Eye OTC Flashcards
what are some classifications of common eye presentations?
- Painful eye
- Inflammatory Conditions
- Drainage or Tear formation
abnormalities - Eye disorders with systemic illness
- Foreign Body present
what is subconjunctival haemorrhage?
Part of the conjunctiva covering the white of the eye appears bright red because a small blood vessel has burst
how should you help someone with subconjunctival haemorrhage?
If the only symptom, and not caused by physical
injury is considered harmless
* However the patient may be very concerned →
reassure
what are general eye red flag symptoms?
Moderate to severe eye pain: secondary cause must be excluded
Marked redness of the eye: the greater the redness, the more likely it is that there is a serious secondary cause.
Ciliary injection: engorgement of the deep vessels around the limbus, giving the eye a bluish discolouration
Reduced visual acuity: any loss of visual acuity, may indicate a secondary cause
Severe Photophobia: Of unexplained origin
what would be a serious cause of a red eye?
acute glaucoma
keratitis
iritis/ uveitis
what is acute glaucoma?
Raised intra-occular pressure with pain in the eye, headache and blurring of vision
what are the signs of acute glaucoma?
Ciliary injection
o Diminished vision
o Hazy cornea
o Fixed dilated pupil
o Eye is rock hard and tender
what is keratitis?
(corneal ulcer) presents: pain unilateral,
photophobic and injected eye
what are the signs of keratitis?
o Ciliary injection.
o Corneal ulceration: dendritic (latin ‘many
fingered’) if herpes simplex.
o Vision may be affected, depending on the site of the ulcer.
what is iritis?
(uveitis –inflammation of the iris) typically
presents with pain, watering of the eye and
headache may be present
what are the signs of iritis?
o Ciliary injection (engorgement of the deep vessels around the limbus, indicated by redness and enlarged blood vessels) may be the only sign
o The pupil may be fixed and mid-dilated or
distorted from previous attacks
what is conjunctivitis?
Conjunctivitis is inflammation of the conjunctiva:
-conjunctival blood vessels dilate and the eye appears red.
* Can be bacterial or viral infection or allergic response
what are the different types of conjunctivitis?
primary conjunctivitis –Inflammation limited to the conjunctiva
* secondary conjunctivitis - widespread affecting other parts of the eye
what is bacterial conjunctivitis caused by?
Staphylococcus species
Streptococcus pneumoniae
Moraxella catarrhalis
Gonorrhoea very rare, purulent conjunctivitis
what is viral conjunctivitis associated with?
- Viral conjunctivitis is associated with upper RTI -usually caused by adenovirus
what is a rarer type of conjunctivitis that can present?
Chlamydia (rare) presents with a chronic
conjunctivitis in newborns and people who are
sexually active
what are the symptoms of conjunctivitis?
Eye discomfort –burning, gritty –minimal pain
Minimal photophobia - Rarely present
Eyelids stuck –Green/yellow sticky discharge
Blurring of vision –due to discharge
History of close contact - with affected person increases the likelihood of an infective cause
what would be the differential diagnosis for conjunctivitis?
- Irritant conjunctivitis
- Mechanical causes of conjunctivitis
eg. eyelashes rubbing surface of the eye
eg. foreign body lodged beneath the upper eyelid
would you give antibiotics for conjunctivitis?
bacterial- self limiting- not much benefit
what antibiotics are available for conjunctivitis?
Chloramphenicol - broad spectrum of action - little evidence of bacterial resistance –although this is a growing concern.
who is chloramphenicol not recommended for?
people with a personal or family history
of blood dyscrasias, or women who are pregnant
what is the risk with chloramphenicol in pregnant women?
there is a theoretical risk of grey baby syndrome (chloramphenicol toxicity in
newborns from the lack of liver enzymes necessary to metabolise the drug)
how should chlormhenicol eye drops be given?
- Apply one drop to eye every two hours for first 48 hours
- Thereafter QDS for up to 5 days
when should you see GP when chlormenicol doesnt work?
48 hours if no improvement
or immediately if symptoms worsen
what are alternative treatments to chlormephenicol?
- Propamidine eye drops (Golden Eye)
- Dibromopropamidine iserionate eye ointment
(Golden Eye) - Evidence for use –weak
- Eye hygiene may be just as effective
how should you bathe eyes?
Using warm, not hot, preboiled water and cotton or gauze pads.
* Each eye should be swabbed once from the inside corner to the outside edge, using each pad once then discarding.
* The same pad should never be used for both eyes.
* The use of cotton wool is not recommended as the tiny fibres can get into the eye and cause irritation and a place for germs to grow.
* Every individual should have their own flannel and towel, which should be washed regularly and never shared.
what are the signs of allergic conjunctivitis?
- Bilateral itchy eyes
- Oedema: cobblestone appearance on inner
surface of the eyelids - Associated with other atopic/allergic conditions:
eczema, allergic rhinitis, or asthma
what do sympathomimetics do?
constrict blood vessels in the eye
* DI - Care with MAOIs because of risk of hypertensive crisis.
how do you treat bloodshot eyes?
Naphazoline 0.01% (Optrex Bloodshot Eye Drops) adults and children >12
* Reduce redness only for short term use
* use 3-7 days at most because of rebound effects.
who should you avoid sympathomimetics in?
galucoma
what are the 3 main eyelid disorders?
- Stye (usually one eye) should resolve spontaneously within 2-3 days
- Blepharitis (usually both eyes) inflammation of the lid margins
- Meibomian cyst hard painless lump under the eyelid should resolve spontaneously
what is blepharitis?
Inflammation of the margin of the eyelid.
Usually a chronic condition that is typically bilateral
what are the causes of blepharitis?
Several causes, characterised by overlapping symptoms and signs.
how do you classify blepharitis?
▪ base of the lashes (anterior blepharitis)
▪ meibomian glands (posterior blepharitis).
how do you classify blepharitis by clinical symptoms?
Staphylococcal blepharitis affects the anterior
eyelid margin : lash collarettes crusting, lid
ulceration, folliculitis.
* Seborrhoeic blepharitis affects the anterior eyelid
margin
* caused by excessive sebum, associated with
seborrhoeic dermatitis involving other areas.
* Meibomian gland dysfunction posterior eyelid
margin - often associated with seborrhoeic
dermatitis and/or rosacea.
what are the symptoms of blephiritis?
Often intermittent and usually bilateral:
* Sore eyelids most common symptom
* Eyes may feel ‘gritty’
* Symptoms of dry eye include blurred vision and contact lens intolerance
* Eyelids sticking together, particularly in the morning, suggests infection
what are the signs of blephritis?
- Swollen eyelids are the defining sign of staphylococcal blepharitis and meibomitis, but are unusual in the less severe types of blepharitis.
- Inflamed lid margins are usually present
- Altered eyelash appearances: misdirection, crusting and eyelash loss
- Eyelid surfaces may be scaly, oily or greasy.
- Styes are much more common in people with blepharitis
- Inflamed conjunctiva common complication of blepharitis
how would you council a patient on blepharitis?
- Blepharitis is a chronic condition
- Symptoms can frequently be improved, but condition may not cure permanently.
- Compliance with the recommended treatment is important, particularly lid hygiene.
- Contact lenses should not be worn during any eye infection
when do you refer blephritis to GP?
- underlying conditions causing or exacerbating the blepharitis eg……
- Rosacea (meibomian gland dysfunction)
- Seborrhoeic dermatitis (seborrhoeic blepharitis)
- Atopic eczema (staphylococcal blepharitis)
what is involved in eyelid hygiene?
- Warm compresses to the eyelids
loosen the crusts, making cleaning
more effective and comfortable
applied to the closed eyelids for 5-10
minutes. - Lid massage expresses the contents of
the meibomian glands.
what is dry eye syndrome?
A disorder of the tear film due to tear deficiency or excessive evaporation
* Causes damage to the ocular surface, and is associated with symptoms of discomfort.
* Syndrome aggravated by dry air, wind, dust, and smoke
what is the pathogenesis of dry eye syndrome?
- The ocular surface, tear-secreting glands, meibomian glands, and lids function as an integrated unit to secrete and clear tears
- Dysfunction of any component results in an unstable and unrefreshed tear film that causes the set of symptoms called dry eye syndrome.
what are tears composed of?
Tears are a complex mixture of water, lipids, salts, mucins,
immunoglobulins, antimicrobial proteins, and growth factors
what is the structure of tears?
- Inner layer of mucins adheres to corneal epithelium
- Middle layer is an aqueous/mucin phase
- Outer layer of lipids
what are tears produced by?
- Lacrimal glands, ocular surface epithelium, and conjunctival
goblet cells (secrete hydrated mucous gel of inner and middle
layers) - Meibomian glands (produce outer lipid layer)
what are the symptoms of dry eye syndrome?
- Both eyes are usually affected
- Sensations are of foreign body, irritation, soreness
- Contact lenses are poorly tolerated.
- Sufferers may not describe their eyes as feeling ‘dry’.
- Vision may be transiently affected due to loss of surface moisture
- Photophobia is occasionally present
what treatment should be given for dry eyes?
Hypromellose 0.3% eye drops
when are lubricants best for dry eyes?
Useful at bedtime because it provides prolonged lubrication.
may affect sight during the day
