Eyes, ears and oral health

Question 1

Conjunctivitis

Answer 1

• Irritation and itching
• Grittiness in the eye
• Watering or discharge

Question 2

Bacterial conjunctivitis

Answer 2

• Yellow white discharge
• Bilateral infection
• Absence of itching

Question 3

Allergic conjunctivitis

Answer 3

• Bilateral
• Itchy eyes
• Clear watery discharge

Question 4

Danger symptoms of conjunctivitis

Answer 4

• Conjunctivitis symptoms in a baby under 28 days old require urgent medical attention (999)
• Pregnancy and children under the age of 2 require routine referral to GP

Question 5

Treatment options for infective conjunctivitis

Answer 5

1. Chloramphenicol eye drops and ointments
   - Apply drops every 2 hours for the first 2 days, then every 4 hours thereafter continuing for 5 days even if the symptoms improve
   - Ointment should be applied three-four times daily for 5 days
   - Not used in pregnancy, breastfeeding or children under the age of 2

Question 6

Treatment options for allergic conjunctivitis

Answer 6

1. Topical anti-histamines i.e. Otrivine-anistin
2. Topical mast cell stabilisers i.e. Sodium cromoglicate

Question 7

Practical tips for conjunctivitis

Answer 7

• Avoid contact lens wear during infection and for 24 hours after treatment is completed
• Wash hands after touching the eye
• Avoid sharing the towel and pillows
• Cold compresses may help soothe the eye

Question 8

Dry Eye

Answer 8

• Tear deficiency
• Affects both eyes usually
• Irritation or grittiness in the eye
• Excessive tearing or watery eyes

Question 9

Treatment options for dry eyes

Answer 9

• Hypromellose - 1/2 drops in each eye three times a day. Keep eyes closed for a minute or two.
• Lubricant eye ointments (Lacri lube)
• Optrex

Question 10

Practical tips for dry eyes

Answer 10

• Soak cotton wool in boiled and cooled water to clean eyelids for 2-3 minutes
• A cotton bud used to clean the edge of the lower lid to remove any crusts.

Question 11

Mouth ulcers

Answer 11

• Painful, shallow, rounded and clearly defined lesions

Question 12

Danger symptoms of mouth ulcers

Answer 12

• Lasting longer than 3 weeks requires routine referral

Question 13

Treatment options for mouth ulcers

Answer 13

• Topical corticosteroids - Hydrocortisone muco adhesive buccal tablets sucked and allowed to slowly dissolve in the mouth in contact with the ulcer 4 times a day
• Local analgesics - Difflam mouthwash or spray or Bonjela applied every 3 hours (max 6 applications) not suitable for anyone under 16
• Antiseptic mouthwashes i.e. chlorhexidine
• Mechanical protection i.e. Aloclair mouthwash

Question 14

Practical tips for mouth ulcers

Answer 14

• Use a softer toothbrush
• Suggest a visit to the dentist
• If there are obvious food causes avoid them

Question 15

Dry mouth

Answer 15

• Difficulty eating or speaking
• Can occur as a side effect to certain medications
• Breathing through the mouth
• Anxiety
• Dehydration

Question 16

Danger symptoms of dry mouth

Answer 16

• If the patient has dry eyes, dry mouth or vaginal dryness they need to referred to their GP

Question 17

Treatment options for dry mouth

Answer 17

Artifical saliva

Question 18

Practical tips for dry mouth

Answer 18

• Take frequent sips of cold water or suck on an ice cube
• Sugar free chewing stimulates production of saliva
• Cut down on tea, coffee, cola or alcohol
• Petroleum jelly to lips to prevent drying and cracking

Question 19

Oral thrush

Answer 19

• Sore and painful mouth
• Burning tongue
• Altered taste
• White discrete plaques on buccal mucosa, throat, tongue or gums

Question 20

Treatment options for oral thrush

Answer 20

1. Miconazole oral 2% gel to be used after food and drink and to be held in the mouth for as long as possible until 2 days after the infection has cleared up

Question 21

Practical tips for oral thrush

Answer 21

• Dentures should be removed before treatment
• Rinse mouth with water after using a corticosteroid inhaler
• Diabetics

Question 22

Axial cheilitis

Answer 22

• Cracked fissures in the corners of the mouth
• May crust and bleed
• often painful

Question 23

Treatment options for axial cheilitis

Answer 23

1. Clotrimazole 1% cream
   - If symptoms do not improve within 1 week then refer to GP

Question 24

Practical tips for axial cheilitis

Answer 24

• Avoid licking your lips
• Use paraffin based lip balm
• If poorly fitted dentures are the cause, see your dentist to get them refitted
• Improve dental hygeine

Question 25

Treatment options for sore throat

Answer 25

1. OTC analgesics i.e. paracetamol, ibuprofen
2. Local anaesthetics i.e. benzocaine, lidocaine in sprays or throat lozenges
3. Glycerin, honey and lemon preparations
4. Gargle with salt water