D&M Eyes

Question 1

Allergic eyes – 4

Answer 1

1. Watery
2. Itching/gritty pain
3. Generalised redness, greatest in fornices
4. Rhinitis possible

Question 2

Referral symptoms - 10

Answer 2

1. Eye pain
2. Limbal redness
3. Clouding of cornea
4. Suspected herpes infection
5. Altered vision – including loss vision and general changes/field of vision
6. Irregular shaped pupil
7. Photophobia
8. Foreign body
9. Contact Lense infection – risk of corneal involvement
10. Neonate with sticky eye

Question 3

Subconjunctival haemorrhage - 5

Answer 3

1. Blood vessel rupture causes subconjunctival haemorrhage.
2. Segment of eye may appear red
3. Can occur spontaneously but can also be precipitated by coughing, straining or lifting.
4. No pain
5. Resolves in fortnight, but if history of trauma then make referral

Question 4

Red eye Referral - 8

Answer 4

1. Keratitis (corneal trauma – pain, blurry vision)
2. Uveitis (very red eyes)
3. Glaucoma (pale eyes, painful)
4. Scleritis (Bloodshot iris)
5. Herpes Zoster (red patches around eye)
6. Entropion (Inversion of eyelid, pushes eyelashes into eye)
7. Orbital cellulitis (Swollen eyelids, inflammation of skin around eye)
8. Basal cell carcinoma - Nodular reddish lesion, possible cancer

Question 5

Conjunctivitis management - 4

Answer 5

1. Most cases are self-limiting & will resolve within 5-7 days
2. Self help methods preferred, unless severe symptoms or last longer than 3 days/rapid resolution is needed
3. Consider if the patient is an infant/child & there are implications for childcare – many nurseries & schools have exclusion criteria despite NICE recommending the opposite
4. Distinguishing between bacterial & viral infections is not possible in the community pharmacy

Question 6

Management of conjunctivitis – bacterial (crusty eyes) – 5

Answer 6

1. Bathe eyelids with lukewarm water or saline to remove any discharge
2. Use tissues to wipe the eyes then discard
3. Avoid contact lenses till symptoms have cleared
4. Wash hands, avoid sharing towels, good hygiene etc.
5. Chloramphenicol - Drops & ointment for over 2yrs. Avoid in pregnancy or breastfeeding or history of blood bone marrow problems. Store in the fridge.

Question 7

Management of conjunctivitis – allergic (crusty, gritty, watery) – 3

Answer 7

1. Allergen avoidance, cold compress, avoid eye rubbing, consider artificial tears
2. Opticrom allergy - Must be used continuously when exposed to the allergen. One to two drops in each eye four times daily.
3. Antihistamine combination (Otrivine Antistin): Reduces redness – does not treat underlying pathology. Short term use only to prevent rebound effects. Avoid in patients with glaucoma

Question 8

Management - styes (swollen eyelids, possible conjunctivitis, painful to touch) -5

Answer 8

1. Styes are self limiting & should resolve once the stye has ruptured
2. Topical antibacterial agents will not speed up healing – might be needed if conjunctivitis is present
3. Warm compress application for 5-10 minutes, 2-4 times daily will bring stye to a head quicker
4. Referral only needed if symptoms don’t resolve or are severe/get worse/large internal stye
5. Don’t recommend picking or squeezing

Question 9

Management – blepharitis (itching burning ks==skin, skin flakes, missing lashes, possible conjunctivitis) - 6

Answer 9

1. Blepharitis – chronic & intermittent condition which can be managed by self care measures
2. Advise good eyelid hygiene. Clean the eyelids in a stepwise manner twice daily, then reduce to once daily as symptoms improve
3. Apply a warm compress to the closed eyelids for 5–10 minutes once or twice daily
4. Baby shampoo diluted 1:10 with warm water & wiped on eye lids with cotton bud or cloth twice daily, reducing to once daily. There are proprietary lid cleaning wipes/preparations available.
5. Treat any dry eyes as needed
6. Refer if no improvement in 7-14 days or it worsens.

Question 10

Ectropion - 3

Answer 10

1. Eye lid turns outwards facing the atmosphere (Opposite of entropion)
2. Patients will often present with a continually watering eye.
3. This can then lead to a dry eye which then result in artificial tears being needed.

Question 11

Dry eyes - 4

Answer 11

1. Reduced tear volume or alteration in tear composition causes dry eyes
2. Reduced tear production & increased tear drainage are both factors
3. Likely cause - related to ageing
4. Symptoms: Burning eyes, tired eyes, itching, irritated or gritty, lack of ocular redness, long standing history of symptoms

Question 12

OTC prescribing for dry eyes – 3

Answer 12

OTC prescribing for dry eyes – 3
1. Hypromellose, polyvinyl alcohol, carmellose, carbomer, sodium hyaluronate & wool fats
2. Hypromellose is considered first line
3. Carbomer is more expensive, but has better wetting characteristics so used less often