Eye coniditons

Question 1

Most common cause of conjunctivitis

Answer 1

Viral (upto 80% of acute conjunctivitis) - mainly adenovirus

Question 2

2nd common cause of conjunctivitis and most common in children

Answer 2

Bacterial

Question 3

General symptoms of conjunctivitis

Answer 3

Itchy/ gritty feeling
discharge
Discomfort (not pain)
Red/pink eye which can be unilateral or bilateral
Blood shot eye

Question 4

What symptoms are indicative of bacterial cause of conjunctivitis

Answer 4

if purulent discharge + sticky eyes on waking up in the morning

usually starts in one eye and spread to the other

Question 5

Indicative symptoms of viral cause

Answer 5

Flu-like symptoms such as sore throat, cough

& Clear discharge with possible tender periauricular LN

Question 6

What would u see in contact lens associated conjunctivitis

Answer 6

Inflammation in the superior conjunctiva especially under the eyelid

Question 7

Management of suspected infectious conjunctivitis

Answer 7

Self-help measures - clean eyes with warm water and cotton wool if needed
avoid spread as contagious - sharing towels, rubbing of eye, regular hand washing, avoid use of contacts until fully heals

• can consider antibiotic eye drops e.g. chloramphenicol or fusidic acid - but note: tend to make little difference in mild cases (recommended more in severe cases/ those not clearing on there own)

Question 8

Management of allergic conjunctivitis

Answer 8

Antihistamines eye drops e.g. azelastine

Mast cell stabilizer eyedrops e.g. sodium cromygelate

Others include antihistamine tablets, steroid eyedrops/tablets/injection

Question 9

Examination in ? conjunctivitis

Answer 9

Eye examination

• signs of inflammation
• vesicles on eyelids (?herpesV)
• visual acuity
• pupils size, symmetry and reaction to light
• LNs

Question 10

Red flags that require urgent eye assessment

Answer 10

Reduced visual acuity.
Marked eye pain, headache or photophobia— ?serious systemic conditions such as meningitis in a person presenting with photophobia.
Red sticky eye in a neonate (within 30 days of birth – take swabs for)
History of trauma (mechanical, chemical or ultraviolet) or possible foreign body.
Copious rapidly progressive discharge — may indicate gonococcal infection.
Infection with a herpes virus.
Soft contact lens use with corneal symptoms (e.g. photophobia and watering).

Question 11

Management of neonate (<30 days) with conjunctivitis

Answer 11

Urgent referral to opthalmological assessment (could be as a result of gonorrhea)

Question 12

Blepharitis

Answer 12

Chronic relapsing-remitting condition caused by inflammation of the eyelid margin

It is usually bilateral and can be anterior (base of eyelashes) or posterior (Meibomian gland)

Question 13

The associated condition with Blepharitis

Answer 13

1. Seborrhoeic dermatitis
2. Dry eye syndrome
3. Rosacea

Question 14

Symptoms of Blepharitis

Answer 14

usually intermittent occuring over long periods of time
include:
Burning, itching and/or crusting of the eyelids.
Symptoms are worse in the mornings.
Both eyes are affected.

If left can cause > Stye or Chalazion on upper/lower lid, Loss of eyelashes (madarosis)

Question 15

Management of blepharitis

Answer 15

Patient information

Advise:

1. Chronic with periodic remissions, relapses, and exacerbations are typical
2. Self-care measures e.g. Gentle cleaning of the eyelid margins to remove debris using a cotton bud dipped in a cleanser or diluted baby shampoo.
   * Eyelid cleaning 2/day then 1/day when symptoms improve (prevents relapse)
   * avoid eye make-up
   * Warm compress on closed eyelids for 5-10 minutes for 1-2/day

If measures ineffective:

Review and consider referral – 2nd line treatment is topical Abx in anterior (chloramphenicol) + oral Abx in posterior (doxycycline)