Seminar O - Opthamology Section 2 Flashcards
Lids
common conditions
Blepharitis
Chalazion
Malposition
Conjunctiva common conditions
Conjunctivitis
common conditions Sclera
Episcleritis
Scleritis
common conditions Cornea
Keratitis
common conditions Uveal Tract
Uveitis
common conditions Trabecular Meshwork
Acute Glaucoma
Periorbital Skin common conditions
Preseptal cellulitis
Orbital Cellulitis
Blepharitis: Definition:
A combination of:
• Infection of the lid margins by staphylococcal bacteria
• Overproduction of sebum by the glands at the lid margin
Blepharitis: History Presentation
- Chronic ocular irritation
- Watery eye
- Red eye
Blepharitis: Examination results
- Crusting and scaling of the lash line
* Careful examination can demonstrate plugs of sebum in the meibomian gland orifices.
Chalazion – a meibomian cyst (lipogranuloma) Definition
Meibomian gland dysfunction
Chalazion – a meibomian cyst (lipogranuloma) Occurs with
Increased frequency in patients with acne rosacea and seborrhoeic dermatitis
Chalazion – a meibomian cyst (lipogranuloma) Treatment
Hot Spoon bathing and antibiotics but often chalazia require surgical incision and curettage.
Malposition:
Definition:
Abnormal position of the lids is extremely common and can often be overlooked as a cause of red eye.
Entropion: Definition
Turning inwards of the lid margin
Can affect the upper or lower eyelid
Normal eyelashes cause corneal abrasions
Entropion: Causes of entropion include
• Ageing (involuntional) • Conjunctival scarring (cicatricial) o Trachoma o Stevens-Johnson syndrome o Ocular pemphigoid • Acute spastic entropion - spasm of orbicularis muscle
Conjunctiva: Aetiology
- Bacterial
- Viral
- Chlamydial
- Allergic
- Neonatal
- Iatrogenic
Conjunctiva: Memorable way to remember causes
Ocular Cicatricial Pemphigoid
Herpes
Gonococcal infection
Ligneous
Adenoviral infection
Diptheria infection
Stevens-johnson syndrome Candida or chlamidya infection (newborn only) Alkali burn Beta-haemolytic streptococcal infection Springtime (allergic conjunctivitis)
Bacterial Conjunctivitis: Main symptoms
- Red eye
- Eyelids stuck together
- Minimal pain
- Purulent discharge
Bacterial Conjunctivitis: On examination
- Red eye
- Purulent discharge
- Conjunctival papillae
Bacterial Conjunctivitis: Cause
- Staphylococcal aureus
- staphylococcal epidermidis
- streptococcus pneumoniae.
Bacterial Conjunctivitis: Management
via broad spectrum topical antibiotics such as chloramphenicol or fucithalmic acid.
Viral Conjunctivitis: Symptoms
- Red eye
- Watery discharge
- Usually bilateral
- Often preceding coryzal symptoms
Viral Conjunctivitis: On examination
- Red eye
- Watery discharge
- Conjunctival follicles
- Preauricular lymph nodes
- Keratitis (see later)
Viral Conjunctivitis: Usual Organisms
o Adenovirus (different serotypes) o Herpes Simplex Virus (HSV-1)
Viral Conjunctivitis:Treatment
Conservative – spontaneously resolves in approx. 2 weeks
• Lubricants - can be used for comfort
• Antibiotics (chloramphenicol) - to prevent secondary bacterial infection
• Topical Aciclovir (Zovirax) drops - if HSV-1 has been isolated
• Topical steroid drops - should only be used under ophthalmological supervision, and only if the inflammation is very severe.
Viral Conjunctivitis: Contagious
Viral conjunctivitis is extremely contagious and patients should avoid touching their eyes, shaking hands with other people as well as sharing hand towels.
Chlamydial Conjunctivitis → Chlamydia Trachomatis is
An obligate intracellular bacterium with multiple serotypes.
Chlamydial Conjunctivitis →Serotypes:
Serotypes A-C cause Trachoma (a chronic conjunctivitis, endemic to Africa and Asia)
Serotypes D-K cause Adult inclusion conjunctivitis
Chlamydial Conjunctivitis →Adult inclusion conjunctivitis
- Young adults
- Possible concomitant urethral or vaginal symptoms
- Transmission is via autoinoculation from genital secretions, although eye-eye spread may occur
Chlamydial Conjunctivitis →Symptoms
- Unilateral mucopurulent discharge
* The conjunctivitis can become chronic and persist for months if left untreated
Chlamydial Conjunctivitis →Signs
- Large conjunctival follicles
- Preauricular lymphadenopathy
- Subepithelial corneal deposits
Chlamydial Conjunctivitis → Treatment:
- Topical erythromycin ointment - 2 weeks
- Referral to GUM clinic for one of the following systemic antibiotic treatment
- Azithromycin single dose
- Doxycycline
- Erythromycin
- Trace sexual contacts
Allergic Conjunctivitis: Definition
Seasonal allergic rhinoconjunctivitis (allergen most commonly pollen with onset of ‘hayfever’ in summer months)
Perennial allergic rhinoconjunctivitis (allergen such as house dust mite may cause symptoms throughout year)
Allergic Conjunctivitis: Main presenting Symptoms
Rapid onset
Itching
Red eye
Often in children following exposure to an allergen usually pollen
Allergic Conjunctivitis: On Examination
- Usually bilateral
- Conjunctival papillae (GIANT)
- Conjunctival Chemosis (Oedema)
- Preauricular lymphadenopathy
Allergic Conjunctivitis: Treatment
- Topical Antihistamine - e.g: levocabastine
- Topical Mast Cell Stabiliser - e.g: Sodium cromoglycate
- Combination of both antihistamine & mast cell stabiliser - e.g. olopatadine
- Systemic antihistamines
- Topcial steroid use under ophthalmological supervision
Follicles
• Significant diagnostic importance
• Hyperplasia of lymphoid tissue
• Translucent avascular mounds of plasma cells and lymphocytes
• Each follicle is encircled by a small blood vessel
• Main causes include:
o Viral infections including HSV
o Chlamydial infections