Managment Of Inflammatory Eye Disease Flashcards
Entry level management of episcleritis, including if there’s no resolution of symptoms after 1 and 2 weeks
Discomfort
- artificial tears
- cold compress
Persisting after 1 week
- refer to IP practitioner
- 7 day course of soft steroid
- FML 0.1%
Persisting after 2 weeks.
- refer to HES
- may require increased dosing
- investigate potential systemic cause
Different types of scleritis
- anterior scleritis
- non necrotising
- diffuse
- nodular
- necrotising
- with inflammation
- without inflammation
- posterior scleritis
Entry level management of scleritis
- ensure dilated fundus exam reformed
- might suggest oral analgesic as first aid
- call HES ad arrange same day referral, letter in hand
what is anterior uveitis
- inflammation of iris and anterior ciliary body
- most common
- idiopathic, systemic disease
What’s is intermediate uveitis
- inflammation of posterior ciliary body, anterior vitreous and peripheral choroid
What is posterior uveitis
- inflammation of the vitreous, choroid and retina
Signs/symptoms of intermediate uveitis
- Blurred vision
- floaters
- absence of pain
- reduced VA
- vitritis
- snowballs
- snow banking
Signs/symptoms of posterior uveitis
- Blurred vision
- floaters
- absence of pain
- choroiditis
- retinitis
- vasculitis
- CMO
Entry level management of uveitis
If first episode,unilateral, no known systemic aetiology, no posterior involvement, liaise with IP optom or GP to manage in community
Or else
- same day referral to IP optometrist
- same day referral to HES
Management of second episode
If first episode resolved well, management as previous
Second or third episodes may need further investigation of underlying cause
Topical steroids shouldn’t be prescribed for more than 6 weeks in any 4 month period
IP management of persisting episcleritis
- 7 day course of soft steroids
- betakmethosone or FML or prednisolone
- Bds
Persisting after 2 weeks
- may require increased dose
- refer to HES
- investigation for systemic cause
Considerations when prescribing steroids
- check IOPs
- review IOP weekly
What is scleritis
- severe inflammatory disease of the sclera
- idiopathic or linked to systemic condition
Scleritis categories
- anterior
- non necrotising
- diffuse
- nodular
- necrotising
- with inflammation
- without inflammation
- non necrotising
- posterior
Scleritis symptoms
- pain around the eye and forehead
- may even aching jaw
- intense
- unilateral or bilateral
- redness
- blurred vision
- gradual onset
- previous Hx
- photophobia
Signs of anterior non-necrotising scleritis
- diffuse - no nodule
- nodular - nodule that wont move
- dark hyperaemia that doesn’t blanch with phenylepharine
- possibly AC involvement
Necrotising AS signs
With inflammation
- hyperaemia
- avascular patches
Without inflammation
- dark blue grey appearance
Posterior scleritis signs
Retinal swelling/oedema/disruption
Entry level management of scleritis
- dilated fundus exam
- oral analgesic for pain
- call HES and arrange same day referral letter in hand
- px requires topical and systemic anti inflammatory
- investigate systemic disease
IP management of Anterior uveitis
- cyclopentolate 1% tds
- prednisolone 1% or dexamethosone 1% drops every hour for 2 days
- review after 2 days
- if improving monitor weekly
- taper steroid
- every hour 7 days
- 6 times daily for 7 days
- 4 times daily for 7 days
- refer if posterior involvement
What if there’s no improvement after 2 days
- phone ophthalmology
- may be asked to prescribe omeprazole 20 mg daily for gastric protection
- prednisolone 30 mg daily for 1 week, 20mg daily for 1 week, 15mg daily for 1 week, 10mg then 5mg
When to refer anterior uveitis
- bilateral
- children
- IOP >30
