Eye infections Flashcards
What is blepharitis and what can it be caused by (2)?
Common chronic inflammation affecting eyelids
Caused:
Bacterial - staphylococcal blepharitis
Seborrhoeic dermatitis - blepharitis
What are the clinical features of blepharitis?
burning
itching
erythema
crusting of eyelids esp worse in mornings
Management of blepharitis includes? (2)
What might a poor response indicate?
Most cases are self-limiting
- Eyelid hygiene measures and warm compress
- Topical antibacterial eye ointment/drops e.g chloramphenicol
A poor response may indicate viral or allergic conjunctivitis
What are the symptoms of conjunctivitis and especially the hallmark of allergic conjunctivitis? (6)
- Itching (usually bilateral) - a hallmark
- watery or mucoid
- discharge
- redness
- swelling
- eyelid swelling
Chloramphenicol has a broad spectrum of activity.
Which other antibacterials have a broad spectrum of activity?
- Quinolones
- Ciprofloxacin
- Levofloxacin
- Moxifloxacin
- Aminoglycosides - gentamicin and tobramycin
Gentamicin, tobramycin, quinolones (except moxifloxacin) and polymyxin B are effective for infections caused by…..
Pseudomonas aeruginosa
common gram negative bacteria
Administration of eye drops depends on severity but what is the usual administration guidance for eye drops and ointments?
Eye drops - apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing.
Ointment - apply either at night ( if eye drops used during the day) or 3-4 times daily.
best to apply at night (due to possible visual disturbance
A patient has bacterial conjunctivitis
What advice and pharmacological options (3) are there?
Self-limiting usually resolves 5-7 days without treatment.
Topical antibiotics if not resolved within 3 days
Chloramphenicol 0.5% eye drops - 1 drop 2 hourly for first 2days then QDS daily for 5 days
Chloramphenicol 1% ointment - apply QDS daily for 2 days, then BD daily for 5 days.
Second line:
Fusidic acid 1% eye drops - apply BD for 7 days
A patient has conjunctivitis associated with contact lens wear. What would you advise?
- Remove & stop contact lens wear
- Regular bathing/cleaning of eyelids with saline or boiled and cooled water to remove any discharge
- Not to use contact lens until infection has gone
- Can be treated as other conjunctivitis scenarios
Clinical symptoms of conjunctivitis? (4)
Discharge - watery or purulent - worst when waking up from sleep
Itching
Changes in vision - blurring
Eyelid swelling
Red flags for conjunctivitis?
- Eye pain - photophobia, headache
- Reduced vision
- History of trauma /foreign body
- Red sticky eye in a neonate (within 30days of birth)
- Copious progressive discharge - could be gonococcal infection
- Infection with herpes virus
- Associated URTI or enlarged tender lymph nodes
A pregnant patient with an eye infection asks you for chloramphenicol eye drops.
Can chloramphenicol be used in pregnancy and breastfeeding?
Avoid unless essential.
No information on topical use but with ORAL in 3rd trimester - there is a risk of neonatal grey -baby syndrome
Avoid in breastfeeding - theoretical risk of bone-marrow toxicity
Chloramphenicol is usually POM - when can it be sold as a P medicine? Pack size, Age group & max duration
0.5% eye drops max 10ml
1% ointment max 4g
Age 2 years and above
Max duration treatment 5 days
What other product is there for local eye infections?
Include generic and brand name
Propamidine isetionate (antiprotozoals)
Brand - golden eye & brolene
What can you use for viral conjunctivitis ?
Aciclovir
5 times a day until 3 days after healing
What is blepharitis?
inflammation of the eyelids.
Usually affects both eyes along the edges of the eyelids.
Commonly occurs when tiny oil glands near the base of the eyelashes become clogged, causing irritation and redness.
What bacteria using causing blepharitis and conjunctivitis ?
Staphylococci
Blepharitis is usually treated with…?
in more serious cases can be treated with systemic abx such as …
topical ointment - fusidic acid (narrow spec)
systemic 3 months of tetracyclines
Which abx can be used for purulent bacterial conjunctivitis and conjunctivitis caused by chlamydia trachomatis?
Azithromycin (macrolide)
How often are antibacterial eye preparations applied?
Drops- apply 1 drop at least every 2 hours then reduce frequency as infection is controlled and continue for 48 hours after healing
Ointment - apply either at night if using drops during the day or 3-4 times daily if used alone
How often is fusidic acid applied for staphylococcal eye infections?
Child & Adult
BD daily
they are modified release eye drops!!
What are some side effects with fusidic acid?
common (3)
freq. not known (2)
Common:
- Dry eyes
- Eye discomfort
- Vision blurred
Freq. not known
- Eye inflammation
- Angioedema
What is ganciclovir used for and the dose?
Acute herpetic keratitis
5 times a day until healing complete. then 3 times a day for 7 days
treatment doesn’t usually exceed 21 days
What advise is given with ganciclovir with conception and contraception?
Teratogenicity impaired fertility
Women should use effective contraception during treatment
Men with partners of childbearing potential should be advised to use barrier contraception during and for at least 90 days after treatment.
