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36 Cards in this Set
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Subconjunctival Haemorrage
Signs: Pooled blood in conjunctiva, bright red and obscures sclera Should be able to see border at the limbus Symptoms: Asymptomatic but may have some discomfort or soreness
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Development and Cause of Subconjunctival haemorrhage |
Spontaneous Hypertension/systemic issue Traumatic |
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D.O. Management |
Sporadic: px reassured, prescribed eye drops for discomfort Recurring: Routine referral to GP for systemic disease Traumatic: Emergency referral to hospital |
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Scleritis Signs: Generalised deep inflammation of sclera Diffuse bulbar injection and hyperaemia of scleral tissue Symptoms: Deep intense pain, worse with eye movement Photophobia Potential loss of va if anterior chamber responds |
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Development and cause of scleritis |
Collagen vascular diseases such as rheumatoid arthritis and Herpes zoster Can be infective Can be accompanied by uveitis, glaucoma and cataract Can affect optic nerve and cause retinal detachment if posterior Can be necrotising A gradual progression |
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D.O. management of scleritis |
Emergency referral to hospital There it is treated with steroids. Systemic immuno suppressants Investigation for systemic associations Unsuitable for cl wear |
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Episcleritis Signs: Injection if the episcleral vessels Hyperaemia of superficial layers Can be localised or segmented Slight oedema Symptoms: Acute onset, no effect on vision Irritation and mild burning sensation Minor lacrimation |
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Development and cause of episcleritis |
Inflammation of the vascular connective tissue that lies between sclera and conjunctiva A third of these cases are associated with systemic disorders such as collagen vascular disease |
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D.O. management of episcleritis |
Px reassured, eye drops to ease irritation Self Limiting (7-10 days) Rarely associated with any systemic issues If reoccurring or severe then refer to GP |
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Anterior Uveitis (Iritis) Signs: Inflammation of the iris Limbal (circum-corneal) injection and hyperaemia An anterior response (infiltrates) Iris bombe can form Clover or irregular shaped pupil caused by posterior synechiae In severe cases, hypopyon can form Symptoms: Sudden or insidious If chronic, sometimes none In acute form, severe pain, lacrimation and photophobia Pain increases with pupil constriction Reduced vas |
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Development and cause of iritis |
Can be limited or persistent and can become chronic Autoimmune issues such as AIDs, TB, sarcoidosis, Behcets, psoriasis. Can occur following injury, infection or surgery White blood cells can block trabecular meshwork leading to secondary glaucoma Can lead to macula/optic nerve issues and sight loss Can result in cataract |
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D.O. management of iritis |
Emergency referral to HES or I.P. Sunglasses for photophobia |
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Bacterial Keratitis Signs: White corneal opacity (ulcer) visible under slit lamp or naked eye Usually unilateral Lid oedema Mucopurulent discharge Inflammation Ciliary injection, can be Diffuse Hypopyn in severe cases Symptoms: Foreign body sensation Acute rapid onset Severe pain and lacrimation Va loss if central |
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Development and cause of bacterial Keratitis |
Overnight cl wear or non compliant cl wearers Smoking Ocular surface trauma Lid margin infection Being male/young Cosmetitic cls |
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D.O. management of bacterial Keratitis |
Discontinue cl wear but keep them and the case for culture Emergency referral to HES |
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Viral keratitis Signs: Inflammation of cornea Ciliary injection Dendritic ulcer visible under slit lamp Hypopyn in severe cases Symptoms: Pain Photophobia Lacrimation Loss of Va if central |
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Development and cause of viral keratitis |
Viral infection of cornea Dry eye or breach in corneal epithelium by trauma or cl wear allows ingress of virus More prevalent in people with poor immune systems Can be caused by Herpes simplex Cl wearers who suffer from cold sores more at risk |
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D.O. management of viral keratitis |
Discontinue cl wear Keeps cls and case for culture Emergency referral to HES |
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Keratitis (Acanthamoeba) Signs: Diffuse red eye One or more white patches on cornea Ring shaped ulcer if advanced Epiphoria Anterior chamber response Symptoms: Mild pain in earlier stages Severe pain Blurred vision Photophobia |
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Development and cause of keratitis (acanthamoeba) |
Inflammation of the cornea due to infection by acanthamoeba 90% cases are cl related Penetrates an intact corneal epithelium Caused by swimming in cls, washing cl case with water and poor compliance Caused by corneal trauma with soil or water |
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D.O. management of keratitis (acanthamoeba) |
Discontinue cl wear and keep cls and case for culture Emergency referral to HES |
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Contact Lens Associated Infiltrates/CLPU Signs: White corneal opacity (ulcer) Unilateral and peripheral No lid oedema Conjunctival hyperaemia (mild) Anterior chamber quiet Symptoms: Mild foreign body sensation Mild photophobia Can be Asymptomatic Some people experience more pain |
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Development and cause of CLPU |
Inflammatory, non infective Caused by bacteria on lens or lids Inflammatory response is due to antigens produced by bacteria |
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D.O. management of CLPU |
Discontinue cl wear and keep cls and case for culture Refer to optometrist or CLO If none available refer to HES as an emergency to rule out bacterial Keratitis |
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Bacterial Conjunctivitis Signs: Mucopurulent discharge (can harden) 'Pink eye' in fornices Conjunctival hyperaemia Tarsal conjunctiva may show mild papillary reaction Usually bilateral (may start in one eye) Symptoms: Discomfort and irritation Mild photophobia Pain indicates corneal involvement Absence of severe photophobia and va loss indicates Conjunctivitis Hot, gritty eye |
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Development and cause of bacterial Conjunctivitis |
Bacterial infection of the conjunctiva Children and elderly more at risk Very contagious, spreads quickly Superficial trauma Blepharitis or disease compromising immune system Cl wear increases risk |
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D.O. management of bacterial Conjunctivitis |
Non-pharmacological: Reassure px it's self limiting Self resolves in 7-14 days Return if Symptoms don't resolve or get worse Discuss out of hours care Full and extensive note taking Refer to GP if non resolving Cool compresses to aid itching or discomfort Boil wash towels, bedding etc Lid wipes, boiled cooled water on cotton wool for lid hygiene Lubricating eye drops for discomfort Cease cl wear Wash hands
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Viral Conjunctivitis Signs: Watery discharge Diffuse red eye, conjunctival hyperaemia and chemosis Small pinpoint subconjunctival haemorrages Unilateral but becomes bilateral Sometimes cornea involvement Eyelids stuck together in morning Symptoms: Discomfort or grittiness Associated with systemic viral issues Px could have fatigue |
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Development and cause of viral Conjunctivitis |
Most common cause of infective Conjunctivitis Associated with flu like symptoms Ranges from mild to severe |
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D.O. management of viral keratitis |
Refer to optom or CLO for corneal and tarsal check Usually self limiting 7-21 days Very virulent Non-pharmacological advice |
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Papillary (Allergic) Conjunctivitis Signs: Eversion of lids shows tarsal conjunctiva appearing rough with vascular swellings Usually bilateral May have conjunctival injection Loss of cl comfort Blurring of vision Mucus discharge Conjunctival oedema Symptoms: Eyes feel itchy or gritty Mild photophobia Lacrimation Accompanied by sneezing or nasal discharge Itching worse with cl removal Cls have deposits |
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Development and cause of papillary Conjunctivitis |
Seasonal allergies Acute allergies such as dust, fur or mites General atopy Allergic reaction to protein deposits on CL Reaction to CL solutions CLAPC |
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D.O. management of papillary Conjunctivitis |
Refer to optom/CLO Temporary Cease of cl wear |
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Primary Angle Closure Glaucoma
Signs: Acute attack: pupil is dilated into a vertical oval Pupil is fixed, semi dilated Cornea becomes cloudy Diffuse red eye High IOPs Anterior chamber flare Symptoms: Can be Asymptomatic Rapid deterioration of vas Severe ocular pain inducing nausea Haloes around lights Photophobia May have had minor attacks in past Blurry or smoky vision Eye ache and frontal headaches |
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Development and cause of angle closure glaucoma |
Closure of Anterior angle Raises IOP Pupil block Can be unilateral or bilateral Females more likely Age Hyperopic patients more at risk Small corneal diameter Drug or surgery induced |
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D.O. management of primary Angle Closure Glaucoma |
Emergency referral to HES Urgent referral to optom/I.P if early episode |
