IPP: Eye Health Flashcards
What is the professional term for short and long sightedness?
What are the main focusing errors?
Definitions:
- Myopia – Short sightedness
- Hypermetropia - long sightedness
- Astigmatism & Presbysipia are main focusing errors of the eye
Problem with eyes - where to refer too?
Problem with Eyes – Where to go?
GP – limited equipment for eye examinations, generally refer eye problems to optometrists
Grampian Eye Health Network – Optometrist first port of call for any eye problem. Links primary care, optometrists and hospital for advice. Optometrist independent prescriber.
What is sub-conjunctival haemorrhage and how does it happen?
How long should it last?
Treatment?
- Redness under the conjunctiva/white of the eye due to a burst small blood vessel under the conjunctiva. This can be caused by high blood pressure, straining when coughing or sneezing or even for no apparent reason.
- Not usually serious – should not be painful or affect your vision and should resolve in a few days (Although can take 2-3 weeks to settle completely and during this time it might spread and their might be a yellow tinge before getting better).
- In general no treatment is required – However if the eye feels gritty or full a lubricant eye drop can be supplied (e.g hypromellose drops or clinitas carbomer gel drops).
What is Blepharitis?
What causes it?
- # eyelid condition which causes red, swollen and itchy eyelids and flakes/crusts around the roots of the eyelashes.
- # Symptoms usually are itching, burning, foreign body sensation, crusting on lids especially on wakening. Symptoms can worsen/improve overtime.
- Can be classed as anterior or posterior.
- Blepharitis can be caused by a skin condition e.g. atopic dermatitis, acne rosacea, seborrheic dermatitis or a skin bacteria e.g. staphylococcal or seborrheic. . It cannot be spread.
- Can be classed as anterior or posterior.
- Blepharitis can be caused by a skin condition e.g. atopic dermatitis, acne rosacea, seborrheic dermatitis or a skin bacteria e.g. staphylococcal or seborrheic. . It cannot be spread.
How is blepharitis treated?
TREATMENT
Not normally serious – treated by washing the eye lids everyday – this should be continued even after symptoms clear up.
- Lid hygiene – clean lids more than normal by wetting cotton wool ball with warm water/ boiling water and leaving to cool and washing with that..
- Warm compresses -use heat pad over closed eye lids a couple times a day for 5-10min.
- This dilates and improves functioning of the Meibomian glands and reduces symptoms
- Artificial tears
- Chloramphenicol or occasionally Fusidic acid to try reduce bacterial load
- Oral doxycycline – shown to be beneficial in patients with persistent blepharitis
What is Marginal keratitis?
Symptoms?
Small area of inflammation or ulceration on the cornea of the eye. May infiltrate into peripheral part of cornea.
Often associated with chronic blepharitis (inflammation of eyelids). Staphylococci on lid margins produce toxins onto surface of eye resulting in allergic hypersensitivity and localised ulceration
Symptoms:
- Discomfort and foreign body sensation in eye
- Redness
- Watering
- Light sensitivity
- May have eyelid disease such as blepharitis (inflammation of eyelid)
Treatment for marginal keratitis?
- Usually self- limiting condition
- Cleaning lids & lubricating
- Treatment will shorten course and relieve symptoms
- Anti-biotic/ anti-microbial agents will reduce bacterial load
- Topical steroid for 7 days (exclude herpes infection)
- Need to be confident about diagnosis before adding in
What is pterygium?
How does it progress?
Treatment?
Causes?
- A pinkish triangular growth that affects both eyes and begins on the white of the eye nearest the nose and very slowly progresses to the cornea. This red/pinkness is due to growing blood vessels.
- No treatment is normally needed. It is very rarely covers the pupils and impairs vision – however in this case surgery may be considered.
- It tends to occur more in those exposed to UV light, rain and wind. Wearing UV protected sunglasses can help prevent this.
*
What is episcleritis?
Cause?
Acute onset of a red patch of inflammation on the episclera of the eye of one or both eyes.
Very common, however cause is unknown but is related to autoimmune inflammatory condition.
Fairly benign a little uncomfortable.
What are questions to ask regarding differential diagnosis?
- Unilateral/ Bilateral (one or both eyes)
- Area of redness
- Where is redness, is it is one section, is it on white of the eye?
- Itchy/ Gritty/ burning?
- Discharge? Sticky/ watery/ stringy?
- Bacteria conjunctivitis – produces discharge at night which dries on the surface of the eye causing the eyes to be stuck together and making them more sticky
- White, stringy discharge – allergic
- Is it the eye itself, lids or lashes?
- Pain/ discomfort/ photophobia
- Sensitive to light
- Vision affected?
What advise should be given to contact lens wearers if their eyes are irritated or red?
- Remove lenses
- If problem still present when lenses out 24 hrs or more, see optometrist
- Be cautious about treating with chloramphenicol as contact lens wearers much more likely to have corneal involvement
What are the causes of watery eyes?
This could be caused by:
- Too much tear production
- Insufficient tear drainage
What can cause overproduction of tears?
- Excessive secretion from lacrimal gland
- Corneal irritation - Cold wind, glare, foreign body, entropion (eyelid sits incorrectly against eye therefore eyelashes rub along cornea), trichiasis (eye lashes turned in against the surface of the eye), chemical irritant, dry eye (trigeminal stimulation – causing irritation therefore stimulates), allergy
- Emotional cause
- Drugs e.g. pilocarpine
What is entropion?
Cause of water eye – eyelid curls inwards so eyelashes rubbing against eye
What are causes insufficent drainage
- 5.B1 FUNCTIONAL OBSTRUCTION
- Small or occluded punctum (gateway to the lacrimal drainage system which opens into the tubular canaliculus)
- Blockage in canaliculus, common duct, lacrimal sac or naso-lacrimal duct
- 5.B2 Lacrimal pump failure
- Ectropion – Eyelid curls away from eye so drainage system not working properly - the punctum which catches tears when you blink is it the wrong place
- Facial Nerve Paralysis (Bell’s Palsy, stoke)
What is chalazion?
A small, slow-growing lump that is painless and develops within the eye lid (little away from lid margin).
They develop when the Meibomian gland is blocked. These glands are responsible for oil production which lubricates the surface of the eye.
May occur spontaneously or follow an acute hordeolum (internal).
What is external hordolum/ stye?
What is it typically caused by?
A small painful, inflamed lump of the lid margin. May point anteriorly through the skin.
Acute bacterial infection of the lash follicle and its associated gland of Zeis or Moll (usually staphylococcal).
What is anterior uvetitis (iritis)?
Treatment?
- Auto immune inflammation
- Dull pain, photophobia, redness, vision blurry, watery eye
nTreatment
nRefer to optometrist or ophthalmologist (not GP)
nTopical cycloplegic – Cyclopentolate 1%
nTopical steroid – Prednisolone 1%
What is acute glaucoma?
Symptoms?
Treatment?
- Rapid rise in Intra Ocular Pressure
- Red eye
- Oval pupil
- Loss of vision, rapid
- Cornea hazy or cloudy
- Pain above affected eye
- Nausea / vomiting
- Refer to an Ophthalmologist/IP Optometrist
- OCULAR EMERGENCY
- Any delay in treatment will result in permanent damage to vision
