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Declaration of interests

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Title: Declaration of interests


1
1
2
Declaration of interests
2
  • I have declared that I have no interests

3
Diagnosis?
Header
3
Handbook Page 202
4
Questions
4
  • What dermatological conditions may accompany this
    eyelid problem?

5
Questions
5
  • What dermatological conditions may accompany this
    eyelid problem?
  • What eyelid or ocular complications can occur
    from this condition?

6
Questions
6
  • What dermatological conditions may accompany this
    eyelid problem?
  • What eyelid or ocular complications can occur
    from this condition?
  • What is the management?

7
Questions
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?

8
History of recurrent sticky eye since birth.
Diagnosis?
Header
8
Handbook Page 201
9
Questions
9
  • What is the appropriate management ?

10
This patient presents with an acute red eye
Header
10
Handbook Page 201
11
Questions
11
  • What questions should we ask him?

12
Questions
12
  • What questions should we ask him?
  • How should we examine him?

13
Questions
13
  • What questions should we ask him?
  • How should we examine him?
  • What is the management?

14
Why is the development of a red eye in a patient
wearing contact lenses potentially serious?
Header
14
Handbook Page 201
15
12 yr old boy presents with pain, diplopia,
decreased vision, feels unwell
15
16
Diagnosis?
16
17
Questions
17
  • Is this an urgent or non-urgent problem?

18
Questions
18
  • Is this an urgent or non-urgent problem?
  • What is the appropriate management?

19
Patient presents with red eye and tenderness over
area of injection
19
Handbook Page 201
20
Diagnosis?
20
Handbook Page 201
21
Questions
21
  • What is the differential diagnosis

22
Questions
22
  • What is the differential diagnosis?
  • What is the appropriate management?

23
The red eye fill in the gaps
23
24
Sudden onset of severe itching and
irritationDiagnosis?
24
Handbook Page 201
25
Questions
25
  • What would you prescribe and why?

26
Diagnosis?
26
Handbook Page 200/203
27
Questions
27
  • What symptoms will this patient have experienced?

28
Questions
28
  • What symptoms will this patient have experienced?
  • Is this an urgent or non-urgent problem?

29
Questions
29
  • What symptoms will this patient have experienced?
  • Is this an urgent or non-urgent problem?
  • What is the appropriate management?

30
Patient presented with acute distortion of
vision. Diagnosis?
30
Handbook Page 199/201/203
31
Questions
31
  • Is this an urgent or non-urgent problem?

32
Questions
32
  • Is this an urgent or non-urgent problem?
  • What are risk factors for the development of this
    condition?

33
Questions
33
  • Is this an urgent or non-urgent problem?
  • What are risk factors for the development of this
    condition?
  • What is the appropriate management?

34
Diagnosis?
34
Handbook Page 203/204
35
Questions
35
  • Is this an urgent or non-urgent problem?

36
Questions
36
  • Is this an urgent or non-urgent problem?
  • What symptoms will the patient have?

37
Questions
37
  • Is this an urgent or non-urgent problem?
  • What symptoms will the patient have?
  • Are there any systemic implications for its
    treatment?

38
Diagnosis? Blepharitis
Header
38
Handbook Page 202
39
Questions
39
  • What dermatological conditions may accompany this
    eyelid problem?

40
Questions
40
  • What dermatological conditions may accompany this
    eyelid problem?
  • Seborrhoeic dermatitis/acne rosacea

41
Questions
41
  • What eyelid or ocular complications can occur
    from this condition?

42
Questions
42
  • What eyelid or ocular complications can occur
    from this condition?
  • Chalazion (meibomian cyst)
  • Styes
  • Trichiasis
  • Dry eye
  • Corneal ulcers

43
Chalazion
Header
43
Handbook Page 202
44
Complications of blepharitis
Header
44
Handbook Page 202
45
Questions
45
  • What is the management?

46
Practical 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
47
Treatment 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
48
Blephaclean wipes
48
49
Blephasol solution
49
50
Hyabak drops
50
51
The Eye Bag
51
52
Take away message
Header
52
  • Do not prescribe steroid drops/ointments

53
Do not prescribe steroid eye drops/ointments
Header
53
Why not?
54
Steroids can cause
54
  • Cataracts
  • Glaucoma
  • Infection

55
Steroids can cause
55
  • Cataracts
  • Glaucoma
  • Infection
  • In addition to dramatic worsening of HSK

56
Questions
56
  • What serious condition can mimic unilateral
    blepharitis or chronic chalazion?

57
Questions
57
  • What serious condition can mimic unilateral
    blepharitis or chronic chalazion?
  • Sebaceous gland carcinoma

58
Masquerage syndrome
58
59
History of recurrent sticky eye since
birthDiagnosis?
Header
59
Handbook Page 201
60
History of recurrent sticky eye since
birthDiagnosis? Congenital NLD obstruction
Header
60
Handbook Page 201
61
Questions
61
  • What is the appropriate management ?

62
Questions
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

63
This patient presents with an acute red eye
Header
63
Handbook Page 201
64
Questions
64
  • What questions should we ask him?

65
Questions
65
  • What questions should we ask him?
  • Visual problem?
  • Pain?
  • Discharge?
  • URTI?
  • Travel?
  • Contacts?

66
Questions
66
  • How should we examine him?

67
Questions
67
  • How should we examine him?
  • Visual acuity
  • Cornea
  • Fornices looking for follicles
  • Lymphadenopathy

68
Questions
68
  • What is the management?

69
Questions
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

70
Why is the development of a red eye in a patient
wearing contact lenses potentially serious?
Header
70
Handbook Page 201
71
Risk 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
72
Acanthamoebic keratitis
Header
72
Can be extremely painful Contact lens wearers
particularly predisposed Associated with poor
hygiene
73
Take away message
Header
73
  • Refer patients with a red eye and a history
    of contact lens wear to an ophthalmologist

74
12 yr old boy presents with pain, diplopia,
decreased vision, feels unwell
74
75
Diagnosis?
75
76
Diagnosis? Orbital cellulitis with subperiosteal
abscess
76
77
Questions
77
  • Is this an urgent or non-urgent problem?

78
Questions
78
  • Is this an urgent or non-urgent problem?
  • Urgent

79
Questions
79
  • What is the appropriate management?

80
Questions
80
  • What is the appropriate management?
  • Immediate antibiotics - ciprofloxacin
  • - clindamycin
  • Urgent referral to hospital
  • Keep nil by mouth

81
Orbital cellulitis with subperiosteal abscess
81
82
Patient presents with red eye and tenderness over
area of injection
82
Handbook Page 201
83
Diagnosis?
83
Handbook Page 201
84
Diagnosis? Episcleritis
84
Handbook Page 201
85
Questions
85
  • What is the differential diagnosis

86
Questions
86
  • What is the differential diagnosis
  • Scleritis

87
Questions
87
  • What is the appropriate management?

88
Questions
88
  • What is the appropriate management?
  • Oral anti-inflammatory agent

89
The red eye fill in the gaps
89
90
The red eye - making the diagnosis
90
Handbook Page 201
91
Iritis
91
  • Note circumcorneal injection and irregular pupil
    (after dilating drops)

Handbook Page 201
92
The red eye - making the diagnosis
92
Handbook Page 201
93
Diagnosis? Episcleritis
93
Handbook Page 201
94
The red eye - making the diagnosis
94
Handbook Page 201
95
Scleritis
95
  • Variable appearance
  • Can result in scleral necrosis with underlying
    uvea showing through

Handbook Page 201
96
Management
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
97
Sudden onset of severe itching and
irritationDiagnosis?
97
Handbook Page 201
98
Questions
98
  • What would you prescribe and why?

99
Questions
99
  • What would you prescribe and why?
  • Opatanol
  • (Olopatadine hydrochloride) antihistamine
  • Opticrom
  • (Sodium cromoglycate) mast cell stabiliser

100
Diagnosis?
100
Handbook Page 200/203
101
Diagnosis? Retinal detachment
101
Handbook Page 200/203
102
Posterior vitreous detachment (PVD)
102
Handbook Page 200/203
103
Questions
103
  • What symptoms will this patient have experienced?

104
Questions
104
  • What symptoms will this patient have experienced?
  • Flashing lights (photopsia), floaters, and a
    shadow encroaching on the visual field from below

105
Questions
105
  • Is this an urgent or non-urgent problem?

106
Questions
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

107
Questions
107
  • What is the appropriate management?

108
Questions
108
  • What is the appropriate management?
  • Urgent referral to an ophthalmologist
    (vitreo-retinal surgeon)

109
Take 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
110
Patient presented with acute distortion of
vision. Diagnosis? Wet macular degeneration
110
Handbook Page 199/201/203
111
Questions
111
  • Is this an urgent or non-urgent problem?

112
Questions
112
  • Is this an urgent or non-urgent problem?
  • Urgent

113
Dry macular degeneration
113
Handbook Page 199/201/203
114
ARMD
114
Handbook Page 199/201/203
115
Amsler grid
115
Handbook Page 199/201/203
116
Questions
116
  • What are risk factors for the development of this
    condition?

117
Questions
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).

118
Questions
118
  • What is the appropriate management?

119
Questions
119
  • What is the appropriate management?
  • Urgent referral to an ophthalmologist
  • May require intravitreal injections (Lucentis or
    Avastin), steroid injections, PDT

120
Take 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
121
Diagnosis?
121
Handbook Page 203/204
122
Diagnosis? Glaucomatous cupping and atrophy of
the optic disc
122
Handbook Page 203/204
123
Questions
123
  • Is this an urgent or non-urgent problem?

124
Questions
124
  • Is this an urgent or non-urgent problem?
  • Non-urgent

125
Questions
125
  • What symptoms will the patient have?

126
Questions
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

127
Questions
127
  • Are there any systemic implications for its
    treatment?

128
Questions
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

129
Glaucoma
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
130
130
131
What 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

132
132
www.faceandeye.co.uk
Tel 08458 332233
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