Ophthalmology Conditions
Blepharitis
Definition Inflammation of the eyelid margins (and meibomian glands)
- Anterior: affects roots of lashes = sensitivity to bacteria
- Posterior: affects internal eyelid margins due to meibomian gland
dysfunction
Epidemiology
Aetiology Staphylococcus, HSV, VZV infections
Risk Factors - Young children and 50+
- Seborrheic dermatitis
- Acne around the centre of the face
, Symptoms - Painful, gritty, itchy eyes
- Burning/stinging of eyes
- Eyelids sticking together when waking
- Dry eye symptoms
Signs - Redness of eyelid margins
- Crusting/scaling of eyelid margins
- Misdirection of lashes
- Loss of lashes
*Ingrown lashes and stye may also be present
Investigations –
*Ensure there is no associated corneal ulceration
Management Conservative:
1. Lid hygiene (twice a day) for 3 months
2. Avoidance of contact lens use during flare ups
Pharmacological:
1. For ANTERIOR: Abx chloramphenicol ointment rubbed into lash
bases 2-4 times a day
For POSTERIOR: Abx oral tetracycline for a few weeks
2. Steroids – under specialist advice ONLY
Referral Same day ophthalmology referral IF:
- Pain
- Blurred vision
- Rapid onset visual loss
- Orbital/preseptal cellulitis
- Eye becomes red
Conjunctivitis
Definition Infection or inflammation of the conjunctiva (“pink eye”)
*Conjunctiva covers sclera (white part of eye)
Epidemiology
Aetiology - Allergic: type 1 hypersensitivity reactions – pollen, dust mites, pet
dander
- Viral: associated with URTI – adenoviruses (commonest), herpes
- Bacterial: S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis
, STIs like gonorrhoea and chlamydia can also cause conjunctivitis
Risk Factors Occupation (metal worker) and recent URTI
Symptoms - Red eye
- Itching and irritation
- Excessive tearing
- Discharge from eye – consistency based on cause
*Watery = viral/allergic + sticky/purulent discharge = bacterial
- Photophobia – suggests corneal involvement
- Preauricular lymphadenopathy – viral conjunctivitis
Signs
Investigations - Bloods – CRP/ESR + FBC (inflammation)
- RAST/skin patch – allergic
- Eye swab – purulent discharge/suspicion of STIs or herpes
- Fluorescein staining – rule out dendritic ulceration
Management 1. Eye drop of chloramphenicol (frequency will depend on severity)
2. Fusidic acid (pregnant patients or second line)
Allergic: avoid allergens/rubbing eyes + can be given mast cell
stabilisers (anti-histamines)
Referral - Ophthalmia neonatorum
- Suspected gonococcal or chlamydial conjunctivitis
- Suspected herpes infection
- Suspected periorbital or orbital cellulitis
- Severe disease
- Recent intraocular surgery
- Conjunctivitis with a severe underlying condition
Dacryoadenitis
Definition Infection/inflammation of the lacrimal gland
- Can be secondary to blockage of nasolacrimal duct
Epidemiology
Aetiology
Risk Factors - Female
Blepharitis
Definition Inflammation of the eyelid margins (and meibomian glands)
- Anterior: affects roots of lashes = sensitivity to bacteria
- Posterior: affects internal eyelid margins due to meibomian gland
dysfunction
Epidemiology
Aetiology Staphylococcus, HSV, VZV infections
Risk Factors - Young children and 50+
- Seborrheic dermatitis
- Acne around the centre of the face
, Symptoms - Painful, gritty, itchy eyes
- Burning/stinging of eyes
- Eyelids sticking together when waking
- Dry eye symptoms
Signs - Redness of eyelid margins
- Crusting/scaling of eyelid margins
- Misdirection of lashes
- Loss of lashes
*Ingrown lashes and stye may also be present
Investigations –
*Ensure there is no associated corneal ulceration
Management Conservative:
1. Lid hygiene (twice a day) for 3 months
2. Avoidance of contact lens use during flare ups
Pharmacological:
1. For ANTERIOR: Abx chloramphenicol ointment rubbed into lash
bases 2-4 times a day
For POSTERIOR: Abx oral tetracycline for a few weeks
2. Steroids – under specialist advice ONLY
Referral Same day ophthalmology referral IF:
- Pain
- Blurred vision
- Rapid onset visual loss
- Orbital/preseptal cellulitis
- Eye becomes red
Conjunctivitis
Definition Infection or inflammation of the conjunctiva (“pink eye”)
*Conjunctiva covers sclera (white part of eye)
Epidemiology
Aetiology - Allergic: type 1 hypersensitivity reactions – pollen, dust mites, pet
dander
- Viral: associated with URTI – adenoviruses (commonest), herpes
- Bacterial: S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis
, STIs like gonorrhoea and chlamydia can also cause conjunctivitis
Risk Factors Occupation (metal worker) and recent URTI
Symptoms - Red eye
- Itching and irritation
- Excessive tearing
- Discharge from eye – consistency based on cause
*Watery = viral/allergic + sticky/purulent discharge = bacterial
- Photophobia – suggests corneal involvement
- Preauricular lymphadenopathy – viral conjunctivitis
Signs
Investigations - Bloods – CRP/ESR + FBC (inflammation)
- RAST/skin patch – allergic
- Eye swab – purulent discharge/suspicion of STIs or herpes
- Fluorescein staining – rule out dendritic ulceration
Management 1. Eye drop of chloramphenicol (frequency will depend on severity)
2. Fusidic acid (pregnant patients or second line)
Allergic: avoid allergens/rubbing eyes + can be given mast cell
stabilisers (anti-histamines)
Referral - Ophthalmia neonatorum
- Suspected gonococcal or chlamydial conjunctivitis
- Suspected herpes infection
- Suspected periorbital or orbital cellulitis
- Severe disease
- Recent intraocular surgery
- Conjunctivitis with a severe underlying condition
Dacryoadenitis
Definition Infection/inflammation of the lacrimal gland
- Can be secondary to blockage of nasolacrimal duct
Epidemiology
Aetiology
Risk Factors - Female
