What questions should be asked regarding the eye?
- Is vision affected
- Any family history of eye complaints e.g glaucoma
- Severity and type of discomfort if any (itchy treat or STABBING REFER)
- Ask about discharge (EXAMIN EYE)
- Previous eye history - contacts, had issues before
- Anything in the eye
What are the steps in an eye examination?
- Inform about examination
- Gain consent
- Wash hands
- Sit down and look straight ahead
- Pull down lower lid and ask to look up, down, left, right (foreign objects?)
- Check reaction to light and pupil size and shape
- Check visual acuity by getting to read small print
- Both eyes
- Wash hands
On inspection, a patients eye had thick, purulent discharge and generalised redness.
They say it feels gritty.
They have no other symptoms.
What is the likely cause?
- Bacterial conjunctivitis
- Thick purulent discharge
- Gritty feeling
- No other symptoms
- Generalised and diffused redness
One eye usually affected before other
What are the red flag/referral symptoms that could come with conjunctivitis?
- Clouding of cornea (black of eye)
- Distortion of vision
- Irregular shape pupil
- Photophobia
- Foreign body
- Contact lenses (can’t use chloramphenicol)
- Vomiting
- ## True eye pain
What are the symptoms of allergic conjunctivitis?
What treatment can be suggested?
- Watery discharge
- Itchy sensation
- Generalised redness but greatest in fornices
- Associated rhinitis (nasal inflamm)
- SEASONAL
- ANIMALS?
- Do you suffer from hay fever?
- OPTICROM dye drops
- Wrap around sunglasses
- Hayfever measures
What are the symptoms of viral conjunctivitis?
- Watery discharge
- Generalised redness
- Associated cough and cold
How long should Chloramphenicol drops/ointment be used for?
When should drops/ointment be used
Any other advice?
- 5 days minimum
- Drops daytime, ointment at night as thicker
- Keep in the fridge when not using
- Dispose of drops after treatment
A patient presents with dry, gritty eyes.
What should you do?
- Ask how long been suffering
- Ask to take a look
- Ask if anything known might be causing issue (something in eye, air conditioning, staring at screen)
- Ask if any other medical conditions e.g sjogrens, bells palsy
- Ask if dry secretions in mouth too? SJOGRENS
- Ask if taking other meds e.g TCA’s dry secretions
- ASK AGE - sometimes older = eyes dry
- Ask if taken anything before?
- Contact lenses user?
- Suggest drops
- Use PRN
- Can use thicker Carbomer 940/geltears - night
A patient comes into your pharmacy really concerned about their eye.
They felt a pop like feeling and now their eye is extremely red and appears to be bleeding
What should you do?
- Examine the eye
- Ensure redness is not on the iris
- Check to see if they are on any medication
- If on Warfarin then refer
- Say that it is nothing to worry about it no other symptoms
- If it doesn’t get better within a week then see optometrist
A patient comes into your pharmacy with a spider like redness on their eye
What should you do?
- Examine the eye
- Ask if any other symptoms e.g pain, photophobia, loss of visual acuity, watery discharge RULE OUT SCLERITIS
- If no then could be episcleritis
- Advise that this should resolve but if gets worse or no better within a week then see optometrist
What is keratitis?
What should happen if a patient is suspected of having it?
- Inflammation of the cornea as a result of trauma
- Long term steroid eye drops/contact lenses
- Redness around iris
- Painful
- Watery discharge
- Photophobia
- Open lesion on eye
- REFER THIS
On examination, a patients pupil appears jagged.
They also have photophobia, watery discharge and redness of the eye.
What do you suggest?
- Could be uveitis
- Caused by inflammation of uveal tract
- Refer to optometrist to rule it out
What are the symptoms of glaucoma?
What should happen if a patient is suspected of having it?
- Cloudy pupil
- Pain
- Loss of vision
- Vomiting
- Family history
- Elderly
- Loss of visual acuity
- INCREASED OCULAR PRESSURE AND INC IN AQ HUMOUR
REFER TO A AND E!
A patient comes in with a swollen upper eye lid.
It is painful to touch
It is only affecting one eye
What do you recommend?
- On inspection it looks like a stye
- They are self limiting and will go away with time
- No OTC products will help
- Can recommend a warm compress to be applied 3-4 times daily to bring the stye to a head
- DO NOT TRY AND POP A STYE
- If it gets worse or persists and you are concerned then see you optometrist
A patient presents with eyelids that are irritated, itching and they say they are burning.
- The skin around the eyelashes is flaking and some lashes are missing
What do you advise?
- Check for referral symptoms
- Have they had it before?
- Sounds like blepharitis
- No OTC products are especially helpful
- Suggest using a mild baby shampoo diluted in recently boiled and cooled water on cotton wool balls to bathe the eyelids and to moisturise the flaky areas
- Apply a warm compress a few times a day to soothe the itching
- AVOID MAKE UP
- See optometrist if the problem does not improve within a week or begins to worsen
A patient comes into the pharmacy with a large swollen area on their eyelid
- They say that it is not causing them any issues but they are concerned about it
What should you do?
- Advise that it may be Chalazion
- They are known to be self limiting and no action is usually taken if it is not causing any issues
- If it begins to cause issues e.g impairing vision or causing pain then see optometrist
A patient presents with an eye lid that is folding inwards.
What do you suggest?
- This is a case of entropion
- The eyelashes may start to scratch against the cornea which can be uncomfortable
- Referral to optometrist is needed
A patient presents with an eye lid that is folding outwards.
What do you suggest?
- This is a case of ectropion
- Can cause dry eyes as the blink reflex may be affected
- Referral to optometrist is needed
A patient comes into the pharmacy with an extremely swollen eye area.
Their eye is red, hot, sore and extremely inflamed
What do you suggest?
- This might be a case of orbital cellulitis
- Infection causing inflammation
- Seek advice from an optometrist
A patient has come in to purchase some Carbomer 90 eye drops. She is also using eye drops for glaucoma. What do you say to her?
- Advise to wait 5 mins between administration of each different eye drop
How do you examine the inner ear?
1) Gain consent
2) Wash hands
3) Ask patient to sit down and face ahead
4) Observe ear
5) Inspect external ear for redness, swelling and discharge
6) Apply pressure to the mastoid area
7) Move pinna up and down and manipulate tragus
8) Wash hands
A patient comes into the pharmacy complaining of an issue with his ear.
- It feels ‘full’, uncomfortable and he has slight hearing loss
What do you say to him?
What else should you advise?
- Sounds like a case of ear wax compaction
- Arises when ear wax builds up in the ear
- Check that no dizziness or tinnitus
- Check no foreign bodies
- Check no pain from inner ear
- Suggest oil based ear drops to soften wax and aid removal
- Can use Otex ear drops that fizz and pop in the ear to dispel wax
DO NOT INSERT BUDS INTO EARS
Otitis externa is what?
How is it treated?
- Also known as swimmers ear
- Generalised inflammation of ear canal
- Common in those with exposure to water can be shampoo irritating
- Irritation, pain, discharge, hearing loss, redness
- Analgesics for pain e.g para or ibu
- Acetic acid 2% (ear calm spray) if itching or discomfort OVER 12 YEARS
What are general referral symptoms for the ear?
- Pain in children under 6 years
- Inflammation of the pinna (perichondritis)
- Symptoms last more than 7 days
- Hearing loss in children
- Discharge from ear
- Pain on palpitation of mastoid
- Growths on pinna of elderly
