Eye Disorders Flashcards
What is a stye (hordeola)?
Localised infection (usually staphylococcus aureus) of sebaceous or sweat glands.
Usually at base of eyelash, can be broader, and can coexist with conjunctivitis
Usually self-limiting
List some symptoms associated with a stye
Pain, soreness, tenderness, inflammation
localised redness effecting one eye
Swelling of eye margin
Conjunctivitis symptoms may be present
What is blepharitis?
Blepharitis is a bilateral (typically) inflammation of the eyelid margin, typically chronic recurring
Caused by = S. aureus, Seborrhoeic dermatitis or Meibomian gland dysfunction
Can coexist with both conjunctivitis and dry eyes (50%)
What age group is commonly affected by blepharitis?
50 years of age, bacterial types are usually seen at 42 years
What are the symptoms of blepharitis?
Irritated, red, burning, itchy, excess tears, photophobia
Eyelids present red and crusty (Skin flakes)
Morning symptoms = symptoms worsen, eyelids stuck together
Ulceration at base of eyelashes
Staph blepharitis = foreign body sensation, matting of eyelashes, burning feeling
What are some defining factors between the types of blepharitis?
Staphylococcal epidermis blepharitis = missing eye lashes
Staphylococcal = eyelash turned inwards
seborrheic = greasy crusting of eye lashes
What is a chalazion?
Granulomatous, non-infectious inflammatory lesion on the eyelids common in adults
Cause = obstruction of Meibomian gland at the rim of the eyelids –> foreign body reaction to sebum
Name the symptoms seen with chalazion
swelling, minimal pain and tenderness
Symptoms are localised, usually painless
How is chalazion treated?
Apply warm compress, should resolve within several weeks
Incision & drainage may be required
Topical or systemic antibacterial usually not indicated
What are some questions you can ask a patient presenting with eye condition?
Can you please describe your symptoms? How did they develop and when did you first notice them?
Where is it? (localised or is it diffuse)
Does it effect one or both eyes?
What have you done so far to treat this?
What other risk factors are there? (contacts, comorbidities, medications, allergies)
Treatment goals for styes and chalazion
They’re self-limiting, resolve 5-7 days (chalazion is a little longer)
Keep eye clean and free of discharge = dilute baby shampoo
Refer when needed and prevent recurrence
Evidence based management = warm compress 3-4 times/day (promote drainage), prescription only medicine for widespread infection affecting vision
Treatment goals and steps for seborrheic blepharitis
improve eyelid hygiene= warm compress to closed eye (5-10 mins, twice daily), scrub eyelid with 1:10 diluted baby shampoo or diluted sodium bicarbonate solution twice daily
Clean daily –> prevent recurrence
Treat other affected areas = scalp dandruff (med shampoo), dry eyes (ocular lubricant), antibiotics (infection)
What is the non-pharmacological treatment of staph blepharitis?
Warm compress to closed eye (5-10 mins, twice daily)
Will see loss/breaking of eyelashes
Very contagious, avoid rubbing/touching eyes, sharing towels
What is the pharmacological treatment of staph blepharitis?
Antibacterial eye ointment = chloramphenicol (chlorsig) twice daily, massage into base of eyelash
Use until clinically resolved (10-14 days)
What are some tips to tell people about eye conditions?
Wash hands regularly, bathe eyelids with warm water to clear off discharge
If you wipe with tissues, throw them away, do not share towels
Do not wear contact lenses for up to 48 hrs after symptoms are resolved
When should you refer a patient to a doctor when it comes to eye conditions?
Staph/chalazion = progress from localised to more spread/diffuse
True eye pain (something in eye), sensitivity to light, severe pain, swelling or pus
Systemic symptoms (nausea, vomiting, headache, dry mouth), sudden and severe pain onset
Lowe eyelid turned down, history of eye trauma, changes in vision, irregularly shaped pupils, redness localised to the centred of the eye
What bacteria commonly cause conjunctivitis?
Strep. pneumoniae, H. influenzae, Staph. aureus, morazella catarrhalis
What are the symptoms of conjunctivitis?
Rapid onset, variable redness, burning, irritation, gritty feeling tearing, purulent (yellow-white) discharge
Second eye will be involved within 24-48 hours
What is viral conjunctivitis (pink eye)?
Conjunctivitis caused by adenovirus (most common), herpes simplex, varicella zoster
Typically preceded by a recent cold, very contagious and starts in one eye usually
Infectious until redness and weeping resolves (10-12 days)
What is irritant conjunctivitis?
Caused by: foreign matter - chlorine, air-borne pollutants, dirt, eyelashes, shampoo, dry eyes, entropion (eyelid turned inward)
Gradual onset, can affect 1 or both eyes
What are the symptoms of irritant conjunctivitis?
inflammation (Red eyes), irritation, stinging, burning
Profuse tears (Watery) and blinking (blepharospasm) to remove material
What is allergic conjunctivitis?
Allergen exposure= intermittent (pollen), persistent (house dust mites)
Contact allergic conjunctivitis due to chemical hypersensitivity = cosmetics, industrial chemicals, preservatives in eye drops
What are the symptoms of allergic conjunctivitis?
itching, water eyes, burning, slightly red, slight oedema
Usually both eyes
How is bacterial conjunctivitis treated?
Highly contagious but self-limiting. Should remove discharge with saline
Resolves within 2-5 days, only 1/5 will benefit from treatment
Recommend Abx if not resolved after 5 days
How is viral conjunctivitis treated?
Short lived, self-limiting
Non pharm = hygiene/cold compress, avoid bright light, simple analgesics
Pharm = topical vasoconstrictors, topical antibiotics (rare, secondary bact infection uncommon)
If HSV-1 causes = aciclovir ointment (Zovirax), 1 cm ointment into lower conjunctival sac 5x/day for 14 days/3 days after corneal epithelium has healed
How is mild allergic conjunctivitis treated?
Irrigate with normal saline twice daily, cool compress as required
Use artificial tears 4-8x daily
How is moderate allergic conjunctivitis treated?
antihistamine drops = levocabastine, azelastine, anatazoline, pheniramine
Combine antihistamines with decongestants
How is severe allergic conjunctivitis treated?
Combination of antihistamine & mast cell stabilisers (prevent, treat)= ketotifen, olapatadine
Mast cell stabilisers = prevention only, not immediate relief
- cromoglycate
- Lodoxamide
What are some differential diagnoses for eye conditions?
Entropion = inversion of eyelid margin, lowering of eyelid more often, eye lids push against cornea (redness, irritation)
Ectropion = eyelid turns out, continually watery eyes
Contact dermatitis = allergic reaction to cosmetics (itchy, flaking skin)
Orbital cellulitis = swelling of eyelids, feeling unwell, restricted eye movement; stye/sinus infection complication
What are some differential diagnoses for conjunctivitis?
Scleritis = inflammation of scleral, associated with autoimmune disease, pain, blurred vision, eye movement can worsen pain
Episcleritis = inflammation of episclera in single eye, painless/dull ache, more common in young women (self-limiting = 2-3 wks)
Keratitis (corneal ulcer) = inflammation from trauma, contact lenses, long term steroid. Pain, photophobia, water discharge, visual clarity reduced, redness worse around iris
Uveitis = antibody/antigen reaction (ulcerative colitis). Photophobia, pain, watering of one eye, redness localised, irregular pupil, impaired reading
