Title: Declaration of interests
11
2Declaration of interests
2
- I have declared that I have no interests
3Diagnosis?
Header
3
Handbook Page 202
4Questions
4
- What dermatological conditions may accompany this
eyelid problem?
5Questions
5
- What dermatological conditions may accompany this
eyelid problem? - What eyelid or ocular complications can occur
from this condition?
6Questions
6
- What dermatological conditions may accompany this
eyelid problem? - What eyelid or ocular complications can occur
from this condition? - What is the management?
7Questions
7
- What dermatological conditions may accompany this
eyelid problem? - What eyelid or ocular complications can occur
from this condition? - What is the management?
- What serious condition can mimic this condition
when it occurs unilaterally?
8History of recurrent sticky eye since birth.
Diagnosis?
Header
8
Handbook Page 201
9Questions
9
- What is the appropriate management ?
10This patient presents with an acute red eye
Header
10
Handbook Page 201
11Questions
11
- What questions should we ask him?
12Questions
12
- What questions should we ask him?
- How should we examine him?
13Questions
13
- What questions should we ask him?
- How should we examine him?
- What is the management?
14Why is the development of a red eye in a patient
wearing contact lenses potentially serious?
Header
14
Handbook Page 201
1512 yr old boy presents with pain, diplopia,
decreased vision, feels unwell
15
16Diagnosis?
16
17Questions
17
- Is this an urgent or non-urgent problem?
18Questions
18
- Is this an urgent or non-urgent problem?
- What is the appropriate management?
19Patient presents with red eye and tenderness over
area of injection
19
Handbook Page 201
20Diagnosis?
20
Handbook Page 201
21Questions
21
- What is the differential diagnosis
22Questions
22
- What is the differential diagnosis?
- What is the appropriate management?
23The red eye fill in the gaps
23
24Sudden onset of severe itching and
irritationDiagnosis?
24
Handbook Page 201
25Questions
25
- What would you prescribe and why?
26Diagnosis?
26
Handbook Page 200/203
27Questions
27
- What symptoms will this patient have experienced?
28Questions
28
- What symptoms will this patient have experienced?
- Is this an urgent or non-urgent problem?
29Questions
29
- What symptoms will this patient have experienced?
- Is this an urgent or non-urgent problem?
- What is the appropriate management?
30Patient presented with acute distortion of
vision. Diagnosis?
30
Handbook Page 199/201/203
31Questions
31
- Is this an urgent or non-urgent problem?
32Questions
32
- Is this an urgent or non-urgent problem?
- What are risk factors for the development of this
condition?
33Questions
33
- Is this an urgent or non-urgent problem?
- What are risk factors for the development of this
condition? - What is the appropriate management?
34Diagnosis?
34
Handbook Page 203/204
35Questions
35
- Is this an urgent or non-urgent problem?
36Questions
36
- Is this an urgent or non-urgent problem?
- What symptoms will the patient have?
37Questions
37
- Is this an urgent or non-urgent problem?
- What symptoms will the patient have?
- Are there any systemic implications for its
treatment?
38Diagnosis? Blepharitis
Header
38
Handbook Page 202
39Questions
39
- What dermatological conditions may accompany this
eyelid problem?
40Questions
40
- What dermatological conditions may accompany this
eyelid problem? - Seborrhoeic dermatitis/acne rosacea
41Questions
41
- What eyelid or ocular complications can occur
from this condition?
42Questions
42
- What eyelid or ocular complications can occur
from this condition? - Chalazion (meibomian cyst)
- Styes
- Trichiasis
- Dry eye
- Corneal ulcers
43Chalazion
Header
43
Handbook Page 202
44Complications of blepharitis
Header
44
Handbook Page 202
45Questions
45
46Practical management tips
46
- Lid hygiene - with 25 baby shampoo
- Tear substitutes - for associated tear film
instability - Systemic tetracyclines - for severe posterior
blepharitis - Warm compresses - to melt solidified sebum in
posterior blepharitis
Handbook Page 202
47Treatment of chronic blepharitis
47
- Lid hygiene Blephaclean wipes and Blephasol
- Tear substitutes Hyabak drops
- Warm compresses The Eyebag
- www.faceandeye.co.uk
Handbook Page 202
48Blephaclean wipes
48
49Blephasol solution
49
50Hyabak drops
50
51The Eye Bag
51
52Take away message
Header
52
- Do not prescribe steroid drops/ointments
53Do not prescribe steroid eye drops/ointments
Header
53
Why not?
54Steroids can cause
54
- Cataracts
- Glaucoma
- Infection
55Steroids can cause
55
- Cataracts
- Glaucoma
- Infection
- In addition to dramatic worsening of HSK
56Questions
56
- What serious condition can mimic unilateral
blepharitis or chronic chalazion?
57Questions
57
- What serious condition can mimic unilateral
blepharitis or chronic chalazion? - Sebaceous gland carcinoma
58Masquerage syndrome
58
59History of recurrent sticky eye since
birthDiagnosis?
Header
59
Handbook Page 201
60History of recurrent sticky eye since
birthDiagnosis? Congenital NLD obstruction
Header
60
Handbook Page 201
61Questions
61
- What is the appropriate management ?
62Questions
62
- What is the appropriate management ?
- Topical Fucithalmic
- Massage over the lacrimal sac in a downward
direction - Most cases resolve spontaneously by age of 2
years - Refer those that persist or associated with other
problems e.g. lacrimal sac mucocele
63This patient presents with an acute red eye
Header
63
Handbook Page 201
64Questions
64
- What questions should we ask him?
65Questions
65
- What questions should we ask him?
- Visual problem?
- Pain?
- Discharge?
- URTI?
- Travel?
- Contacts?
66Questions
66
- How should we examine him?
67Questions
67
- How should we examine him?
- Visual acuity
- Cornea
- Fornices looking for follicles
- Lymphadenopathy
68Questions
68
69Questions
69
- What is the management?
- Swabs bacterial, viral, chlamydial
- Topical antibiotics
- Strict hygiene
- Steroids for adenoviral keratoconjunctivitis
under supervison of ophthalmologist - Tetracycline/Erthromycin for chlamydia with
referral to GU clinic
70Why is the development of a red eye in a patient
wearing contact lenses potentially serious?
Header
70
Handbook Page 201
71Risk of serious sight threatening infection
- 55 years old male
- 30 days continuous wear CL
- 1 day h/o FB sensation
- S/B AE- abrasion given CPL
- 3 days later increase pain and decrease vision
- Growth of Pseudomonas
71
72Acanthamoebic keratitis
Header
72
Can be extremely painful Contact lens wearers
particularly predisposed Associated with poor
hygiene
73Take away message
Header
73
- Refer patients with a red eye and a history
of contact lens wear to an ophthalmologist
7412 yr old boy presents with pain, diplopia,
decreased vision, feels unwell
74
75Diagnosis?
75
76Diagnosis? Orbital cellulitis with subperiosteal
abscess
76
77Questions
77
- Is this an urgent or non-urgent problem?
78Questions
78
- Is this an urgent or non-urgent problem?
- Urgent
79Questions
79
- What is the appropriate management?
80Questions
80
- What is the appropriate management?
- Immediate antibiotics - ciprofloxacin
- - clindamycin
- Urgent referral to hospital
- Keep nil by mouth
81Orbital cellulitis with subperiosteal abscess
81
82Patient presents with red eye and tenderness over
area of injection
82
Handbook Page 201
83Diagnosis?
83
Handbook Page 201
84Diagnosis? Episcleritis
84
Handbook Page 201
85Questions
85
- What is the differential diagnosis
86Questions
86
- What is the differential diagnosis
- Scleritis
87Questions
87
- What is the appropriate management?
88Questions
88
- What is the appropriate management?
- Oral anti-inflammatory agent
89The red eye fill in the gaps
89
90The red eye - making the diagnosis
90
Handbook Page 201
91Iritis
91
- Note circumcorneal injection and irregular pupil
(after dilating drops)
Handbook Page 201
92The red eye - making the diagnosis
92
Handbook Page 201
93Diagnosis? Episcleritis
93
Handbook Page 201
94The red eye - making the diagnosis
94
Handbook Page 201
95Scleritis
95
- Variable appearance
- Can result in scleral necrosis with underlying
uvea showing through
Handbook Page 201
96Management
96
- Iritis (refer)
- Topical steroid (Predsol Forte 2 hourly)
- Topical dilating agents (Cyclopentolate 1)
- Episcleritis (advise and treat?)
- Usually self limiting
- Topical lubricants and oral NSAIDS can speed
recovery - Scleritis (refer)
- Variable dependent on type and aetiology
- From oral NSAID to topical steroid to systemic
immunosuppresion
Handbook Page 201
97Sudden onset of severe itching and
irritationDiagnosis?
97
Handbook Page 201
98Questions
98
- What would you prescribe and why?
99Questions
99
- What would you prescribe and why?
- Opatanol
- (Olopatadine hydrochloride) antihistamine
- Opticrom
- (Sodium cromoglycate) mast cell stabiliser
100Diagnosis?
100
Handbook Page 200/203
101Diagnosis? Retinal detachment
101
Handbook Page 200/203
102Posterior vitreous detachment (PVD)
102
Handbook Page 200/203
103Questions
103
- What symptoms will this patient have experienced?
104Questions
104
- What symptoms will this patient have experienced?
- Flashing lights (photopsia), floaters, and a
shadow encroaching on the visual field from below
105Questions
105
- Is this an urgent or non-urgent problem?
106Questions
106
- Is this an urgent or non-urgent problem?
- Urgent if referral is delayed the retinal
detachment will involve the macula with a
permanent central visual loss even with
successful reattachment of the retina
107Questions
107
- What is the appropriate management?
108Questions
108
- What is the appropriate management?
- Urgent referral to an ophthalmologist
(vitreo-retinal surgeon)
109Take away message
Header
109
- A patient complaining of flashing lights and
floaters has a retinal tear/retinal detachment
until proven otherwise and should be referred to
the acute ophthalmic referral centre
Handbook Page 200/203
110Patient presented with acute distortion of
vision. Diagnosis? Wet macular degeneration
110
Handbook Page 199/201/203
111Questions
111
- Is this an urgent or non-urgent problem?
112Questions
112
- Is this an urgent or non-urgent problem?
- Urgent
113Dry macular degeneration
113
Handbook Page 199/201/203
114ARMD
114
Handbook Page 199/201/203
115Amsler grid
115
Handbook Page 199/201/203
116Questions
116
- What are risk factors for the development of this
condition?
117Questions
117
- What are risk factors for the development of this
condition? - Main factors are age, diet, hypertension,
exercise ( regular exercise reduces risk by 70),
genes, smoking (even passive), alcohol and skin
pigment ( more frequent in Caucasians than
Afro-Caribbeans).
118Questions
118
- What is the appropriate management?
119Questions
119
- What is the appropriate management?
- Urgent referral to an ophthalmologist
- May require intravitreal injections (Lucentis or
Avastin), steroid injections, PDT
120Take away message
Header
120
- A patient complaining of acute distortion of
vision (metamorphopsia) should be referred to an
ophthalmologist without delay
Handbook Page 199/201/203
121Diagnosis?
121
Handbook Page 203/204
122Diagnosis? Glaucomatous cupping and atrophy of
the optic disc
122
Handbook Page 203/204
123Questions
123
- Is this an urgent or non-urgent problem?
124Questions
124
- Is this an urgent or non-urgent problem?
- Non-urgent
125Questions
125
- What symptoms will the patient have?
126Questions
126
- What symptoms will the patient have?
- The patient may be asymptomatic or may have
noticed some visual field loss - Often picked up on routine opticians test
127Questions
127
- Are there any systemic implications for its
treatment?
128Questions
128
- Are there any systemic implications for its
treatment? - Beware of the use of topical B-blockers e.g.
Timolol in patients with obstructive airways
disease and heart failure - Beware drug interactions
129Glaucoma
129
- Q. What are the first and second line drops of
choice? - First line Xalatan/Travatan/Lumigan
- Second line Timolol / Azopt
Handbook Page 203/204
130130
131What have we learned?
131
- Blepharitis - masquerade syndrome
- The red eye avoid steroids
- Contact lens and conjunctivitis serious
- Allergic eye disease rationale for drops
- Orbital cellulitis an ophthalmic emergency
- Retinal detachment urgent referral
- ARMD urgent referral for acute symptoms
- Glaucoma optometrist very useful
132132
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