Wk 15: Minor eye conditions (Red flags, serious red eye, conjunctivitis) Flashcards
What is subconjunctival haemorrhage?
- Conjunctiva is bright red bc small blood vessels burst
- If not caused by physical injury = harmless
What are the red flag symptoms?
- Mod-severe eye pain
- Marked redness: greater redness, more serious secondary cause
- Ciliary injection: deep vessel engorgement round limbus (bluish discolouration)
- Red visual acuity
- Severe photophobia: unexplained origin
- Injury
What are the types of serious causes of a red eye + what do you do when a patient presents with a serious cause of red eye?
- Acute glaucoma
- Keratitis
- Iritis/uveitis
Refer same day assessment
What is acute glaucoma?
Raised intra-ocular pressure with pain in eye, headache and blurry vision
What are the signs of acute glaucoma?
- Ciliary injection
- Diminished vision
- Hazy cornea
- Fixated dilated pupil
- Eye rock hard + tender
What are the signs of keratitis?
- Ciliary injection
- Corneal ulceration: dendritic if herpes simplex
- Vision affected depending on site of ulcer
What are the signs of iritis?
- Ciliary injection (engorgement of deep vessels round limbus, redness + enlarged blood vessels)
- Pupil fixed + mid-dilated or distorted from previous attacks
What is the conjunctiva?
Thin protective membrane covering white of eye + eyelid
What is conjunctivitis?
- Inflammation of conjunctiva
- Conjunctival blood vessels dilate + eye red
- Bacterial/viral/allergic
What is the difference between primary + secondary conjunctivitis?
- Primary: limited to conjunctiva
- Secondary: wide spread
What is bacterial conjunctivitis caused by?
- Staph a
- Strep pneumoniae
- Gonorrhoea (purulent conjunctivitis)
- Chlamydia (new borns + sexually active)
What is viral conjunctivitis caused by?
Adenovirus - Upper RTI
What are the symptoms of conjunctivitis?
- Eye discomfort: burning, gritty
- Minimal photophobia
- Eyelids stuck: green sticky discharge
- Blurry vision: due to discharge
- History of close contact
What are examples of differential diagnosis of conjunctivitis?
- Irritant conjunctivitis
- Mechanical: foreign body or eyelash rubbing surface
- Chemical: shampoo, chlorine (settles when removed)
What are self care advice you’d give for conjunctivitis?
- Advice it is self limiting
- Wash hands regularly after touching infected secretions
- Avoid towel sharing
- Time off school
- Eye hygeine
- Contact lense not worn til symptoms resolved + treatment completed for 24hrs
What can happen if you continue to use contact lense in conjunctivitis?
Keratitis
What is the antibiotic treatment for conjunctivitis?
Chloramphenicol
What are the CI of chloramphenicol?
- Fx blood dyscrasias
- Pregnant (grey baby syndrome from lack of liver enzymes)
What is the treatment for severe infective conjunctivitis?
- Initiate topical antibiotics if symptoms not resolved w/in 3 days
- POM: fusidic acid 1% eye drops (2nd line)
What is the OTC treatment for conjunctivitis?
Chloramphenicol eye drops (>2 yrs old)
What are the counselling points of OTC chloramphenicol eye drops?
- 1 drop every 2 hrs for 1st 48hrs
- After, QDS upto 5 days
- GP if not improvement after 48hrs or symptoms worsen
- S/e: stinging burning transient, blurring
When is OTC chloramphenicol eye drops CI?
- Hx myelosuppression
- Blood dyscrasias
What are alternative OTC treatments for conjuctivitis?
- Propamidine eye drops
- Dibromopropamidine isethionate eye ointment
How would you counsel a patient on bathing the eyes?
- Warm pre boiled water + cotton
- Eye swabbed once from inside corner to outside edge
- Each pad used once then discarded
- Same pad never for both eyes
- Cotton wool not recommended bc tiny fibres in eye cause irritation + germs grow
- Own flannel
What is allergic conjunctivitis?
- Bilateral itchy eye
- Oedema: cobblestone appearance on inner surface of eyelid
- Associated: eczema, allergic rhinitis or asthma
What are the treatments for allergic conjunctivitis?
Mast cell stabiliser: sodium cromoglycate (opticrom allergy)
How do you use sodium cromoglycate (opticrom allergy)?
Prophylactic 1-2 drops QDS
