Eyes, Ears and Oral Health Flashcards
Minor Ailment
“A condition requiring little or no medical intervention and thus can be treated using non prescription medication bought OTC.”
Conjunctivitis
Inflammation of the conjunctiva, the thin protective membrane that covers the white of the eye and inside surface of the eyelids. It is characterised by varying degrees of ocular redness, irritation, itching and discharge. Can be infective or allergic in origin
Infective Conjunctivitis
Infective conjunctivitis may be bacterial, viral or parasitic. Seems to affect sexes equally and may present in any age of patient, although bacterial conjunctivitis is more common in children and viral conjunctivitis more common in adults
The most common bacterial causes of conjunctivitis are streptococcus pneumoniae, staphylococcus aureus and haemophilus influenzae.
Bacterial Conjunctivitis
Bacterial conjunctivitis is usually self and resolve within 5-7 days without treatment
Viral Conjunctivitis
Viral conjunctivitis is self limiting and do not require antimicrobial treatment. Usually resolves in 1-2 weeks
Chlamydial Conjunctivitis
Chlamydial conjunctivitis is the least common type of conjunctivitis encountered and is more common in yoinger adults than older people
Usually accompanied by a systemic infection
Urgent referral
Bacterial Conjunctivitis Symptoms
- Both, but one eye affected a day or so before the other
- Purulent discharge
- Gritty feeling
Generalised and diffuse distribution
Viral Conjunctivitis Symptoms
- Both
- Watery discharge
- Gritty feeling
- Generalised distribution
Cough and cold symptoms
Allergic Conjunctivitis Symptoms
- Both
- Watery discharge
- Itching
- Generalised but greatest in fornices
Rhinitis
Bacterial Conjunctivitis Referral
- Eye or head injury
- Painful eye movements, severe pain within the eye or photophobia
- Vision is affected
- Eye surgery or laser treatment in the past 6 months
- Symptoms get worse despite using chloramphenicol
- Pupil looks unusual e.g. torn, irregular, dilated or sluggish/ non reactive to light
- Eye looks cloudy
Contact lens weare and has worn re usable lenses in the shower or the eye with contact lens in may have come into contact with tapwater
Chloramphenicol OTC restrictions
being under 2 years old, pregnancy and breast feeding
Conjunctivitis Practical Advice
- Bathe the eyelids with tepid water to remove any discharge
- When cleaning the eye, wipe from the bridge of the nose to the outer corner of the eye with a fresh piece of cotton wool
- As eye infections are easily passed to others, avoid sharing towels/face cloths etc.
- Use of OTC lubricant eye drops can reduce discomfort
- Remove contact lenses until all symptoms and signs of infection have completely resolved and any treatment has been completed for 24 hrs.
Wash hands regularly
Bacterial Conjunctivitis Treatment
Chloramphenicol drops:
Every 2 hrs for first 48hrs and 4 hrly thereafter if symptoms improve
If no improvement is seen after 2 days referral is appropriate
Ointment:
3-4 times daily
Store in fridge and use for 5 days even if symptoms clear
Allergic Conjunctivitis advice
- Remove contact lenses until symptoms resolve
- Avoid rubbing their eyes
- Avoid exposure to the allergen
Place cool compress on the eyes
Allergic Conjunctivitis Treatment
- Topical antihistamines
mast cell stabilisers- sodium cromoglicate 1-2 drops qds
Chronic Dry Eye Symptoms
dryness, grittiness or soreness in both eyes that worsen throughout the day and watering of the eyes particularly when exposed to wind
Dry Eye Red Flag Symptoms
- Associated dryness of the mouth and other mucous membranes
Outward turning of the lower eyelid (ectropion)
Dry Eye Practical Advice
- Eyelid hygiene to control the blepharitis that most people with dry eye disease have
- Limiting the use of contact lenses if these cause irritation
- Stopping medication that exacerbates dry eyes- under the guidance of a prescriber
- Using a humidifier to moisten the air
- Stopping smoking
If using a monitor, ensure it is below eye level
Dry Eye eyelid hygiene
- Apply warm compresses to the closed eyelids for 5-10 mins
- For posterior blepharitis, massage the eyelid to express meibomian glands
- Clean the eyelid- wet a cotton bud with cleanser and rub along lid margins
Avoid eye makeup
Dry eye treatment
- Low viscosity drops are usually recommended for daytime use due to the reduced risk of adverse effects such as blurred vision, eyelid debris, and eye stinging
- Hypromellose
- Carbomers
- Sodium hyaluronate
Preservative free preparations for chronic use
Ear Wax
More common in men than women and particularly common in the elderly and people with intellectual impairment
Ear Wax practical advice
Advise people against inserting anything in the ear.
Ear Wax Treatment
- Olive oil
- Almond (careful with nut allergies)
- Sodium bicarbonate- may dry out ear canal
Drops are used 3-4 times daily for 3-5 days initially
Ear Wax red flag symptoms
- Dizziness/tinnitus
- Pain from middle ear
- Fever in children
- Deafness
- OTC treatment failure
Suspected foreign body
Otitis Externa
Inflammation of the external auditory canal. The acute form is usually caused by bacterial infection but it may also be fungal or viral. The chronic form is eczematous and may be atopic or a contact dermatitis. The symptoms of acute otitis externa include ear pain, itch, discharge and hearing loss.
Otitis Externa Practical Advice
- Avoid damage to ear canal
Keep ears clean and dry by using ear plugs when swimming and a hair dryer at lowest heat to dry the ear canal after bathing etc. abstain from water sports for 7-10 days.
Otitis Media
- Reassure that antibiotics aren’t usually needed because they make little difference to symptoms and can cause adverse effects e.g. D&V
- Prescribing antibiotic appropriate if:
- Bilateral AOM in children under 2 yrs
AOM in children and young people with otorrhoea
Glue Ear
hearing loss often with no other symptoms. Often a relationship between recurrent ear infection and glue ear
Ear Red Flags
- Generalised inflammation of the pinna
- Impaired hearing in children
- Mucopurulent discharge
- Pain on palpitation of the mastoid area
- Patients showing signs of systemic infection
- Slow growing growths on the pinna in elderly people
Symptoms that are not improving and have been present for 4 or more days
Aphthous Ulcers
Painful clearly defined round or ovoid shallow ulcers that are confined to the mouth and are not associated with systemic disease. They generally occur on mucosal surfaces such as the inside of the lips, the inside of the cheeks, the floor of the mouth or the under surface of the tongue
Describe minor aphthous ulcers
Most common and are typically 2-4mm in diameter. Heal in 7-10 days
Describe major aphthous ulcers
Deeper and larger than minor ulcers and have a raised, irregular border. They are often 1 cm or more in diameter. They heal slowly over several weeks and often lead to scarring
Describe Herpetiform
Uncommon
Present as multiple pin head sized ulcers that increase in size and coalesce to leave large areas of ulceration. Usually extremely painful and can involve any oral site. They heal in 10 days or longer
Things to consider with ulcers
Ulcers are more common in women than men
Uncommon in children
Can be caused by damage to the mouth e.g. biting, brushing
Ulcers Red flags
- Ulcer lasting more than 2 weeks- urgent referral to exclude oral cancer
- Diameter greater than 10 mm
- Children under 10
- Painless ulcer
- Eye involvement
- Systemic symptoms
- Crops of 5 or more
Unexplained red or white patches that are painful, swollen or bleeding
Ulcer practical advice
- Avoid trigger factors including oral trauma and certain foods and drinks
- Toothpaste containing SLS
Any people with local trauma from broken teeth, dentures or orthodontic appliances should see a dentist
- Toothpaste containing SLS
Ulcer treatment
- Symptomatic treatment for pain discomfort and swelling, especially when ulcers cause problems eating
- Hydrocortisone sodium succinate 2.5mg oromucosal tablets for adults and children over 12 yrs of age. One should be allowed to slowly dissolve in the mouth in contact with the ulcer four times a day for up to 5 days
- Chlorhexidine mouthwash to prevent secondary infection
Topical analgesic- benzydamine hydrochloride every 1.5-3 hrs as required
Dry Mouth causes
Drugs with antimuscarinic side effects
Diuretics
Irradiation of the head and neck region
Damage or disease of the salivary glands
Dry mouth practical advice
Frequent sips of cold unsweetened drinks
Sugar free pastilles
Chewing sugar free gum
what is oral candidiasis
Fungal infection of the oral mucosa most commonly caused by candida albicans
who is more likely to have oral thrush
Most common in neonates, elderly people, people who are immunocompromised and people with xerostomia
what is erythematous oral candidiasis
Presents with marked soreness and erythema, particularly on the palate and dorsum of the tongue. Usually asymptomatic or is accompanied by a mild burning sensation
Commonly occurs after treatment with oral antibiotics
what is Hyperplastic oral candidiasis
Plaque like usually chronic
Oral thrush classic presentation
Creamy white soft elevated patches that can be wiped off revealing underlying erythematous mucosa. Burning or irritation is associated with the infection rather than pain. Patients complain of malaise and lack of appetite.
Oral thrush red flags
- Healthy adult with no risk factors
- Immunocompromised
- Diabetes
- > 3 weeks
- Painless
- Don’t improve after treatment for 1 week
- <4 months
- Widespread infection
ALARM
Oral thrush treatment
- Daktarin >4 months
- 4-24 months 1.25ml applied qds after meals
- 2+ 2.5ml qds after meals
Continue treatment for a week after symptoms have cleared
what is axial cheillitis
Inflammatory condition that occurs in one or both angles of the mouth
Can occur at any age but common in people who wear dentures
symptoms of axial cheillitis
- Erythema
- Painful cracking
- Scaling
- Bleeding
- Ulceration
- Slow to heal
axial cheillitis practical advice
- Avoid licking lips
- Use of paraffin based protective lip balm can help protect the lips
If poorly fitting dentures are a suspected cause, a visi t to the dentist should be recommended for re fitting
- Use of paraffin based protective lip balm can help protect the lips
sore throat practical advice
- Generally self limiting
- See HCP if no imrovement or worsening
- Advice regarding food and drink to avoid exacerbating pain
Adequate fluid intake
sore throat treatment
- Paracetamol
- Ibuprofen
sore throat red flags
- Fever pain score of 4 or 5
- Systemically very unwell
Difficulty breathing, swallowing, severe pain, drooling
- Systemically very unwell
