Eye OTC

Question 1

what are some classifications of common eye presentations?

Answer 1

• Painful eye
• Inflammatory Conditions
• Drainage or Tear formation
  abnormalities
• Eye disorders with systemic illness
• Foreign Body present

Question 2

what is subconjunctival haemorrhage?

Answer 2

Part of the conjunctiva covering the white of the eye appears bright red because a small blood vessel has burst

Question 3

how should you help someone with subconjunctival haemorrhage?

Answer 3

If the only symptom, and not caused by physical
injury is considered harmless
* However the patient may be very concerned →
reassure

Question 4

what are general eye red flag symptoms?

Answer 4

Moderate to severe eye pain: secondary cause must be excluded
Marked redness of the eye: the greater the redness, the more likely it is that there is a serious secondary cause.
Ciliary injection: engorgement of the deep vessels around the limbus, giving the eye a bluish discolouration
Reduced visual acuity: any loss of visual acuity, may indicate a secondary cause
Severe Photophobia: Of unexplained origin

Question 5

what would be a serious cause of a red eye?

Answer 5

acute glaucoma
keratitis
iritis/ uveitis

Question 6

what is acute glaucoma?

Answer 6

Raised intra-occular pressure with pain in the eye, headache and blurring of vision

Question 7

what are the signs of acute glaucoma?

Answer 7

Ciliary injection
o Diminished vision
o Hazy cornea
o Fixed dilated pupil
o Eye is rock hard and tender

Question 8

what is keratitis?

Answer 8

(corneal ulcer) presents: pain unilateral,
photophobic and injected eye

Question 9

what are the signs of keratitis?

Answer 9

o Ciliary injection.
o Corneal ulceration: dendritic (latin ‘many
fingered’) if herpes simplex.
o Vision may be affected, depending on the site of the ulcer.

Question 10

what is iritis?

Answer 10

(uveitis –inflammation of the iris) typically
presents with pain, watering of the eye and
headache may be present

Question 11

what are the signs of iritis?

Answer 11

o Ciliary injection (engorgement of the deep vessels around the limbus, indicated by redness and enlarged blood vessels) may be the only sign
o The pupil may be fixed and mid-dilated or
distorted from previous attacks

Question 12

what is conjunctivitis?

Answer 12

Conjunctivitis is inflammation of the conjunctiva:
-conjunctival blood vessels dilate and the eye appears red.
* Can be bacterial or viral infection or allergic response

Question 13

what are the different types of conjunctivitis?

Answer 13

primary conjunctivitis –Inflammation limited to the conjunctiva
* secondary conjunctivitis - widespread affecting other parts of the eye

Question 14

what is bacterial conjunctivitis caused by?

Answer 14

 Staphylococcus species
 Streptococcus pneumoniae
 Moraxella catarrhalis
 Gonorrhoea very rare, purulent conjunctivitis

Question 15

what is viral conjunctivitis associated with?

Answer 15

2. Viral conjunctivitis is associated with upper RTI -usually caused by adenovirus

Question 16

what is a rarer type of conjunctivitis that can present?

Answer 16

Chlamydia (rare) presents with a chronic
conjunctivitis in newborns and people who are
sexually active

Question 17

what are the symptoms of conjunctivitis?

Answer 17

Eye discomfort –burning, gritty –minimal pain
Minimal photophobia - Rarely present
Eyelids stuck –Green/yellow sticky discharge
Blurring of vision –due to discharge
History of close contact - with affected person increases the likelihood of an infective cause

Question 18

what would be the differential diagnosis for conjunctivitis?

Answer 18

• Irritant conjunctivitis
• Mechanical causes of conjunctivitis
  eg. eyelashes rubbing surface of the eye
  eg. foreign body lodged beneath the upper eyelid

Question 19

would you give antibiotics for conjunctivitis?

Answer 19

bacterial- self limiting- not much benefit

Question 20

what antibiotics are available for conjunctivitis?

Answer 20

Chloramphenicol - broad spectrum of action - little evidence of bacterial resistance –although this is a growing concern.

Question 21

who is chloramphenicol not recommended for?

Answer 21

people with a personal or family history
of blood dyscrasias, or women who are pregnant

Question 22

what is the risk with chloramphenicol in pregnant women?

Answer 22

there is a theoretical risk of grey baby syndrome (chloramphenicol toxicity in
newborns from the lack of liver enzymes necessary to metabolise the drug)

Question 23

how should chlormhenicol eye drops be given?

Answer 23

• Apply one drop to eye every two hours for first 48 hours
• Thereafter QDS for up to 5 days

Question 24

when should you see GP when chlormenicol doesnt work?

Answer 24

48 hours if no improvement
or immediately if symptoms worsen

Question 25

what are alternative treatments to chlormephenicol?

Answer 25

* Propamidine eye drops (Golden Eye) * Dibromopropamidine iserionate eye ointment (Golden Eye) * Evidence for use –weak * Eye hygiene may be just as effective

Question 26

how should you bathe eyes?

Answer 26

Using warm, not hot, preboiled water and cotton or gauze pads. * Each eye should be swabbed once from the inside corner to the outside edge, using each pad once then discarding. * The same pad should never be used for both eyes. * The use of cotton wool is not recommended as the tiny fibres can get into the eye and cause irritation and a place for germs to grow. * Every individual should have their own flannel and towel, which should be washed regularly and never shared.

Question 27

what are the signs of allergic conjunctivitis?

Answer 27

* Bilateral itchy eyes * Oedema: cobblestone appearance on inner surface of the eyelids * Associated with other atopic/allergic conditions: eczema, allergic rhinitis, or asthma

Question 28

what do sympathomimetics do?

Answer 28

constrict blood vessels in the eye * DI - Care with MAOIs because of risk of hypertensive crisis.

Question 29

how do you treat bloodshot eyes?

Answer 29

Naphazoline 0.01% (Optrex Bloodshot Eye Drops) adults and children >12 * Reduce redness only for short term use * use 3-7 days at most because of rebound effects.

Question 30

who should you avoid sympathomimetics in?

Answer 30

galucoma

Question 31

what are the 3 main eyelid disorders?

Answer 31

* Stye (usually one eye) should resolve spontaneously within 2-3 days * Blepharitis (usually both eyes) inflammation of the lid margins * Meibomian cyst hard painless lump under the eyelid should resolve spontaneously

Question 32

what is blepharitis?

Answer 32

Inflammation of the margin of the eyelid. Usually a chronic condition that is typically bilateral

Question 33

what are the causes of blepharitis?

Answer 33

Several causes, characterised by overlapping symptoms and signs.

Question 34

how do you classify blepharitis?

Answer 34

▪ base of the lashes (anterior blepharitis) ▪ meibomian glands (posterior blepharitis).

Question 35

how do you classify blepharitis by clinical symptoms?

Answer 35

Staphylococcal blepharitis affects the anterior eyelid margin : lash collarettes crusting, lid ulceration, folliculitis. * Seborrhoeic blepharitis affects the anterior eyelid margin * caused by excessive sebum, associated with seborrhoeic dermatitis involving other areas. * Meibomian gland dysfunction posterior eyelid margin - often associated with seborrhoeic dermatitis and/or rosacea.

Question 36

what are the symptoms of blephiritis?

Answer 36

Often intermittent and usually bilateral: * Sore eyelids most common symptom * Eyes may feel 'gritty' * Symptoms of dry eye include blurred vision and contact lens intolerance * Eyelids sticking together, particularly in the morning, suggests infection

Question 37

what are the signs of blephritis?

Answer 37

* Swollen eyelids are the defining sign of staphylococcal blepharitis and meibomitis, but are unusual in the less severe types of blepharitis. * Inflamed lid margins are usually present * Altered eyelash appearances: misdirection, crusting and eyelash loss * Eyelid surfaces may be scaly, oily or greasy. * Styes are much more common in people with blepharitis * Inflamed conjunctiva common complication of blepharitis

Question 38

how would you council a patient on blepharitis?

Answer 38

* Blepharitis is a chronic condition * Symptoms can frequently be improved, but condition may not cure permanently. * Compliance with the recommended treatment is important, particularly lid hygiene. * Contact lenses should not be worn during any eye infection

Question 39

when do you refer blephritis to GP?

Answer 39

* underlying conditions causing or exacerbating the blepharitis eg...... * Rosacea (meibomian gland dysfunction) * Seborrhoeic dermatitis (seborrhoeic blepharitis) * Atopic eczema (staphylococcal blepharitis)

Question 40

what is involved in eyelid hygiene?

Answer 40

* Warm compresses to the eyelids loosen the crusts, making cleaning more effective and comfortable applied to the closed eyelids for 5-10 minutes. * Lid massage expresses the contents of the meibomian glands.

Question 41

what is dry eye syndrome?

Answer 41

A disorder of the tear film due to tear deficiency or excessive evaporation * Causes damage to the ocular surface, and is associated with symptoms of discomfort. * Syndrome aggravated by dry air, wind, dust, and smoke

Question 42

what is the pathogenesis of dry eye syndrome?

Answer 42

* The ocular surface, tear-secreting glands, meibomian glands, and lids function as an integrated unit to secrete and clear tears * Dysfunction of any component results in an unstable and unrefreshed tear film that causes the set of symptoms called dry eye syndrome.

Question 43

what are tears composed of?

Answer 43

Tears are a complex mixture of water, lipids, salts, mucins, immunoglobulins, antimicrobial proteins, and growth factors

Question 44

what is the structure of tears?

Answer 44

* Inner layer of mucins adheres to corneal epithelium * Middle layer is an aqueous/mucin phase * Outer layer of lipids

Question 45

what are tears produced by?

Answer 45

* Lacrimal glands, ocular surface epithelium, and conjunctival goblet cells (secrete hydrated mucous gel of inner and middle layers) * Meibomian glands (produce outer lipid layer)

Question 46

what are the symptoms of dry eye syndrome?

Answer 46

* Both eyes are usually affected * Sensations are of foreign body, irritation, soreness * Contact lenses are poorly tolerated. * Sufferers may not describe their eyes as feeling 'dry'. * Vision may be transiently affected due to loss of surface moisture * Photophobia is occasionally present

Question 47

what treatment should be given for dry eyes?

Answer 47

Hypromellose 0.3% eye drops

Question 48

when are lubricants best for dry eyes?

Answer 48

Useful at bedtime because it provides prolonged lubrication. may affect sight during the day