EYE AND EAR

Question 1

Both eyes affected, watery discharge, associated cough and cold. This is a description of what?

Answer 1

Viral eye infection.

Generalised redness.

Question 2

What are the warning signs and referral symptoms when dealing with the eyes?

Answer 2

True eye pain.
Loss of vision
Vomiting
Limbal redness only
Clouding of cornea
Distortion of vision
Irregularly shaped pupil
Photophobia
Foreign body

Question 3

How should subconjunctival haemorrhage be treated?

Answer 3

Reassurance.

Question 4

Which eye conditions should be referred?

Answer 4

Keratitis (corneal ulcer)
Uveitis
Acute angle glaucoma
Scleritis

Question 5

What is firstline treatment for bacterial conjunctivitis?

Answer 5

Chloramphenicol eye drops and ointment.

Question 6

Purulent discharge, both eyes affected but one became affected a day or so before the other describes what?

Answer 6

Bacterial eye infection.

Question 7

What is blepharitis?

Answer 7

Flaky skin around eyelashes

Question 8

How should blepharitis be treated?

Answer 8

Improved lid hygiene - warm compress bathing - mild shampoo

Question 9

How should styes be treated?

Answer 9

Warm compress application 3-4 times daily will bring the stye to a head quicker.

Question 10

Watery discharge from both eyes with associated rhinitis describes what?

Answer 10

Allergic eye irritation.

Question 11

When would a chalazion need to be referred?

Answer 11

If problematic to patient,

Question 12

How can dry eyes be treated?

Answer 12

Most products (hypromellose, liquifilm tears, Sno Tears) have no evidence behind their efficacy but remain very popular
 Carbomer 940 has clinical evidence to show it is significantly better than placebo

Question 13

What referral symptoms are there for ears?

Answer 13

Trauma related deafness
Dizziness or tinnitus
Foreign body
OTC medication failure
Pain originating from the middle ear

Question 14

What are the referral symptoms for otitis externa?

Answer 14

Ear pain in children under 6years old.
Generalised inflammation of the pinna.
Symptoms lasting >7days or longer after starting treatment.
Impaired hearing in children
mucopurulent discharge
Pain on palpation of the mastoid area.
Slow growing growths on the pinna of elderly patients.

Question 15

What products can be used for otitis externa?

Answer 15

Antihistamines – to combat itch and irritation
 Analgesics – to relieve pain
 Choline salicylates (Earex Plus or Audax) have a local analgesic effect that provide a rapid analgesic effect
 Acetic acid 2% (available OTC as Earcalm spray) is indicated for superficial infections of the ear

Question 16

When should ear ache be referred?

Answer 16

if symptoms are severe

Question 17

Before offering something for bacterial conjunctivitis what should be established?

Answer 17

If the patient has ever had an adverse effect to chloramphenicol or other blood disorders.
Do they wear contact lenses?

Question 18

Why are eye drops preferred to eye ointment?

Answer 18

Eye drops are easy to apply.

Question 19

What would Otex ear drops be used for?

Answer 19

Dislodge ear wax in lieu of syringing.

Question 20

How should every patient interaction be ended?

Answer 20

1. Summary
2. Ensure patient is happy with agreed actions
3. Ensure patient is okay to stick to agreed plan
4. Ask for any last questions
5. Ensure they know what to do if no response i.e. visit GP or back to pharmacy.

Question 21

Why is an irregular shaped pupil a referral symptom?

Answer 21

Linked to uvetitis: inflammation of ureal tract

Question 22

Opticrom drops would be used to treat what?

Answer 22

Allergic conjunctivitis

Question 23

Why is treatment not recommended for episcleritis?

Answer 23

Usually self-limting