conmon eye conditions

When should you refer (pupil)

*If pupil isn’t normal shape (round and circular) = immediate referral 

What is subconjunctival haemorrhage 

burst blood vessels in the eye 

Is subconjunctival haemorrhage painful

It is painless, looks worse than it is 

Medications such as aspirin and warfarin which make you bleed more 

What can cause subconjunctival haemorrhage 

Straining or coughing, vomiting can cause blood vessels to burst on the eye surface, causing a bright red blotch 

 How is subconjunctival haemorrhage treated usually 

Self- limiting treats itself within 10-14 days 

 *patients with history of trauma should be referred to exclude ocular injury

Where does the episclera lie 

Beneath the conjunctiva 

Where does the redness present in episcleritis 

Segmental : in the corner of the eye 

EPI means corner

How many eyes are usually affected in episcleritis 

Usually one eye affected

What type of pain does episcleritis cause 

Either painless or dull ache 

How is episcleritis treated 

Self limiting resolves in 2-3 weeks 

What is keratitis 

Inflammation of the cornea usually caused by an abrasion which allows infection ( pathogens can infiltrate)

What type of pain does keratitis cause + what sort of redness

Unilateral severe pain and ciliary injection ( a ring of red or violet-coloured blood vessel dilation surrounding the cornea)

What is photophobia (keratitis)

a medical symptom characterized by an abnormal intolerance to light, causing discomfort, eye strain, or sharp pain in the eyes

Symptoms of keratitis (5)

• Severe pain with ciliary injection 

• Photophobia 

• Vision may be affected, depending on the site of the ulcer 

• Corneal ulceration 

• Watery discharge 

When someone presents with keratitis what do you do

IMMEDIATE REFERRAL (loss of vision possible if left untreated)

Ophthalmologist o hospital

What is uveitis (iritis)

Inflammation of the uveal tract (middle layer of the eye)

Prominent symptoms of uveitis (iritis)

• Pain 

• Watering of the eye

• redness

• Photophobia 

• Ciliary flush 

• Irregular shape of pupil

• (Less common) headache 

What is the likely cause of uveitis (iritis)

An antigen antibody reaction as part of systemic disease e.g ulcerative colitis, RA (Rhumeroid arthritis)

When someone presents with uveitis (iritis), what are the next steps 

IMMEDIATE REFERRAL

What is glaucoma 

Glaucoma is a group of eye diseases that damage the optic nerve due to increase of the intraocular pressure due to the build up of aqueous humour anterior chamber 

What is normal intraocular pressure

10- 21 mmHg (millimoles of mercury)

What pressure of the eye is classified as glaucoma

Above 21mmHg

What is used to determine the intraocular pressure

A tonometer 

Can be contact or non-contact 

What are the 4 types of glaucoma 

• Chronic open-angle glaucoma 

• Acute closed-angle glaucoma 

• Secondary glaucoma 

• Developmental glaucoma (congenital glaucoma/ childhood glaucoma)

What is Chronic open-angle glaucoma

The most common type of glaucoma and develops very slowly and is painless 

What is Acute closed-angle glaucoma 

 A rare and can occur slowly (chromic) or may develop rapidly (acute) with a sudden, painful build-up of pressure in the eye 

What is secondary glaucoma 

A glaucoma that mainly occurs as a result of an eye injury or another eye condition such as uveitis 

What is Developmental glaucoma (congenital glaucoma/ childhood glaucoma)

A rare but sometimes serious type of glaucoma which occurs in very young children, caused by an abnormality of the eye 

Symptoms of glaucoma 

• Intense eye pain

• Red eye

• Tenderness around the eyes

• Seeing rainbow-coloured circles around bright lights 

• Blurred vision 

• Feeling sickened (nausea) and being sick 

• Headache 

What are 4 drug treatments that can be used for glaucoma 

• Miotics / cholinergics

• Sympathomimetics 

• Beta-blockers 

• Prostaglandin analogues and prostamides

How do prostaglandin analogues treat glaucoma( first line) 

• Relax muscles in the interior structure increase aqueous humour (uveoscleral) outflow which reduces intraocular pressure 

 What are some examples of prostaglandin analogues 

• Latanoprost

• Travoprost

• Bimatoprost

Side effects of prostaglandin analogues

• Increase melanin change colour of the eyes 

• Increase lash length 

• Reduce fat content around the eye causing drooping eyelid and sunken eye appearance 

• Irritation

• blurred vision 

How do beta blockers treat glaucoma

It decreases aqueous humour production in the eye by blocking sympathetic (beta-adrenergic) receptors on the ciliary epithelium in the ciliary body of the eye 

Examples of beta blockers for glaucoma 

• Timolol 

• Betaxolol

• Cartelol

• Levobunolol

Side effects of beta blockers for glaucoma 

• Stinging 

• Itching 

• Blurring

• Enhance asthma and chronic airway disease

How do miotics/cholinergics work for glaucoma (third line)

It increases aqueous outflow by stimulating parasympathetic nervous system which triggers contraction of ciliary muscles and constriction of the pupils 

What is an example of  a miotic/cholinergic drug for glaucoma 

Pilocarpine

What are the side effects of miotics/cholinergic drugs 

• Vomiting 

• Blurring of vision 

• Burning 

• Itching 

• Pain

How do sympathomimetics treat glaucoma

They bind to alpha 2 adrenoceptor agonists and lower intraocular pressure by decreasing aqueous humor production and increasing its outflow

Examples of sympathomimetics

• Brimonidine tartrate : decrease aqueous humor production + increase outflow

• Apraclondine : decrease aqueous humor production 

Side effects of sympathomimetics 

• Lethargy

• Dry mouth 

• Hypertension

• Allergy 

Symptoms of bacterial conjunctivitis

• Both eyes are affected but one eye affected first usually 24h-48h before 

• Purulent discharge ( contains pus)

•  Gritty feeling ( feels like sand/dry)

• Generalised and diffused distribution of redness

•  No associated symptoms commonly

Bacterial conjunctivitis is largely self limiting and will likely resolve within 5-7 days 

What is the OTC treatment for bacterial conjunctivitis 

Chloramphenicol 0.5% drops and 1% ointment is licensed for use in children age 2+ 

How to use chloramphenicol 0.5% drops (optrex brand name)

Instil 1 drop every 2 hours for the first 48 hours, then  4 times a day for the remaining 5 days, 

only use during waking hours 

Don’t let eye drop nozzle touch eye to avoid contamination 

How to use chloramphenicol 1% ointment 

Apply ointment to the eyelid  3-4 times daily for 5 days

Make sure to wash hands after as it is contagious 

Fusidic acid 1% eye drops for bacterial conjunctivitis

1 drop twice a day 

Acts as an antibiotic that stops bacteria multiplying

What are the side effects of chloramphenicol 

• Burning 

• Staining 

• Blurring of vision 

Where should chloramphenicol eye drops be stored + after the 5 days what should you do 

In the refrigerator

Discard eye drops after 5 days 

If there is no improvement after 48h of using chloramphenicol what should you do

Refer to the GP

If you’re using eye drops and ointment, when should you use the ointment

Apply the ointment at night 

If you’re using eye drops and ointment, when should you use the ointment

Apply the ointment at night 

How to instil eye drops : look at prework for video

• Check the expiry date on the eye drop bottle and shake if required 

• Wash hands before opening the bottle 

• Lie down or sit down and tilt your head back

• Make a fist with one hand and use your knuckles to pull your lower eyelid downwards. Place your other hand with the eye drop bottle onto your knuckles 

• Look up and squeeze one drop into your lower eyelid, making sure the nozzle doesn’t touch your eye, eyelashes or eyelid 

• Close your eye and press gently on the inner corner of your eye for 30-60 seconds to ensure the drop if fully absorbed 

• Wash hands after

Should you wear contact lenses if you have conjunctivitis

NO AVOID WEARING CONTACT LENSES, wear glasses instead

What is allergic conjunctivitis

When the conjunctiva becomes inflamed due to environmental pollution/ irritants 

What are the symptoms of allergic conjunctivitis 

• Eye redness 

• Itching 

• Watery eyes 

• Burning of both eyes

• Swelling of the eyes 

What are the treatments for allergic conjunctivitis

Mast cell stabilisers (Sodium cromoglicate): prophylactic 

Sympathomimetics and antihistamines 

What are mast cell stabilisers used for 

Prophylaxis agent must be used continuously while exposed to allergen 

How do you use Mass cell stabilisers (sodium cromoglicate) for allergic conjunctivitis + what is the dose+ what ages can use it 

Prophylactic agent must be used before + continuously while exposed to allergen 

Dose: instil 1-2 drops in each eye for QDS : Age 6+

What do sympathomimetics and antihistamines help with for allergic conjunctivitis 

Reduce redness of the eyes, they are limited to short term use to avoid rebound effects 

Give an example of sympathomimetic for allergic conjunctivitis and the dose 

Naphazoline : 1-2 drops 3 or 4 times a day 

Give an example of a combo product of a sympathomimetic and antihistamine for allergic conjunctivitis + dose + what age is it liceny

Ortrivin antistin (antazoline/xylometazoline)

Instil 1-2 drops 2-3 times a day 

Age: 12+ years 

*Avoid in patients with glaucoma, and certain antidepressants 

Risk factor for viral conjunctivitis 

Often follows a recent cold or sore throat