Patients should be referred to GP/Optom if experiencing any of these symptoms? (7)
- Pain
- Vision affected
- Photophobia
- Marked redness
- Conjunctivitis symptoms persist longer than 1 week or recurrent
- No improvement after 48 hours with treatment
- Children under 2
What is conjunctivitis and its symptoms (5)?
Inflammation of the conjunctiva (membrane covering the white part of the eye (sclera) and inside the eyelids)
can be allergic/infection/irritation
Main features:
- eye redness (due to dilation of blood vessels
- discharge (sticky in bacterial and watery in viral)
- NOT painful
- gritty sensation
- usually affects both eyes
Management of bacterial / viral / allergic conjunctivitis ?
Self-limiting - watchful waiting 2 -5 days
Gentle cleaning of outside of the eye regardless of whether treatment is given or not
Abx - for bacterial
Adults & child 2 years +
Chloramphenicol eye drops 0.5% every 2 hours for 24 hours then QDS
OR
Chloramphenicol 1% ointment
5 days treatment - should be continued for 48 hours after resolution of symptoms
Infective conjunctivitis:
wash hands regularly
don’t share towels/pillows
contact lenses shouldn’t be worn until cleared and after 24hour clear
Allergic
due to hay fever? check for other symptoms e.g. runny nose, sneezing, nasal blockage
Oral antihistamines and nasal corticosteroids
Topical antihistamines e.g. Otrivine-antisin contians anatazoline and xylometazoline (vasoconstrictor to relieve redness) - not for prolonged use
What can happen if contact lenses are worn with bacterial conjunctivitis?
ulceration of the eye
What if there is prolonged exposure to allergens. Can antihistamines be used long term for allergic conjunctivitis?
No inappropriate
Switch to mast cell stabiliser eye drops such as:
Sodium cromoglicate (Opticrom 6+ ) 2%, not suitable for under 2 years old (use QDS)
Or
Lodoxamide 0.1 %- should not be used in under 4 years old
How do mast cell stabiliser eye drops work?
They prevent the release of histamine and other inflammatory mediators from the mast cells
What is blepharitis? and its symptoms (3)?
Inflammation of he margin of the eyelid
Itchy, stinging and sticky eye
tends to be confused with conjunctivitis.
Chronic condition with an underlying chronic infection
Management of blepharitis?
Good eyelid hygiene - soaking closed eye with warm cotton/wool pad
Avoiding eye make up
Confirmation of diagnosis and initiation of treatment best done by optom/GP
What is subconjunctival haemorrhage?
When to refer?
Small red bleed behind the membrane layer of the conjunctiva - can look alarming
No discomfort - usually harmless
Clears within 1 -2 weeks
Only reason to refer - if suspected high blood pressure or any unexplained bleeding /bruising elsewhere
What is corneal ulcers and keratitis ?
Corneal ulcers may be due to infection or traumatic abrasion - main symptom - PAIN = REFER
Keratitis - inflammation of cornea often with infection
unilateral, painful red eye, photophobia = REFER
What is acanthamoeba keratitis associated with ?
Soft contact lenses wearers - poor hygiene, extended wear, swimming with lenses
What is Uveitis (iritis)? & symptoms
Inflammation of the iris and surrounding cilia body
can occur in association with some forms of arthritis and tuberculosis
Deep eye pain, blurring of vision and photophobia = REFER -
What are the two types of glaucoma and their differences?
- Acute closed-angle glaucoma - sudden onset, painful red eye
iris fold over & block the drainage from the eye.
Pressure builds up rapidly, cornea swells and becomes hazy/impaired vision/halo - Chronic open angle glaucoma - more common type that affects 2% of people aged over 40 years
starts slowly and without warning symptoms
optic nerve slowly damaged - loss of peripheral visual fields and blindness if not treated
What are the symptoms (6) of Acute closed-angle glaucoma and in which patient groups (3) is it more common in?
- Sudden onset of headache
- Nausea
- Vomiting
- Pupil becomes fixed - eye hard and tender
- Vision impaired
- Halo around lights
- Asian
- Women
- Older people
REFER TO HOSPITAL
Soft contact lenses should not be worn with which preservative ? Why?
Benzalkonium chloride
Irritation and inflammation
Patients with which chronic condition are more likely to experience dry eye? (3)
- Thyroid
- Diabetes
- Rheumatoid arthritis
Symptoms of dry eyes (keratoconjunctivitis sicca)? (4)
- Irritated/gritty feeling
- Burning
- Watering
- Blurred vision especially first when they wake up
Which medications can affect the quantity/composition of dry eyes? (7)
- Antihistamines
- Beta-blockers
- Diuretics
- HRT
- Oral contraceptives
- SSRIs
- Tricyclic antidepressants
Management of dry eyes?
- Lubricant eye preparations
- Replenish the oily layer - reduce evaporation of tears
Mild/Moderate symptoms - artificial tears alone usually sufficient
- Hypromellose (req. freq. administration - 60 mins intervals)
- Carbomers
- Sodium chloride (Saline) - short acting and suitable as comfort drops or with contact lenses
What bacteria is usually responsible for infection in a stye?
Staphylococcus aureus
Pregnant/breastfeeding woman asks for OTC chloramphenicol?
Not suitable - refer to GP
What other OTC preparations are available for conjunctivitis and what do they contain /work against which bacteria?
Brolene
Golden Eye
contain propamidine isethionate
antibacterial and fungicidal activity
against Staphylococcus aureus, streptococcus pygoenes
With ear enquires - when should referral be made? (4)
- Severe pain
- Persisting 3 or more days
- Presence of foreign body
- Glue ear (middle ear becomes filled with fluid that looks like glue)
Treatment options for ear wax?
- First line product for impacted ear wax that soften ear wax
e. g. Otex, Exterol (urea-hydrogen peroxide) - Sodium chloride 0.9%
- Sodium bicarbonate (can cause dryness in ear canal)
- Olive/Almond oil (nut allergy?)
