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Mrcp-2-Opthalmology-Notes-Passmedicine.pdf
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Lacrimal duct problems1.Dacryocystitis
It is infection of the lacrimal sac
Features:
1) watering eye (epiphora)
2) swelling and erythema at the inner canthus of the eye
Management:
1) With systemic antibiotics.
2) Intravenous antibiotics are indicated if there is associated periorbital cellulitis
2.Congenital lacrimal duct obstruction:
It affects around 5-10% of newborns.
It is bilateral in around 20% of cases
Features:
1) watering eye (even if not crying)
2) secondary infection may occur
3) Symptoms resolve in 99% of cases by 12 months of age
1
, Blepharitis
Blepharitis is inflammation of the eyelid margins.
It may due to either:
1) Meibomian gland dysfunction (common, posterior blepharitis) or
2) Seborrhoeic dermatitis/Staphylococcal infection (less common, anterior
blepharitis).
Blepharitis is also more common in patients with Acne rosacea
The meibomian glands secrete oil on to the eye surface to prevent rapid evaporation
of the tear film. Any problem affecting the meibomian glands (as in blepharitis) can
hence cause drying of the eyes which in turns leads to irritation
Features:
1) Symptoms are usually bilateral
2) Grittiness and discomfort, particularly around the eyelid margins
3) Eyes may be sticky in the morning
4) Eyelid margins may be red.
5) Swollen eyelids may be seen in staphylococcal blepharitis
6) Styes and chalazions are more common in patients with blepharitis
7) Secondary conjunctivitis may occur
Management
1) softening of the lid margin using hot compresses twice a day
2) mechanical removal of the debris from lid margins: - cotton wool buds dipped in a
mixture of cooled boiled water and baby shampoo is often used*
3) artificial tears may be given for symptom relief in people with dry eyes or an
abnormal tear film
*an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has
recently been boiled
2
, Herpes Simplex Keratitis
Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer
Features:
1) red, painful eye
2) photophobia
3) epiphora
4) visual acuity may be decreased
5) fluorescein staining may show an epithelial ulcer, dendritic pattern of staining
Management:
1) Immediate referral to an ophthalmologist
2) Topical aciclovir
Herpes zoster ophthalmicus
Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster
virus in the area supplied by the ophthalmic division of the trigeminal nerve.
It accounts for around 10% of case of shingles.
Features:
1) vesicular rash around the eye, which may or may not involve the actual eye itself
2) Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary
involvement and is a strong risk factor for ocular involvement
Management:
1) Oral antiviral treatment for 7-10 days ideally started within 72 hours.
Topical antiviral treatment is not given in HZO
2) Oral corticosteroids may reduce the duration of pain but do not reduce the
incidence of post-herpetic neuralgia
3) Ocular involvement requires urgent ophthalmology review
Complications:
1) ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
2) ptosis
3) post-herpetic neuralgia
3
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