Wk 15: Minor eye conditions (Red flags, serious red eye, conjunctivitis)

Question 1

What is subconjunctival haemorrhage?

Answer 1

• Conjunctiva is bright red bc small blood vessels burst
• If not caused by physical injury = harmless

Question 2

What are the red flag symptoms?

Answer 2

• 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

Question 3

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?

Answer 3

• Acute glaucoma
• Keratitis
• Iritis/uveitis

Refer same day assessment

Question 4

What is acute glaucoma?

Answer 4

Raised intra-ocular pressure with pain in eye, headache and blurry vision

Question 5

What are the signs of acute glaucoma?

Answer 5

• Ciliary injection
• Diminished vision
• Hazy cornea
• Fixated dilated pupil
• Eye rock hard + tender

Question 6

What are the signs of keratitis?

Answer 6

• Ciliary injection
• Corneal ulceration: dendritic if herpes simplex
• Vision affected depending on site of ulcer

Question 7

What are the signs of iritis?

Answer 7

• Ciliary injection (engorgement of deep vessels round limbus, redness + enlarged blood vessels)
• Pupil fixed + mid-dilated or distorted from previous attacks

Question 8

What is the conjunctiva?

Answer 8

Thin protective membrane covering white of eye + eyelid

Question 9

What is conjunctivitis?

Answer 9

• Inflammation of conjunctiva
• Conjunctival blood vessels dilate + eye red
• Bacterial/viral/allergic

Question 10

What is the difference between primary + secondary conjunctivitis?

Answer 10

• Primary: limited to conjunctiva
• Secondary: wide spread

Question 11

What is bacterial conjunctivitis caused by?

Answer 11

• Staph a
• Strep pneumoniae
• Gonorrhoea (purulent conjunctivitis)
• Chlamydia (new borns + sexually active)

Question 12

What is viral conjunctivitis caused by?

Answer 12

Adenovirus - Upper RTI

Question 13

What are the symptoms of conjunctivitis?

Answer 13

• Eye discomfort: burning, gritty
• Minimal photophobia
• Eyelids stuck: green sticky discharge
• Blurry vision: due to discharge
• History of close contact

Question 14

What are examples of differential diagnosis of conjunctivitis?

Answer 14

• Irritant conjunctivitis
• Mechanical: foreign body or eyelash rubbing surface
• Chemical: shampoo, chlorine (settles when removed)

Question 15

What are self care advice you’d give for conjunctivitis?

Answer 15

• 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

Question 16

What can happen if you continue to use contact lense in conjunctivitis?

Answer 16

Keratitis

Question 17

What is the antibiotic treatment for conjunctivitis?

Answer 17

Chloramphenicol

Question 18

What are the CI of chloramphenicol?

Answer 18

• Fx blood dyscrasias
• Pregnant (grey baby syndrome from lack of liver enzymes)

Question 19

What is the treatment for severe infective conjunctivitis?

Answer 19

• Initiate topical antibiotics if symptoms not resolved w/in 3 days
• POM: fusidic acid 1% eye drops (2nd line)

Question 20

What is the OTC treatment for conjunctivitis?

Answer 20

Chloramphenicol eye drops (>2 yrs old)

Question 21

What are the counselling points of OTC chloramphenicol eye drops?

Answer 21

• 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

Question 22

When is OTC chloramphenicol eye drops CI?

Answer 22

• Hx myelosuppression
• Blood dyscrasias

Question 23

What are alternative OTC treatments for conjuctivitis?

Answer 23

• Propamidine eye drops
• Dibromopropamidine isethionate eye ointment

Question 24

How would you counsel a patient on bathing the eyes?

Answer 24

• 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

Question 25

What is allergic conjunctivitis?

Answer 25

• Bilateral itchy eye
• Oedema: cobblestone appearance on inner surface of eyelid
• Associated: eczema, allergic rhinitis or asthma

Question 26

What are the treatments for allergic conjunctivitis?

Answer 26

Mast cell stabiliser: sodium cromoglycate (opticrom allergy)

Question 27

How do you use sodium cromoglycate (opticrom allergy)?

Answer 27

Prophylactic 1-2 drops QDS