eye and nose infections

Question 1

bacterial conjuncitivitis comonly caused by

Answer 1

step pnuemonia
staph aureus
h influenza

Question 2

When would you not sell OTC chloramphenicol

Answer 2

• under 2 (need Rx from doctor, not licensed for OTC)
• pregnancy or BF
• taking SUs: chloramphenicol increases exposure = risk of hypo
• red flag symptoms - vision change, eye pain etc

Question 3

chloramphenicol - how to use

Answer 3

one drop into the affected eye every 2 hours (during waking hours) for the first 2 days. Then every 4 hours for the next 3 day

Question 4

What is a stye, how long does it stay for, and how would you treat it

Answer 4

A stye is a small, painful lump on the eyelid. They’re common and should go away within a week. Styes are rarely a sign of anything serious, but may be painful until they heal.

To reduce swelling and help the stye heal: warm compress 2-4x a day, pain killers, avoid contacts and eye makeup

Question 5

blepharitis often caused by

Answer 5

staph

Question 6

blepharitis what would you advice

Answer 6

Eyelid hygiene measures and warm compresses.

clean your eyelids twice a day to start with and then once a day as your symptoms improve

continue to clean your eyes, even if your symptoms clear up

Do not wear contact lenses while you have symptoms. Do not use eye makeup, especially eyeliner and mascara, while you have symptoms

Question 7

symptoms of blepharitis

Answer 7

often come and go - chronic in nature

sore eyelids
itchy eyes
a gritty feeling in the eyes
flakes or crusts around the roots of the eyelashes
eyelids sticking together in the morning when you wake up

NO DISCHARGE, unlike chloramphenicol

Question 8

patient has itchy swollen eyelids. what is this likely to be

Answer 8

Blepharitis causes swollen, itchy eyelids.

Question 9

keratitis may be …. in origin (4)

Answer 9

• Keratitis may be bacterial, viral or fungal, can also be caused by acanthamoeba (parasite)

Question 10

when to offer abx treatment for sinusitits

Answer 10

systemically unwell, have signs and symptoms of a more serious illness, at high risk of complications due to pre-existing comorbids, or whenever bacterial sinusitis suspected

Question 11

when to prescribe back up rx abx for sinusitits

Answer 11

○ If pt presents with symptoms for around 10 days or more with no improvement, they can be prescribed a back up abx rx which can be used if symptoms do not improve within 7 days or if they worsen significantly at any time

Question 12

patient with sinusitits with symptoms for around 10 days or less - what to advice

Answer 12

give advice about usual duration of acute sinusitis (1 week to 10 days, some people up to 4 weeks), self care of pain or fever with paracetamol/ibuprofen and when to seek medical help
○ Some pt may try nasal saline or nasal decongestants - but limited evidence

Question 13

if sinusitits symptoms present for 10 days or more with no improvement, what to give

Answer 13

consider high-dose nasal CC e.g. mometasone (unlicensed) or fluticasone (unlicensed) for 14 days
○ Consider supply of back up abx rx that can be used if symptoms do not improve within 7 days or if they worsen rapidly or significantly

Question 14

choice of abx for sinusitits

Answer 14

1. phenoxy
   if systemically very unwell, or more serious illness, or high risk complications: co-amoxiclav
2. co amoxiclav if worsening symptoms despite 2-3 days of above

allergy: doxy, clarith, eryth