Ophthalmology Quiz: Blepharitis and Conjunctivitis
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Questions and Answers

Which condition is characterized by the inflammation of the eyelid margins and typically bilateral?

  • Stye
  • Blepharitis (correct)
  • Conjunctivitis
  • Meibomian cyst

    • What is the typical duration for the use of naphazoline 0.01% eye drops due to potential rebound effects?

  • 1-2 days
  • As long as needed
  • 3-7 days (correct)
  • 1-3 weeks

    • Which type of blepharitis is associated with excessive sebum production and seborrhoeic dermatitis?

  • Staphylococcal blepharitis
  • Posterior blepharitis
  • Seborrhoeic blepharitis (correct)
  • Meibomitis

    • What common symptom is associated with blepharitis?

    <p>Sore eyelids (B)</p> Signup and view all the answers

    Which of the following conditions usually resolves spontaneously within 2-3 days?

    <p>Stye (C)</p> Signup and view all the answers

    What notable symptom might suggest an infection in a patient with blepharitis?

    <p>Eyelids sticking together (B)</p> Signup and view all the answers

    Which of the following is a defining sign of staphylococcal blepharitis?

    <p>Swollen eyelids (B)</p> Signup and view all the answers

    Which classification of blepharitis affects the anterior eyelid margin and may cause lash collarettes and crusting?

    <p>Staphylococcal blepharitis (D)</p> Signup and view all the answers

    What is the recommended action regarding children with infective conjunctivitis in schools?

    <p>Allow them to attend school without restrictions. (C)</p> Signup and view all the answers

    What is a significant risk associated with wearing contact lenses during an active infection?

    <p>Development of keratitis. (A)</p> Signup and view all the answers

    What was the relative risk of better outcomes with antibiotic treatment for bacterial conjunctivitis compared to placebo after 2-5 days?

    <p>1.31 (B)</p> Signup and view all the answers

    Why is chloramphenicol not recommended for people with a history of blood dyscrasias?

    <p>It poses a theoretical risk of grey baby syndrome. (A)</p> Signup and view all the answers

    What is the stance on the use of topical ocular antibiotics for those with microbiologically-proven bacterial conjunctivitis?

    <p>They are considered beneficial but have modest effects. (A)</p> Signup and view all the answers

    What should be advised if symptoms of severe infective conjunctivitis do not resolve within 3 days?

    <p>Topical antibiotics should be initiated. (B)</p> Signup and view all the answers

    Which of the following statements about antibiotic treatment for conjunctivitis is true?

    <p>Treating conjunctivitis with antibiotics is beneficial in the short term. (A)</p> Signup and view all the answers

    What was noted about the participants in the meta-analysis regarding bacterial conjunctivitis?

    <p>They had microbiologically proven bacterial conjunctivitis. (B)</p> Signup and view all the answers

    What is a common characteristic of Acute Glaucoma?

    <p>Pain in the eye accompanied by headache (B)</p> Signup and view all the answers

    Which symptom is NOT considered a red flag in eye conditions?

    <p>Minor irritation of the eye (D)</p> Signup and view all the answers

    What does Ciliary injection indicate in an eye condition?

    <p>Engorgement of deep vessels around the limbus (D)</p> Signup and view all the answers

    What is the recommended action for a patient displaying features of a serious red eye condition?

    <p>Refer for same-day assessment by a specialist (C)</p> Signup and view all the answers

    How is Keratitis typically identified?

    <p>Pain in the eye accompanied by photophobia (C)</p> Signup and view all the answers

    Which of the following is a symptom of a subconjunctival hemorrhage?

    <p>Bright red appearance of the conjunctiva (B)</p> Signup and view all the answers

    In which condition is a fixed dilated pupil a sign?

    <p>Acute Glaucoma (B)</p> Signup and view all the answers

    What is the significance of reduced visual acuity in eye conditions?

    <p>It may signify a serious secondary cause. (D)</p> Signup and view all the answers

    What characteristic is typically observed in iritis?

    <p>A fixed and mid-dilated pupil (D)</p> Signup and view all the answers

    Which statement accurately describes conjunctivitis?

    <p>It can be caused by allergic responses, bacterial, or viral infections. (A)</p> Signup and view all the answers

    Which type of conjunctivitis is characterized by the involvement of the conjunctiva without affecting other eye parts?

    <p>Primary conjunctivitis (C)</p> Signup and view all the answers

    What kind of discharge is typically associated with bacterial conjunctivitis?

    <p>Green or yellow sticky (B)</p> Signup and view all the answers

    Which of the following symptoms is LEAST likely to be present in conjunctivitis?

    <p>Severe headache (C)</p> Signup and view all the answers

    What is the most appropriate self-care advice for managing contagious conjunctivitis?

    <p>Isolate from others to prevent spreading. (B)</p> Signup and view all the answers

    Which organism is commonly responsible for bacterial conjunctivitis?

    <p>Moraxella catarrhalis (B)</p> Signup and view all the answers

    What is a common result of irritant conjunctivitis caused by mechanical factors?

    <p>Gritty sensation in the eye (D)</p> Signup and view all the answers

    What is a common complication associated with blepharitis?

    <p>Inflamed conjunctiva (A)</p> Signup and view all the answers

    Why is eyelid hygiene emphasized as the first line of treatment for blepharitis?

    <p>It helps to manage underlying causes and reduce recurrence. (B)</p> Signup and view all the answers

    What is the recommended frequency for eyelid cleansing at the initial stage of treatment?

    <p>Twice daily (C)</p> Signup and view all the answers

    What role do warm compresses play in the management of blepharitis?

    <p>They loosen crusts to enhance cleaning efficacy. (B)</p> Signup and view all the answers

    What secondary condition may contribute to the exacerbation of blepharitis?

    <p>Rosacea (D)</p> Signup and view all the answers

    Which of the following cleaning agents is cited as an option for eyelid cleansing?

    <p>Diluted baby shampoo (A)</p> Signup and view all the answers

    Which practice should be avoided during any eye infection, including blepharitis?

    <p>Wearing contact lenses (B)</p> Signup and view all the answers

    What should be done after symptoms of blepharitis improve?

    <p>Continue daily cleansing indefinitely. (A)</p> Signup and view all the answers

    What is the primary cause of dry eye syndrome?

    <p>Inadequate tear secretion or excessive evaporation (B)</p> Signup and view all the answers

    Which symptom is commonly associated with dry eye syndrome?

    <p>Foreign body sensation (D)</p> Signup and view all the answers

    Which age group has the highest prevalence of dry eye syndrome?

    <p>People in their 70s (A)</p> Signup and view all the answers

    What layer of tears helps to adhere to the corneal epithelium?

    <p>Inner layer of mucins (B)</p> Signup and view all the answers

    What is the recommended initial frequency for using artificial tears in severe cases?

    <p>Every 30 minutes (A)</p> Signup and view all the answers

    Which component is NOT part of the tear composition?

    <p>Nucleic acids (C)</p> Signup and view all the answers

    Which group is more likely to suffer from dry eye syndrome?

    <p>Women (A)</p> Signup and view all the answers

    What role do meibomian glands play in tear production?

    <p>Produce the outer lipid layer of tears (D)</p> Signup and view all the answers

    Study Notes

    OSPAP Programme - Minor Eye Conditions

    • The programme covers minor eye conditions.
    • The presenter is Deanne Marshall, MPHM14.
    • The learning outcomes include identifying key eye disorders, their symptoms, management, and referral criteria (red flags).

    Anatomy of the Eye

    • The slide shows a diagram of the eye, labeling key parts like the eyelid, conjunctiva, sclera, cornea, aqueous humor, iris, lens, ciliary body, trabecular meshwork, choroid, retina, and vitreous humor.
    • The diagram also shows the optic nerve, macula, and suspensory ligament.
    • The diagram helps to visualize the structure of the eye and its parts.

    Classification of Common Eye Presentations

    • Painful eye
    • Inflammatory conditions
    • Drainage or tear formation abnormalities
    • Eye disorders with systemic illness
    • Foreign body present

    Subconjunctival Haemorrhage

    • A small blood vessel burst in the conjunctiva can make the white of the eye appear bright red.
    • If there is no injury, it's usually harmless.
    • Patients may be concerned, reassurance is important.

    Red Flag Symptoms

    • Moderate to Severe eye pain: rule out secondary causes.
    • Marked redness: increased redness suggests serious secondary cause.
    • Ciliary injection: engorgement of blood vessels, creating a bluish discoloration around the limbus.
    • Reduced visual acuity: any loss of vision indicates a possible secondary cause.
    • Severe photophobia: unexplained sensitivity to light.

    Serious Causes of a Red Eye

    • Acute Glaucoma (requires separate lecture).
    • Keratitis (corneal ulcer).
    • Iritis/Uveitis.
    • Patients with serious red eye conditions should be referred for same-day specialist assessment.

    Acute Glaucoma

    • Raised intraocular pressure with pain, headache, and blurred vision.
    • Signs include ciliary injection, diminished vision, hazy cornea, fixed dilated pupil, rock-hard and tender eye.

    Keratitis (Corneal Ulcer)

    • Pain, unilateral, photophobia, and an injected eye.
    • Signs include ciliary injection and corneal ulceration (dendritic if herpes simplex).
    • Vision may be affected depending on the location of the ulcer.

    Iritis (Uveitis)

    • Inflammation of the iris, with pain, eye watering, and possible headache.
    • Signs include ciliary injection (redness and swollen blood vessels), fixed and mid-dilated or distorted pupils.

    Conjunctivitis

    • Conjunctivitis is the inflammation of the conjunctiva, the membrane covering the white of the eye and inside eyelids.
    • The conjunctiva's blood vessels dilate, making the eye appear red.
    • It can be bacterial, viral, or allergic.
    • Primary is inflammation limited to conjunctiva.
    • Secondary conjunctivitis spreads to other parts of the eye.

    Infective Conjunctivitis

    • Approximately 50% of conjunctivitis cases are bacterial and 50% viral.
    • Bacterial conjunctivitis can be caused by Staphylococcus, Streptococcus pneumoniae, or Moraxella catarrhalis.
    • Gonorrhea is a rare, purulent type.
    • Viral conjunctivitis often accompanies upper respiratory tract infections (RTI), usually caused by adenovirus.
    • Chlamydia is a rare form, common in newborns and sexually active individuals.

    Symptoms of Conjunctivitis

    • Eye discomfort (burning, gritty).
    • Minimal photophobia.
    • Eyelids sticking together (green/yellow sticky discharge).
    • Blurred vision (due to discharge).
    • History of close contact with an infected person increases the likelihood of an infection.

    Differential Diagnosis of Conjunctivitis

    • Irritant conjunctivitis
    • Mechanical causes: eyelashes, foreign body.
    • Chemical causes: shampoo, chlorine (obvious and resolves when cause removed).
    • Penetrating injury requires same-day specialist assessment.

    Self-Care Advice for Conjunctivitis

    • Conjunctivitis is often self-limiting.
    • Wash hands frequently. Avoid sharing towels/face cloths.
    • Time off school/work may be necessary (HPA 2010 guidelines).
    • Eye hygiene is essential.
    • Contact lenses should be removed until symptoms and treatment resolve (24 hours).
    • Corneal complications (keratitis) are possible if contact lenses are used during conjunctivitis.

    Antibiotic Treatment for Conjunctivitis

    • Cochrane review suggests bacterial conjunctivitis is self-limiting.
    • Antibiotic treatment may be helpful in the short term, but the benefits are modest.
    • Adverse effects are rare.
    • Antibiotic use is less effective in primary care settings, especially for proven cases of bacterial conjunctivitis.

    Antibiotic Considerations (Chloramphenicol)

    • Chloramphenicol is a broad-spectrum antibiotic.
    • Little evidence of bacterial resistance, but this is a growing concern.
    • Systemic absorption is rare but may still be a concern;
    • Not recommended for pregnant women, or people with blood dyscrasias (especially during the third trimester), due to a possible risk of grey baby syndrome in newborns.

    Current Treatment Recommendations

    • Treatment with topical ocular antibiotics for microbiologically proven cases of bacterial conjunctivitis can be beneficial.
    • Avoid topical antibiotics if the potential benefits are outweighed by the risk of harm from untreated infection.
    • For severe infective conjunctivitis, a delayed approach may be appropriate — start topical antibiotics if symptoms persist for 3 days, or if symptoms are severe.
    • Fusidic acid is a commonly used second-line topical antibiotic.

    OTC Chloramphenicol Eye Drops

    • Licensed for children over 2 years old and adults.
    • Remove contact lenses during treatment.
    • Apply one drop every 2 hours for first 48 hours then every 6 hours until complete resolution.
    • Monitor for symptoms and side effects.
    • Contraindicated if hypersensitivity or a medical history of myelosuppresion/blood dyscrasias.
    • Storage is essential.

    Alternative Treatments (Propamidine Eye Drops)

    • Propamidine eye drops are an alternative treatment option.
    • Evidence for their efficacy is weak.
    • Excellent Hygiene may be just as effective.
    • Licensed for use in children over 12 years of age and adults as a non prescription OTC.

    Eyelid Hygiene

    • Use warm, preboiled water, cotton pads or gauze pads for cleansing;
    • Cleansing should be done from inside to outside the eye margin;
    • Do not reuse a pad for both eyes.
    • Avoid using cotton wool.
    • Use individual towels and wash them regularly.

    Allergic Conjunctivitis

    • Bilateral itchy eyes.
    • Edema (cobblestone appearance) on the inner eyelid surface.
    • Associated with other allergies (eczema, allergic rhinitis, asthma).

    Allergic Conjunctivitis - Treatment

    • Mast cell stabilisers (e.g., Sodium cromoglycate, Opticrom Allergy).
    • The treatment uses 1-2 drops before symptoms appear.
    • Can be used in adults and children.

    Allergic Conjunctivitis - Sympathomimetics

    • Sympathomimetics (e.g., Naphazoline) can constrict blood vessels.
    • Use caution with MAOI inhibitors (risk of hypertensive crisis)
    • Xylometazoline combination with an antihistamine may be used.
    • Use for short terms only.
    • Avoid in patients with Glaucoma, use a maximum of 3-7 days.

    Eyelid Disorders

    • Stye (usually one eye) resolves spontaneously within 2-3 days.
    • Blepharitis (typically both eyes) is eyelid margin inflammation: chronic and recurring.
    • Meibomian cysts: hard, painless lumps under the eyelid that resolve spontaneously.

    Blepharitis

    • Inflammation of the eyelid margin.
    • Usually bilateral.
    • Chronic condition and overlapping symptoms.
    • Anatomical causes: base of eyelashes (anterior) or meibomian glands (posterior).

    Blepharitis - Classification by Clinical Symptoms

    • Staphylococcal blepharitis affects anterior eyelid margin: crusting, lid ulceration, folliculitis.
    • Seborrheic blepharitis affects the anterior eyelid caused by excessive sebum/associated seborrheic dermatitis
    • Meibomian gland dysfunction affects the posterior eyelid margin- often associated with dermatitis and rosacea.

    Blepharitis - Symptoms

    • Sore eyelids (common symptom).
    • Gritty feeling in the eyes.
    • Dry eye symptoms (blurred vision, contact lens intolerance).
    • Eyelids sticking together, especially in the morning.

    Blepharitis - Signs

    • Swollen eyelids (especially in staphylococcal & meibomitis cases), less common in other cases.
    • Inflamed eyelid margins.
    • Eyelash abnormalities: misdirection, crusting, loss.
    • Scaly, oily, or greasy eyelid surfaces.
    • Styes more common in people with blepharitis
    • Inflamed conjunctiva a potential complication.

    Blepharitis - Counselling Points

    • Blepharitis is a chronic condition.
    • Symptoms can be improved (not cured).
    • Compliance with treatment is crucial.
    • Avoid contact lenses during any eye infection.

    Blepharitis - Management

    • Eyelid hygiene is the first line of treatment.
    • Treat marked infection with topical chloramphenicol or fusidic acid.
    • Refer to GP to identify/treat underlying causes (e.g., rosacea, seborrhoeic dermatitis, atopic eczema).

    Eyelid Hygiene - Techniques

    • Warm compresses to eyelids to loosen crusts.
    • Apply for 5-10 minutes while eyelids are closed.
    • Gently massage eyelids to express meibomian gland contents.

    Eyelid Hygiene - Cleansing

    • Clean eyelids twice daily, initially.
    • Can be reduced to once per day with symptom improvement.
    • Continue daily cleansing indefinitely to reduce recurrence.
    • Avoid eye makeup, especially eyeliner, as it can contribute to blepharitis.

    Cleansing of the Eyelids

    • Use agents like sodium bicarbonate (1 tsp in a cup of boiled water).
    • Diluted baby shampoo. Clean cloth used to rub the eyelid margins.
    • Evidence suggests boiled water or preserved water is equally effective.

    Dry Eye Syndrome (Kerato-conjunctivitis Sicca)

    • Caused by tear deficiency or excessive tear evaporation.
    • Damages the ocular surface and causes discomfort
    • Symptoms worsened by: dry air, wind, dust, smoke.
    • Originates from dysfunctional components such as tear-producing glands, meibomian glands, and eyelids, in their integrated functions.

    Tear Physiology - Composition

    • Tears are a mixture of: water, lipids, salts, mucins, immunoglobulins, antimicrobial proteins, growth factors.

    Tear Physiology - Structure

    • Inner layer: mucins adhere to the corneal epithelium.
    • Middle layer: aqueous/mucin phase
    • Outer Layer: lipids.

    Tear Production

    • Tears are produced by lacrimal glands, ocular surface epithelium, conjunctiva's goblet cells (inner/middle layer) and meibomian glands (outer lipid layer).

    Dry Eye Syndrome - Prevalence

    • 7.5% of people in their 50s, increasing to 15% in their 70s.
    • Women are 50% more likely to be affected.

    Dry Eye Syndrome - Symptoms

    • Both eyes affected.
    • Foreign body sensation, irritation, soreness.
    • Poor contact lens tolerance.
    • Sufferers may not report dry eyes, but discomfort or blurring.
    • Transient vision disturbance due to loss of surface moisture.
    • Photophobia may occur.

    Dry Eye Syndrome - Treatment

    • Artificial tears (hypromellose is a common form in the UK).
    • Use tears at 30-minute intervals initially, decrease frequency as symptoms improve.
    • Preserve-free preparations are preferred if more than 6 applications are required per day due to potential irritants, especially in benzalkonium chloride.

    Lubricants for Dry Eye

    • Eye ointments (paraffin or paraffin + lanolin, e.g., simple eye ointment, Lacri-Lube, Lubri-Tears) are useful at bedtime.
    • Not ideal for daytime use (blurs vision).
    • Remove contact lenses before applying ointment.

    Summary of OSPAP Programme

    • Identify key eye disorders.
    • Assess for referral criteria.
    • Recommend appropriate OTC eye preparations.
    • Advise patients on eye conditions.

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    Test your knowledge on blepharitis and conjunctivitis with this quiz. Explore symptoms, treatment options, and important distinctions between various types of eyelid inflammation. Perfect for students in ophthalmology or those interested in eye health.

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