Management

Photokeratitis management

Remove/stop UV exposure

Lubrication: PF artificial tears for comfort

Cold compress Sunglasses

Oral analgesia e.g. paracetamol/NSAID if appropriate

Avoid: Topical corticosteroids routinely

Prophylaxitic antibiotics can be used (chloramphenicol 0.5% QID)

Corneal abrasion management

Remove FB

Topical antibiotic (prophylaxis): chloramphenicol 0.5% QID

PF lubrication

Analgesia (NSAIDS) ± cycloplegia if spasm

Stop CL wear + no patching

Review ~24 h.

Scelritis management

Urgent ophthalmology
→ systemic NSAID for appropriate mild/moderate cases
→ systemic corticosteroids (prednisone) for severe/inadequate response
→ immunosuppression for severe/recurrent/systemic disease
→ investigate underlying autoimmune/inflammatory disease

Episcleritis management

Mild → reassurance + cold compress + artificial tears QID
Moderate/severe → topical NSAID QID 4–7 days
Persistent/severe → topical corticosteroid may be considered
Recurrent → assess systemic associations
🚨 Severe pain/↓VA/non-blanching → consider scleritis + urgent referral

Bacterial conjunctivitis management

Hygiene + saline cleaning + topical antibiotic if indicated
→ Chloramphenicol 0.5% commonly for uncomplicated disease
→ CL wearer: stop CL + Pseudomonas coverage (e.g. tobramycin depending on case)
→ No routine steroid
→ Review if not improving 48–72 h

Allergic conjunctivitis management

Avoid allergen + don't rub + cold compress + PF lubricants
→ topical antihistamine/mast-cell stabiliser ⭐
→ oral antihistamine if systemic allergy/rhinitis
→ severe VKC/AKC → specialist management

Viral conjunctivitis management

• Adenovirus → supportive: PF lubricants + cold compresses

• HSV → antiviral: topical aciclovir / ganciclovir ± systemic therapy depending on involvement

• HZO/VZV → systemic antiviral + urgent ophthalmic management

Chlamydial conjunctivitis management

🚨 SYSTEMIC antibiotic required
→ doxycycline commonly first-line in adults / azithromycin alternative depending on circumstances
→ topical antibiotic alone inadequate
→ sexual health/GP referral
→ partner notification + treatment
→ test for other STIs as appropriate

Blepharitis management

LONG-TERM LID HYGIENE
→ warm compress 10–15 min BID–QID
→ gentle lid massage
→ lid scrubs
→ PF artificial tears if DED
→ moderate/severe anterior → topical antibacterial
→ significant inflammation → short-term topical steroid may be considered
→ MGD/inflammatory → ciclosporin
→ refractory MGD/rosacea → oral doxycycline/tetracycline
→ address Demodex/rosacea/DED
→ consider IPL/thermal treatment where appropriate

DED

⭐⭐⭐ EDUCATE + TARGET DRIVERS
→ artificial tears (aqueous/lipid; PF if frequent)
→ environmental modification + blink hygiene/screen breaks
→ MGD → warm compress + lid hygiene ± expression
→ inflammatory DED → short-term topical steroid
→ chronic inflammation → cyclosporine
→ refractory MGD → oral doxycycline/macrolide ± in-office therapy
→ aqueous deficiency → consider punctal occlusion
→ treat systemic/associated disease
→ severe/refractory → specialist co-management

Dacryocystitis management

⭐⭐⭐ Acute → urgent GP/ophthalmology + systemic antibiotics
→ warm compress ~5 min
→ gentle Crigler/sac massage where appropriate
→ analgesia
→ complicated/abscess/orbital involvement → IV antibiotics ± drainage
→ after acute infection resolves → treat underlying obstruction, often DCR in adults
❌ No routine Jones testing/irrigation during acute infection
❌ No probing during acute infection

Retinal tear management

🚨 URGENT ophthalmology
→ symptomatic retinal tear = laser retinopexy ⭐⭐⭐⭐⭐
→ cryotherapy if appropriate
→ patient RD precautions
→ ophthalmology follow-up

Posterior vitreous detachment

Uncomplicated PVD → NO treatment → educate + RD precautions + ~1-month DFE review

New shower of floaters/flashes, curtain/shadow or ↓VA → immediate reassessment