Eyes, Ears and Oral Health

Question 1

Minor Ailment

Answer 1

“A condition requiring little or no medical intervention and thus can be treated using non prescription medication bought OTC.”

Question 2

Conjunctivitis

Answer 2

Inflammation of the conjunctiva, the thin protective membrane that covers the white of the eye and inside surface of the eyelids. It is characterised by varying degrees of ocular redness, irritation, itching and discharge. Can be infective or allergic in origin

Question 3

Infective Conjunctivitis

Answer 3

Infective conjunctivitis may be bacterial, viral or parasitic. Seems to affect sexes equally and may present in any age of patient, although bacterial conjunctivitis is more common in children and viral conjunctivitis more common in adults
The most common bacterial causes of conjunctivitis are streptococcus pneumoniae, staphylococcus aureus and haemophilus influenzae.

Question 4

Bacterial Conjunctivitis

Answer 4

Bacterial conjunctivitis is usually self and resolve within 5-7 days without treatment

Question 5

Viral Conjunctivitis

Answer 5

Viral conjunctivitis is self limiting and do not require antimicrobial treatment. Usually resolves in 1-2 weeks

Question 6

Chlamydial Conjunctivitis

Answer 6

Chlamydial conjunctivitis is the least common type of conjunctivitis encountered and is more common in yoinger adults than older people
Usually accompanied by a systemic infection
Urgent referral

Question 7

Bacterial Conjunctivitis Symptoms

Answer 7

• Both, but one eye affected a day or so before the other
  
  • Purulent discharge
  • Gritty feeling
    Generalised and diffuse distribution

Question 8

Viral Conjunctivitis Symptoms

Answer 8

• Both
  
  • Watery discharge
  • Gritty feeling
  • Generalised distribution
    Cough and cold symptoms

Question 9

Allergic Conjunctivitis Symptoms

Answer 9

• Both
  
  • Watery discharge
  • Itching
  • Generalised but greatest in fornices
    Rhinitis

Question 10

Bacterial Conjunctivitis Referral

Answer 10

• Eye or head injury
  
  • Painful eye movements, severe pain within the eye or photophobia
  • Vision is affected
  • Eye surgery or laser treatment in the past 6 months
  • Symptoms get worse despite using chloramphenicol
  • Pupil looks unusual e.g. torn, irregular, dilated or sluggish/ non reactive to light
  • Eye looks cloudy
    Contact lens weare and has worn re usable lenses in the shower or the eye with contact lens in may have come into contact with tapwater

Question 11

Chloramphenicol OTC restrictions

Answer 11

being under 2 years old, pregnancy and breast feeding

Question 12

Conjunctivitis Practical Advice

Answer 12

• Bathe the eyelids with tepid water to remove any discharge
  
  • When cleaning the eye, wipe from the bridge of the nose to the outer corner of the eye with a fresh piece of cotton wool
  • As eye infections are easily passed to others, avoid sharing towels/face cloths etc.
  • Use of OTC lubricant eye drops can reduce discomfort
  • Remove contact lenses until all symptoms and signs of infection have completely resolved and any treatment has been completed for 24 hrs.
    Wash hands regularly

Question 13

Bacterial Conjunctivitis Treatment

Answer 13

Chloramphenicol drops:
Every 2 hrs for first 48hrs and 4 hrly thereafter if symptoms improve
If no improvement is seen after 2 days referral is appropriate

Ointment:
3-4 times daily
Store in fridge and use for 5 days even if symptoms clear

Question 14

Allergic Conjunctivitis advice

Answer 14

• Remove contact lenses until symptoms resolve
  
  • Avoid rubbing their eyes
  • Avoid exposure to the allergen
    Place cool compress on the eyes

Question 15

Allergic Conjunctivitis Treatment

Answer 15

• Topical antihistamines
  mast cell stabilisers- sodium cromoglicate 1-2 drops qds

Question 16

Chronic Dry Eye Symptoms

Answer 16

dryness, grittiness or soreness in both eyes that worsen throughout the day and watering of the eyes particularly when exposed to wind

Question 17

Dry Eye Red Flag Symptoms

Answer 17

• Associated dryness of the mouth and other mucous membranes
  Outward turning of the lower eyelid (ectropion)

Question 18

Dry Eye Practical Advice

Answer 18

• Eyelid hygiene to control the blepharitis that most people with dry eye disease have
  
  • Limiting the use of contact lenses if these cause irritation
  • Stopping medication that exacerbates dry eyes- under the guidance of a prescriber
  • Using a humidifier to moisten the air
  • Stopping smoking
    If using a monitor, ensure it is below eye level

Question 19

Dry Eye eyelid hygiene

Answer 19

• Apply warm compresses to the closed eyelids for 5-10 mins
  
  • For posterior blepharitis, massage the eyelid to express meibomian glands
  • Clean the eyelid- wet a cotton bud with cleanser and rub along lid margins
    Avoid eye makeup

Question 20

Dry eye treatment

Answer 20

• Low viscosity drops are usually recommended for daytime use due to the reduced risk of adverse effects such as blurred vision, eyelid debris, and eye stinging
  
  • Hypromellose
  • Carbomers
  • Sodium hyaluronate
    Preservative free preparations for chronic use

Question 21

Ear Wax

Answer 21

More common in men than women and particularly common in the elderly and people with intellectual impairment

Question 22

Ear Wax practical advice

Answer 22

Advise people against inserting anything in the ear.

Question 23

Ear Wax Treatment

Answer 23

• Olive oil
  
  • Almond (careful with nut allergies)
  • Sodium bicarbonate- may dry out ear canal
    Drops are used 3-4 times daily for 3-5 days initially

Question 24

Ear Wax red flag symptoms

Answer 24

• Dizziness/tinnitus
  
  • Pain from middle ear
  • Fever in children
  • Deafness
  • OTC treatment failure
    Suspected foreign body

Question 25

Otitis Externa

Answer 25

Inflammation of the external auditory canal. The acute form is usually caused by bacterial infection but it may also be fungal or viral. The chronic form is eczematous and may be atopic or a contact dermatitis. The symptoms of acute otitis externa include ear pain, itch, discharge and hearing loss.

Question 26

Otitis Externa Practical Advice

Answer 26

* Avoid damage to ear canal Keep ears clean and dry by using ear plugs when swimming and a hair dryer at lowest heat to dry the ear canal after bathing etc. abstain from water sports for 7-10 days.

Question 27

Otitis Media

Answer 27

* Reassure that antibiotics aren't usually needed because they make little difference to symptoms and can cause adverse effects e.g. D&V * Prescribing antibiotic appropriate if: - Bilateral AOM in children under 2 yrs AOM in children and young people with otorrhoea

Question 28

Glue Ear

Answer 28

hearing loss often with no other symptoms. Often a relationship between recurrent ear infection and glue ear

Question 29

Ear Red Flags

Answer 29

* Generalised inflammation of the pinna * Impaired hearing in children * Mucopurulent discharge * Pain on palpitation of the mastoid area * Patients showing signs of systemic infection * Slow growing growths on the pinna in elderly people Symptoms that are not improving and have been present for 4 or more days

Question 30

Aphthous Ulcers

Answer 30

Painful clearly defined round or ovoid shallow ulcers that are confined to the mouth and are not associated with systemic disease. They generally occur on mucosal surfaces such as the inside of the lips, the inside of the cheeks, the floor of the mouth or the under surface of the tongue

Question 31

Describe minor aphthous ulcers

Answer 31

Most common and are typically 2-4mm in diameter. Heal in 7-10 days

Question 32

Describe major aphthous ulcers

Answer 32

Deeper and larger than minor ulcers and have a raised, irregular border. They are often 1 cm or more in diameter. They heal slowly over several weeks and often lead to scarring

Question 33

Describe Herpetiform

Answer 33

Uncommon Present as multiple pin head sized ulcers that increase in size and coalesce to leave large areas of ulceration. Usually extremely painful and can involve any oral site. They heal in 10 days or longer

Question 34

Things to consider with ulcers

Answer 34

Ulcers are more common in women than men Uncommon in children Can be caused by damage to the mouth e.g. biting, brushing

Question 35

Ulcers Red flags

Answer 35

* Ulcer lasting more than 2 weeks- urgent referral to exclude oral cancer * Diameter greater than 10 mm * Children under 10 * Painless ulcer * Eye involvement * Systemic symptoms * Crops of 5 or more Unexplained red or white patches that are painful, swollen or bleeding

Question 36

Ulcer practical advice

Answer 36

* Avoid trigger factors including oral trauma and certain foods and drinks * Toothpaste containing SLS Any people with local trauma from broken teeth, dentures or orthodontic appliances should see a dentist

Question 37

Ulcer treatment

Answer 37

* Symptomatic treatment for pain discomfort and swelling, especially when ulcers cause problems eating * Hydrocortisone sodium succinate 2.5mg oromucosal tablets for adults and children over 12 yrs of age. One should be allowed to slowly dissolve in the mouth in contact with the ulcer four times a day for up to 5 days * Chlorhexidine mouthwash to prevent secondary infection Topical analgesic- benzydamine hydrochloride every 1.5-3 hrs as required

Question 38

Dry Mouth causes

Answer 38

Drugs with antimuscarinic side effects Diuretics Irradiation of the head and neck region Damage or disease of the salivary glands

Question 39

Dry mouth practical advice

Answer 39

Frequent sips of cold unsweetened drinks Sugar free pastilles Chewing sugar free gum

Question 40

what is oral candidiasis

Answer 40

Fungal infection of the oral mucosa most commonly caused by candida albicans

Question 41

who is more likely to have oral thrush

Answer 41

Most common in neonates, elderly people, people who are immunocompromised and people with xerostomia

Question 42

what is erythematous oral candidiasis

Answer 42

Presents with marked soreness and erythema, particularly on the palate and dorsum of the tongue. Usually asymptomatic or is accompanied by a mild burning sensation Commonly occurs after treatment with oral antibiotics

Question 43

what is Hyperplastic oral candidiasis

Answer 43

Plaque like usually chronic

Question 44

Oral thrush classic presentation

Answer 44

Creamy white soft elevated patches that can be wiped off revealing underlying erythematous mucosa. Burning or irritation is associated with the infection rather than pain. Patients complain of malaise and lack of appetite.

Question 45

Oral thrush red flags

Answer 45

* Healthy adult with no risk factors * Immunocompromised * Diabetes * >3 weeks * Painless * Don’t improve after treatment for 1 week * <4 months * Widespread infection ALARM

Question 46

Oral thrush treatment

Answer 46

* Daktarin >4 months - 4-24 months 1.25ml applied qds after meals - 2+ 2.5ml qds after meals Continue treatment for a week after symptoms have cleared

Question 47

what is axial cheillitis

Answer 47

Inflammatory condition that occurs in one or both angles of the mouth Can occur at any age but common in people who wear dentures

Question 48

symptoms of axial cheillitis

Answer 48

* Erythema * Painful cracking * Scaling * Bleeding * Ulceration * Slow to heal

Question 49

axial cheillitis practical advice

Answer 49

* Avoid licking lips * Use of paraffin based protective lip balm can help protect the lips If poorly fitting dentures are a suspected cause, a visi t to the dentist should be recommended for re fitting

Question 50

sore throat practical advice

Answer 50

* Generally self limiting * See HCP if no imrovement or worsening * Advice regarding food and drink to avoid exacerbating pain Adequate fluid intake

Question 51

sore throat treatment

Answer 51

* Paracetamol * Ibuprofen

Question 52

sore throat red flags

Answer 52

* Fever pain score of 4 or 5 * Systemically very unwell Difficulty breathing, swallowing, severe pain, drooling

Question 53

Maximum duration for chloramphenicol treatment

Answer 53

Chloramphenicol may be sold OTC for the treatment of bacterial conjunctivitis. The total treatment time for OTC chloramphenicol must not exceed 5 days.