conjunctivitis –> ophthalmology referral. Topical or systemic anti virals.
What are the possible causes of a painless red eye? (3)
- Conjunctivitis
- Episcleritis
- Subconjunctival Haemorrhage
What are the possible causes of a painful red eye? (7)
- Glaucoma
- Anterior uveitis
- Scleritis
- Corneal abrasions or ulceration
- Keratitis
- Foreign body
- Traumatic or chemical injury
What is an ectropion and its presentation?
- Out turning of eyelids with the inner aspect of the eyelid exposed. It usually affects the bottom lid.
- Most common cause old age –> weakening of small muscles around eyelid.
- Other causes –> trauma or scarring of eyelid. Facial paralysis and facial weakening can lead to ectropion.
- Ectropion à can result in exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected.
- Usually unilateral, can be bilateral.
- Can be severe w whole length eyelid turned outwards
- Epiphora –> excessive watering, more tears produced to protect cornea w cornea irritated.
What are the investigations and management for an ectropion?
Clinical diagnosis
- Conservative –> Avoid lid rubbing as causes dryness and irritation. Horizontal taping at night and during day
- Medical –> Regular eye drops à Hypermellose 0.3% lubricating for cornea
- More severe cases may require surgery to correct defect à Refer to opthalmologist for surgical repair when continuing to persist and to prevent conjunctivitis and keratitis.
- A same-day referral to ophthalmology is required if there is a risk to sight.
What is an entropion and its presentation?
Inturning of eyelids inwards with the lashes against the eyeball.
- Results in pain and can result in corneal damage and ulceration.
- Associated a weak ocular muscles in old age.
- Can occur due to eyelid trauma or infection.
-Watery eyes, Painful.
What are the investigations and management for an entropion?
Investigations
Clinical diagnosis. Swabs when discharge or signs infection.
Management
- Initial management à taping the eyelid down to prevent it turning inwards. Need to prevent eye drying out so also regular lubricating drops w hypermellose.
- Definitive management is with surgical intervention à Surgical referral if above not working or severe symptoms.
- A same-day referral to ophthalmology is required if there is a risk to sight.
What are cataracts?
What are the various causes?
What happens when left untreated?
-Common eye condition –? gradually the lens of eye opacifies –> a cloudy area forms within the lens and can reduce transparency of the lens. This makes it more difficult for light to reach back of eye (retina) therefore reducing visual acuity w reducing/blurred vision.
-A leading cause of curable blindness.
-Cataract can form in one or both eye at any age.
-Most occur as result of ageing most common >60.
-RF –> FH age related cataracts, corticosteroid treatment, smoking, prolonged exposure UVB light, ?alcohol, hypocalcaemia.
Other causes
-Trauma e.g eye injury or operation
-Eye disease e.g chronic anterior uvetitis, acute congestive angle closure glaucoma, retinitis pigmentosa.
-Systemic disease e.g diabetes, neurofibromatatosis type 2, severe atopic dematitis
-Congenital and developmental cataracts in children. Occur before birth, screened for using red reflex during neonatal examination.
- Untreated –> most people with a cataract will become severely visually impaired. With surgery, 95% of people will have 6/12 best-corrected vision if there is no other pre-existing ocular copathology.
- Untreated congenital cataracts in babies cause deprivation amblyopia –> serious lifelong visual impairment,
What is the typical presentation of cataracts?
- Symptoms are usually asymmetrical as both eyes are affected separately.
- Gradual onset, very slow reduction in vision –> main symptom gradual and painless reduction in visual acuity can present as gradulal difficulty reading, recognising faces.
- Progressive blurring of vision
- Change of colour of vision with colours becoming more brown or yellow – increasing difficulty w distinguishing colours
- “Starbursts” can appear around lights, particularly at night time
- Glare w lights appearing brighter than normal or difficulty seeing in presence of bright light can be dominant symptom at first. E.g difficulty seeing in brought sun or driving at night w oncoming bright headlights.
- Key sign –> Loss of red reflex. Lens can appear grey or white. Red reflex usually red orange reflection seen through opthalmosocpy when light shone into retina. Cataracts prevent light reaching retina.
- Can be –> white or grey pupil (leukocoria), invol eye movements (Nstagmus), squint (strabismus)
