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MO1 > Eye OTC > Flashcards

Eye OTC Flashcards

1
Q

what are some classifications of common eye presentations?

A
  • Painful eye
  • Inflammatory Conditions
  • Drainage or Tear formation
    abnormalities
  • Eye disorders with systemic illness
  • Foreign Body present
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2
Q

what is subconjunctival haemorrhage?

A

Part of the conjunctiva covering the white of the eye appears bright red because a small blood vessel has burst

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3
Q

how should you help someone with subconjunctival haemorrhage?

A

If the only symptom, and not caused by physical
injury is considered harmless
* However the patient may be very concerned →
reassure

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4
Q

what are general eye red flag symptoms?

A

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

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5
Q

what would be a serious cause of a red eye?

A

acute glaucoma
keratitis
iritis/ uveitis

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6
Q

what is acute glaucoma?

A

Raised intra-occular pressure with pain in the eye, headache and blurring of vision

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7
Q

what are the signs of acute glaucoma?

A

Ciliary injection
o Diminished vision
o Hazy cornea
o Fixed dilated pupil
o Eye is rock hard and tender

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8
Q

what is keratitis?

A

(corneal ulcer) presents: pain unilateral,
photophobic and injected eye

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9
Q

what are the signs of keratitis?

A

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.

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10
Q

what is iritis?

A

(uveitis –inflammation of the iris) typically
presents with pain, watering of the eye and
headache may be present

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11
Q

what are the signs of iritis?

A

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

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12
Q

what is conjunctivitis?

A

Conjunctivitis is inflammation of the conjunctiva:
-conjunctival blood vessels dilate and the eye appears red.
* Can be bacterial or viral infection or allergic response

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13
Q

what are the different types of conjunctivitis?

A

primary conjunctivitis –Inflammation limited to the conjunctiva
* secondary conjunctivitis - widespread affecting other parts of the eye

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14
Q

what is bacterial conjunctivitis caused by?

A

 Staphylococcus species
 Streptococcus pneumoniae
 Moraxella catarrhalis
 Gonorrhoea very rare, purulent conjunctivitis

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15
Q

what is viral conjunctivitis associated with?

A
  1. Viral conjunctivitis is associated with upper RTI -usually caused by adenovirus
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16
Q

what is a rarer type of conjunctivitis that can present?

A

Chlamydia (rare) presents with a chronic
conjunctivitis in newborns and people who are
sexually active

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17
Q

what are the symptoms of conjunctivitis?

A

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

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18
Q

what would be the differential diagnosis for conjunctivitis?

A
  • Irritant conjunctivitis
  • Mechanical causes of conjunctivitis
    eg. eyelashes rubbing surface of the eye
    eg. foreign body lodged beneath the upper eyelid
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19
Q

would you give antibiotics for conjunctivitis?

A

bacterial- self limiting- not much benefit

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20
Q

what antibiotics are available for conjunctivitis?

A

Chloramphenicol - broad spectrum of action - little evidence of bacterial resistance –although this is a growing concern.

21
Q

who is chloramphenicol not recommended for?

A

people with a personal or family history
of blood dyscrasias, or women who are pregnant

22
Q

what is the risk with chloramphenicol in pregnant women?

A

there is a theoretical risk of grey baby syndrome (chloramphenicol toxicity in
newborns from the lack of liver enzymes necessary to metabolise the drug)

23
Q

how should chlormhenicol eye drops be given?

A
  • Apply one drop to eye every two hours for first 48 hours
  • Thereafter QDS for up to 5 days
24
Q

when should you see GP when chlormenicol doesnt work?

A

48 hours if no improvement
or immediately if symptoms worsen

25
Q

what are alternative treatments to chlormephenicol?

A
  • Propamidine eye drops (Golden Eye)
  • Dibromopropamidine iserionate eye ointment
    (Golden Eye)
  • Evidence for use –weak
  • Eye hygiene may be just as effective
26
Q

how should you bathe eyes?

A

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.

27
Q

what are the signs of allergic conjunctivitis?

A
  • Bilateral itchy eyes
  • Oedema: cobblestone appearance on inner
    surface of the eyelids
  • Associated with other atopic/allergic conditions:
    eczema, allergic rhinitis, or asthma
28
Q

what do sympathomimetics do?

A

constrict blood vessels in the eye
* DI - Care with MAOIs because of risk of hypertensive crisis.

29
Q

how do you treat bloodshot eyes?

A

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.

30
Q

who should you avoid sympathomimetics in?

A

galucoma

31
Q

what are the 3 main eyelid disorders?

A
  • 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
32
Q

what is blepharitis?

A

Inflammation of the margin of the eyelid.
Usually a chronic condition that is typically bilateral

33
Q

what are the causes of blepharitis?

A

Several causes, characterised by overlapping symptoms and signs.

34
Q

how do you classify blepharitis?

A

▪ base of the lashes (anterior blepharitis)
▪ meibomian glands (posterior blepharitis).

35
Q

how do you classify blepharitis by clinical symptoms?

A

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.

36
Q

what are the symptoms of blephiritis?

A

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

37
Q

what are the signs of blephritis?

A
  • 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
38
Q

how would you council a patient on blepharitis?

A
  • 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
39
Q

when do you refer blephritis to GP?

A
  • underlying conditions causing or exacerbating the blepharitis eg……
  • Rosacea (meibomian gland dysfunction)
  • Seborrhoeic dermatitis (seborrhoeic blepharitis)
  • Atopic eczema (staphylococcal blepharitis)
40
Q

what is involved in eyelid hygiene?

A
  • 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.
41
Q

what is dry eye syndrome?

A

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

42
Q

what is the pathogenesis of dry eye syndrome?

A
  • 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.
43
Q

what are tears composed of?

A

Tears are a complex mixture of water, lipids, salts, mucins,
immunoglobulins, antimicrobial proteins, and growth factors

44
Q

what is the structure of tears?

A
  • Inner layer of mucins adheres to corneal epithelium
  • Middle layer is an aqueous/mucin phase
  • Outer layer of lipids
45
Q

what are tears produced by?

A
  • Lacrimal glands, ocular surface epithelium, and conjunctival
    goblet cells (secrete hydrated mucous gel of inner and middle
    layers)
  • Meibomian glands (produce outer lipid layer)
46
Q

what are the symptoms of dry eye syndrome?

A
  • 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
47
Q

what treatment should be given for dry eyes?

A

Hypromellose 0.3% eye drops

48
Q

when are lubricants best for dry eyes?

A

Useful at bedtime because it provides prolonged lubrication.
may affect sight during the day

MO1 (50 decks)

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