South Birmingham VTS

1
(No Transcript)
2
South Birmingham VTS

• February 2006

3
(No Transcript)
4
Episcleritis

• Inflammation of episclera
• Mild discomfort
• Usually no other associations
• May be relapsing and prolonged
• No treatment or NSAID drops

5
(No Transcript)
6
Follicular conjunctivitis

• Viral
• Allergic
• Chlamydial
• Swab
• Treat as STI
• Oral azithromycin / erythromycin

7
Conjunctivitis

• 1.5 2 incidence in primary care
• Approx 30 bacterial
• Sticky, gritty, sometimes itchy conjunctival
  injection unilateral or bilateral vision not
  affected

8
Antibiotics for bacterial conjunctivitis?

• Cochrane review
• Meta-analysis of 5 trials in adults and children,
  antibiotic drops v placebo
• Topical antibiotics of benefit in improving early
  (day 2-5) remission rate
• No difference at days 6-10
• Sheikh, Hurwitz. Br J Gen Pract 200555962-4

9
Bacterial or viral conjunctivitis?

• 184 adults with conjunctivitis in Dutch primary
  care
• Culture positive eye(s) stuck in the morning
• Culture negative itching, previous history of
  conjunctivitis
• Rietveld et al. BMJ 2004329206-9

10
(No Transcript)
11
Acute angle closure glaucoma

• Elderly people
• Red, painful eye, malaise
• Hard eye
• Emergency referral
• Admission, I/V acetazolamide
• Prophylactic laser iridotomy to both eyes

12
(No Transcript)
13
Corneal ulcer

• Beware contact lens wearers
• Emergency referral
• Swab and intensive antibiotic drops
• ?fluorescein in all red eyes

14
(No Transcript)
15
Dendritic ulcer

• Herpes simplex type 1
• AE referral
• Aciclovir drops

16
(No Transcript)
17
Congenital nasolacrimal duct obstruction (CNLDO)

• 20 of neonates
• Constant or recurrent sticky, watery eye(s)
• 95 resolve spontaneously by 1 year old
• Some resolve after 1 year
• Manageable without antibiotic drops
• Refer for nasolacrimal duct probing at 12/12 if
  parent wishes it

18
Neonatal conjunctivitis

• Conjunctivitis in the first month
• Usually staph/strep/
• haemophilus
• Sometimes chlamydial
• Occasionally gonococcal

19
Neonatal conjunctivitis

• Assess risk of STI
• Swab for bacteria
• (also chlamydia/gonococcus if indicated)
• Treat with chloramphenicol if severe
• Review
• (May turn out to be CNLDO)

20
Flashes and floaters - causes

• Posterior vitreous detachment (PVD)
• Vitreous haemorrhage
• retinal break
• proliferative retinopathy, usually diabetic

21
Why worry about retinal breaks?

• Can lead to retinal detachment
• Risk groups
• Elderly people
• Myopia
• After cataract surgery

22
Flashes and floaters

• 295 patients seen in eye AE
• Isolated PVD 64
• Retinal detachment 17
• Retinal break 11
• Reduction of vision most predictive of serious
  pathology
• But floaters alone sometimes caused by retinal
  break
• Dayan et al. Eye 199610456-8

23
Flashes and floaters when to refer

• New or increasing symptoms
• High suspicion
• diabetes
• myopia
• age over 60
• after cataract surgery

24
Dry eyes

• Poor quality tear films
• History most useful for diagnosis
• dry, gritty, burning, itchy eyes
• sometimes watering
• often worse in smoky or warm conditions
• Common, especially with increasing age
• Commonest eye problem in rheumatoid arthritis

25
Dry eyes

• Manage with adequate lubricants
• May need use many times a day
• Add ointment at night (eg Oc lacrilube)
• May need preservative free drops
• (eg G viscotears)

26
Very best wishes to you all
sue.thompson_at_blueyonder.co.uk