The Eye 1 & 2 and The Ear

Who’s more likely to get dry eye?

Who’s more likely to get dry eye?

Older

Women

Contact lenses

Vitamin A deficiency

Smoking

Blood pressure med

Heated enviroment

Screen time

What causes dry eye?

less tear volume

• evaporation/drainage/ lacrimal gland produces less/ different tear composition

What weatehr causes dry eye?

Cold and windy

What colour is the conjuctiva in dry eye?

Not red

What questions have to be asked with eye conditions?

One eye/ two eyes/pain/ photosensitivity/ discharge/ injury/ foreign object/ medications/ conditions/ tried anything'/ contact lenses/ what time of work/ allergies

What’s blepharitis

Inflammation of eyelids TWO OF THEM

What meds cause dry eye?

beta blockers/ diuretics/ isotretroin/ antihistamines/ hrt

What’s ectropion?

Red under eyelid

How to diagnose bell’s palsy?

drooping skin

can they open and close facial features

When to refer patient?

• dry mucous membrane

• outwaard turning of eyelid

• red eye

• photosensitive

• foreign object

• pierced the eye

• pain in eye

• no improvement after otc

How to group eye drops

preservative free vs preservative

what’s the preservative in eye drops thats most commovly used?

benzalkonium chloride

what can bezalalkonium chloride cause

stinging/ itching/ keratitis (Keratitis is an inflammation of the corne)

when cant you use eyedrops with preservatives?

with eye contact lenses- absorbs - toxic

why do preservative free eye drops suck?

have to use 6 times daily

when to use ointents for eyes

may blur vision therefore use at night

what’s the expiry date for eyedrops

may be 28 days as no preservative

name some eye lubricants/ agents

hypromellosea/ carmellose/ polyvinylm alcohol/ propylene glycol/ liposomal spray/ carbomer

parafins for night

how to prevent dry eye

avoid hair dryers/ car heqaters/ fans in your eye

humidifier

wraparound sunglasses

eye breaks

cold/ warm compresses

less coffee/ more water

increase omega 3 fats in diet (oily fish, seeds, and nuts)

whats’ blepharitis?

inflammation of eyelids

what’s rosacea

face goes red and blotchy

what are the two types of blepharitis

anterior —> outisde of eyelid where eyelashses attach (may be bacterial)

posterior—> inside of eye (may be caused by rosacea/ seborhoeic dermatitis —oily and flaky skin/ or not enough oil made by eye glands)

signs of blepharitis

bilateral

irriated eye margins

tearing

sticky eyelids

eyelash loss/turn inward

worst in morning

flaky skin?

crusty?

Discharge?

What are some blepharitis specific questions

any skin conditions?

one eye?

worse at any time?

disrupted vision?

medication?

rosacea signs?

seboherric dermatitis?

what can blepharitis be confused wth?

contact dermatitis/ entropion/ectropion - eyelid falling off the eye/stye (inhection made bumb, photosentisitive)/ dry eye/ chalazion (blocked off oil gland makes lump)/ orbital celluttis

when to refer

entropion- Entropion is a condition where your eyelid turns in toward your eye. As a result, your eyelashes and skin rub against your eyeball, causing discomfort to your cornea

ectropion- eyelid outturned

swollen eyelids and unwell

unresposive to treatment

what is the main treatment for blepharitis?

eyelid hygiene

how to make eyelid wash

warm water withGENTLE CLEANSER—> baby shampoo 10water:1shapoo ratio

or a cup of warm water and 1 teaspoon of sodium bicarbonate

what to do with the cleanser mix

soft cloth/ cotton bud used to clean/ press againts the eye to unclog the gland

gently rub where your eyelids meet eyelashes

rinse with warm water

how often to clean eyelid

twice a day until improves

what can you use to clean eyelids

blephaclean

how else to treat blepharitis

massage ( unclogs stuff) wth CLOSED EYES!!!!!!!!! sweep upward along lower and upper eyelid for 30 secs

cant cause discomfort

or warmth (uncloggy )

• apply warm flannel/ eyebag/microwavable heat pack to closed eye

list lifestle chamged to combat blepharitis

avoid makeup

avoid contact lenses

avoid rubbing eyes

increase omega 3 oils

treat associated conditions (rosacea/ seborrhoeic dermatitis/ dry eye)

what causes stye?

bacterial infection- usueally steaphycoccal 90% of the time

what increases the risk of stye?

chronic blephititis

what are the two types of stye

internal/ external

which is more common

external

which is more painful

internal

what causes the external stye

infected sebaceous Zeis glAND

INFECTED sweat Mol gland

how to spot a stye

pus filled

yellow

painful

spot on eyelid

what causes internal stye

meibomian gland infection

what can stye be confused wwith

chalazion

basal cell carcinoma

how to differenciate from chalazion a stye (grammar lol)

chalazion blocked oil gland—> is hard and painless— goes away on its own— further back on eyelid

how to differenciate frokm basal cell carcinoma

nodular lesion

when to refer

problematic chalazion

eldery patient with painless nodular lesion near eyelid— basal cell carcinoma (long time)

how to treat stye

goes away itself lol

what’s conjuctivitis?

inflamtion of the conjuctiva

what causes conjuctivitis?>

allergic → seasonal/perennial( all year round)/ contact (make-up or eyedrops)/ giant papillary conjucticitis (contact lenses/ stickes/ prosthetics)

infective→ bacterial staph/strep/moraxella/ haemophillus in adults

-→ viral by the adenovirus

→sti

→ irritant causes (shampoo, eyelash, chlorine,smoke and fumes)

which bacterial infectiojnndoesnt cause conjucticits in kids

staph

what stis cause conjucticits

chlamydia

gonorrhoea

what are teh general cojucticits signs?

red eye

irritation

discomfort

discharge

whats specific to allergic conjuctivitis

bilateral/ rhinitis/ itchy/ generalised redness/ watery discharge

whats specific to bacterial conjuctivitis

bilateral (not at the start th0o, becomes two eyes after a day or two)

purulent discharge! specific—> sticky eyelids

grittiness

redness

whats specific to viral conjuctivitis

watery discharge

cough and cold symptoms

grittiness

what may conjucticitis confused with

uveitis, acute clsoed eye glaucome, herpes zoster opthalmuscys, keratis/ episcleritis/ scleritis/ subconjuctival haemorrhage

how to differentiate uvetisi from conjuctivitis

pain. floaters, photophobia, decreased visual acuity

how to differentiate acuted closed angle galucome from conjuctivitis

impaired drainage of aq fluid/ increase intraocular pressyre/ pain/ decreased visiual activity/ halo around eyes/ hazy cornea

how to differentiate herpes zoster ophtalmiscus from conjuctivitis

pain

rash

unilateral rash!

how to differentiate keratitis from conjuctivitis

unilatel, pain, photophobia

• be wary of conctact lens that were contamined!

how to differentiate episcleristis from conjuctivitis

unilateral

rare discharge

painless

scleritis

autoimmune

intetsne pain

decreased visual acuity

how to differentiate subconjuctival haemorrage from conjuctivitis

blood vessel rupture

oainless

resolves in 10 days

when to refer ?

• vomiting

• headache

• hazy cornea

• decreased visual acuity

• photophobia

• eyepain

• trauma

• neonate

• sti

  • rash

how tp treat bacterial conjucticitis

brolene eye solution

when to diagnose bacterial conjucticitis

two eyes (after a delay) sticky discharge

what age can use brolene

from 2 years old

dosing of brolene

1-2 drops up to 4 times a day

when to refer after using brolene

after 48hrs of no improvemnet

who is brolene contracindicated for

contact lense wearers

how to treat viral conjuctivities (watery/ cold symptoms/ grittiness)

articial tears/ cold compress

lifestyle advice fot conjuctivitis

clean eyes with cottom ball with boiled cool water

consult gp after 10days

wash hands before eyedrops

dont share pillows etc

What’s eye irrigation

sterile eyewash to get rid of loose material-sand

not for woodchip/metal if velocity happened

gib edxample of an eyewash

optrex multi action eye wash ( boric acid, water, glycerin, borax and benzalkonium chloride)

hwo to use an eyewash

wash hands

pour into eye batch 1/3 fullness

bend head forward

place bath o the eye and slowly raise the head

keep eye open and rock side to side for 3sec

what else to use for eye irrigation

saline irriagtion pods- single units of saline solution- use like eyedrops

what can cause eye redness

injury/a llergy/infection/inflammation

what can be used for red eyes

optrex clear eyes

what age can have optrex clear eyes

over 12 years old`

what is optrx clear eyes contraindicated for1

glaucoma , seriosu eye disease, injuty, MAOI , contact lenses

what else can be used for eye redness

murine irritaion

whtas the difference betweeen murine and optix clear eyes

muline can be used with MAOI

• both over 12yrs, both CI with conatct lenses, injuty, glaucoma, serious eye disease

what’s the external seection of ear called

pinna

what does the eustachian tube connect

middle ear and the throat

who’s more predisposed to ear wax issues

eldery

in ear headphones

congenital anomally

learning difficuties

hearing aid

what are the symptoms of ear wax impaction

hearing loss

earache

ringing

vertigoo

itchy

what causes ear wax impacttion

narrow ear canals

damaged canals

excessive ahir

skin conditions

inflammation

list the diff diagnosis

ear canal trauma

trapped foreign body

ear infection

trapped water

chnages in altitide

when to refer

trauma

foreign body

fever ,malaise (a general feeling of discomfort,),pain

otc fail after 5 days

ear badly blocked

severe hearing lsos

list ear wax impaction treatments

cerumol- peanut oil

cerumol olive oil

waxsol

tropex

exterol

give ages for

cerumol

cerumol olive oil

waxsol

tropex

exterol

cerumol- over 2 yrs

cerumol olive oil- over 1 yr

waxsol- over 6 years

tropex- over 6years

exterol- over 2 years

give api fro

cerumol

cerumol olive oil

waxsol

tropex

exterol

cerumol- peanut oil

cerumol olive oil (fot smaller kids as they might’ve had no prev interaction with peanuts)

waxsol 0.5% docusate sodium - Sól= sodium

tropex- glycerol and phenazone- phen (fani) ufo sa na TROPie w zone 42

exterol- urea hydrogen peroxide- urea is gotten out of your body to be external

when to use tropex

ear pain

give dosing for

cerumol

cerumol olive oil

waxsol

tropex

exterol

cerumol- 5drops bd 3/7

cerumol olive oil- 1 / 2 drops bd 7/7

waxsol- enough to fill one ear, 2 days max

tropex- 4-6drops tds/qds

exterol- 5 drops od/bd 3/7

give CI for cerumol

peanut allergy

eczema

otis externa

seborhoeic

how to clean ears

no ear cotton buds! in ear canal- only for outside

ear irrigation product

audiclean

hwo to administer ear drops for children/adults

adults- pull ear back and up by the hard part above the helix piercing

children -pull ear down to open canal (pull the soft part for earings gently down)