Anterior Eye Conditions and Management

Question 1

Summarise what are some potential clinical signs of corneal abrasion?

Answer 1

Lid oedema, conj. hyperaemia, corneal epithelial defects that will stain with fluorescein, visual loss, secondary antierior uveitis

Question 2

Summarise management options for corneal abrasion?

Answer 2

Topical anaesthetic to aid investigation - oxybuprocaine, proxymetacaine. Systemic analgesics for next 24 hours, brufen or paracetamol. Ocular lubricants, If risk of infection, chloramphenicol 0.5% QDS, topical NSAIDs diclofenac.

Question 3

List the types of blepharitis?

Answer 3

Bacterial, seborrhoeic, MGD, demodex

Question 4

Define seborrhoeic blepharits, what causes it to occur?

Answer 4

Caused by disorder of the ciliary sebaceous glands of zeis.

Question 5

List some clinical signs of staphylococcal (bacterial) blepharitis?

Answer 5

Lid margin hyperaemia and swelling, CRUSTING OF LID MARGIN, MISDIRECTION OF LASHES DUE TO CRUST, recurrent styes and chalazia, conj. hyperaemia

Question 6

List some clinical signs of seborrheoic blepharitis?

Answer 6

Oily deposits on base of lashes, lid and conj hyperaemia

Question 7

List some clinical signs of demodex blepharitis

Answer 7

Small cyclindrical dandruffs on base of lashes, lid margin hyperaemia

Question 8

What management may be attempted by an optometrist of blepharitis?

Answer 8

Manage causative agents, lid hygiene and management of other DED, avoid cosmetics and return if sx persist.

Question 9

Describe some of the key signs of trichiasis?

Answer 9

Corneal staining with fluorescein, corneal injection, inflamed lid margin, excessive watering, hypersensitivity and maligned lashes.

Question 10

Describe some management options for trichiasis?

Answer 10

Treat underlying conditions, analgesics to assist with pain, brufen and paracetamol, anaesthetics may be indicated when there is intense pain and sever ecorneal damage, proxymetacaine and oxybuprocaine, if damage to cornea appears to indicate risk of infection, chloramphenicol may be indicated. Ocular lubricants.

Question 11

Describe some signs of bacterial conjunctivits?

Answer 11

red eye, purulent or mucopurulent discharge, chemosis of conjunctiva and decreased VA, eyelid swelling, preauricular adenopathy

Question 12

Describe some signs of viral (non-herpetic) conjunctivitis?

Answer 12

Watery discharge, conjunctival chemosis (may be intense), corneal punctate epitheliopathy

Question 13

Describe some signs of viral (herpetic) conjunctivits?

Answer 13

Eyelid oedema, cutaneous or eyelid margin vesicles, ulcers on bulbar conjunctiva, corneal punctate epitheliopathy, unilateral then bilateral

Question 14

Describe some options for management of conjunctivitis?

Answer 14

Bacterial and non-herpetic viral conjunctivitis are self limiting diseases and should resolve in 2 weeks. Herpetic viral conjunctivits should be treated with topical and oral antivirals to shorten course of disease (acyclovir).

Question 15

Describe pinguecula in appearance, cause and risk factors for occurence.

Answer 15

Yellowing gray nodula on the sclera located nasally or temporally, caused by degeneration of collagen. Risk factors include prolonged sun exposure and increasing age.

Question 16

Describe pterygium in appearance, cause and risk factors?

Answer 16

Wing like encroachment of degenerated tissue into the cornea, risk factors are sun exposure and advanced age.

Question 17

Describe concretion, cause and appearance.

Answer 17

Yellowish deposits on the palpebral conjunctiva, occurs as a sign of chronic MGD or blepharitis.

Question 18

Describe conjunctivochalesis, the cause, appearance and possible symptoms.

Answer 18

These are folds in the conjunctiva caused by age related degenerations, appear as fluorescein stained lines that trace the lid margins, can present with dry eye like sx, treated with lubricants and warm compress to ease sx.

Question 19

Describe microbial keratitis?

Answer 19

Very serious sight threatening bacterial infection of the cornea. Requires urgent referral.

Question 20

Describe some signs of microbial keratitis?

Answer 20

Conjunctival injection, focal white inflitrates, corneal thinning, stromal edema, posterior synechiae, hyphema, glaucoma (secondary acute), anterior chamber reaction

Question 21

Describe marginal keratitis?

Answer 21

This is a bacterial hypersensitivity reaction to staphylococcal bacteria antigens, occurs in the corneal margin. Less severe than microbial keratitis as it is not a true infection, but a response to antigens.

Question 22

Describe some signs of marginal keratitis?

Answer 22

Ulceration of limbal region that stain well with fluorescein, hyperaemia and oedema of adjacent bulbar conjunctiva.

Question 23

Describe management of marginal keratitis?

Answer 23

Ease sx, sunglasses for photophobia, system analgesics, regular lid hygiene, chloramphenicol to reduce bacterial load, steroids if infection not spread over margin, refer if recurrent or persistent

Question 24

Describe acanthomoeba keratitis?

Answer 24

Incredibly resilient and severe protozoal infection of the cornea caused by exposure to unflitered water, or through complications with CL wear post lenses being exposed to water.

Question 25

Describe some early signs of acanthomoeba keratitis infection?

Answer 25

Epithelial or subepithelial infiltrates, pseudodendrites, radial keratoneuritis, recurrent breakdown of corneal epithelium.

Question 26

Describe some late signs of acanthomoeba keratitis?

Answer 26

Deep inflammation of the cornea consisting of central or para central ring-shaped or disciform infiltrates or abscess. Stromal thinning, extension of inflamation into sclera, anterior chamber cells and flare, hypopyon.

Question 27

Describe the management of acanthomoeba keratitis?

Answer 27

IMMEDIATE REFERRAL WITH RETENTION OF CURRENT LENSES AND CASE FOR CULTURE IF POSSIBLE TO CONFIRM DIAGNOSIS.

Question 28

Describe scleritis?

Answer 28

This is inflammation of the sclera caused by various sources. Occurs in the sclera, so is more serious that conjunctivitis.

Question 29

Describe the types of scleritis?

Answer 29

Diffuse scleritis covers the entire sclera, nodular scleritis where the inflammation is contained to a single raised nodule, necrotizing where the scleritis can have an almost quiet presentation until the sclera begins to necrotize. Posterior scleritis which presents as serous retinal detachment, choroidal folds or both.

Question 30

Describe some signs of scleritis?

Answer 30

Diffuse or nodular oedema and hyperaemia, violet blue colouration, associated keratitis and uveitis, bilateral 50% of the time, corneal infiltrates

Question 31

Describe symptoms of scleritis?

Answer 31

Severe pain that builds over a few days, exacerbated by eye movement due to the EOM being inserted into the sclera

Question 32

management of scleritis?

Answer 32

NSAID ar efirst line for mild-moderate, corticosteroids administered systematically, immunomudulatory agents if corticosteroids fail, EMERGENCY SAME DAY REFERRAL

Question 33

Describe anterior uveitis?

Answer 33

This is an inflammation of the uvea, the pigmented layer of the globe. Typically considered to be either idiopathic or autoimmune related. As a result those with autoimmune conditions are at significantly increased risk of developing this condition.

Question 34

Name and differentiate the two forms of anterior uveitis?

Answer 34

Non-granulatomous and granulatomous uveitis. Non-granulatomous is a more chronic condition, with dense mutton fat like keratic precipitates and iris nodules and is more likely associated with systemic autoimmune conditions. Granulatomous typically has acute onset and shows fine KP and is likely idiopathic.

Question 35

Describe some signs of anterior uveitis?

Answer 35

Hyperaemia (circumcorneal injection due to this being next to the angle, which in itself has the uvea contained within next to the trabecular meshwork), KP, aqeous cells and flare, IOP may be raised, posterior synechiae and iris nodules.

Question 36

Describe management of anterior uveitis?

Answer 36

Assess IOP to ensure no glaucoma (>25 mmHg or higher than prevous results), dilated fundus exam to rule out intermediate and posterior uveitis. Topical steroids and topical cycloplegics, if not controlled within 1 week, then refer to HES.

Question 37

Describe episcleritis?

Answer 37

Recurrent inflammation of the episclera, relatively common condition most commonly affecting younger adults. Mostly idiopathic. Can be associated with systemic diseases.

Question 38

Signs of episcleritis?

Answer 38

Hyperemia (diffuse or sectoral), BV will blanch when phenylephrine (adrenergic agonist) is instilled as this trigger vasoconstriction of more superficial vessels.

Question 39

Describe managment of episcleritis?

Answer 39

Self limiting condition that should resolve in 1-2 weeks, sterile so no need to worry about passing on. manage sx with cold compress and ocular lubricants, if frequently recurrent, refer for evaluation of systemic auto immune conditions.