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• Bacterial conjuctivities.
○ Symptoms.
Lids stuck down in mornings.
Sensation of foreign body
Crusting.
Pseudomembranous discharge.
○ Management.
At least 7 days of either.
• Chloramphenicol ointment qds
• Chloramphenicol drops hourly
• Management.
○ No effective management.
○ May cause corneal scaring if severe.
○ Highly contagious due to aerosol transmission caused by blinking.
Isolation
Glasses/ ski goggles
• Catch droplets.
Scarred cornea.
Acute Iritis
• Symptoms.
○ Red eye
○ Blurred vision
○ Photophobia.
• Signs.
○ Small pupil.
May not react directly.
○ Irregular pupil.
If recurrent attacks.
○ Red eye.
Worse around cornea.
Compare with conjunctivitis.
○ Associated with HLAb27.
• Management.
○ Atropine
○ Steroids.
Corneal Ulcer
• Degree of severity of signs and symptoms depend on where in the cornea the ulcer is.
○ Ulcers in the peripheries cause less symptoms than central ulcers.
• Symptoms
○ Visual loss
○ Pain
○ Opacity
• Signs
○ Stains with fluorosceine.
○ Small pupil
○ Red eye.
Worse nearer ulcer.
• Investigating the corneal ulcer of unknown aeitiology.
○ Remove and culture contact lenses.
○ Triple scrape, culture and gram stain.
Viral
Bacterial
Fungal.
• Causative agents.
○ Contact lenses.
Rigid lens 0.0003%
Day wear soft lens 0.03%
Extended wear soft lens 3%
Daily disposables ?
○ Bacteria.
Positive cocci.
• Staphylococci
• Streptococci
Negative cocci.
• Neisseria
• Moraxella
Positive rods.
• Rarely found
Negative rods.
• Pseudomonas
• Enterobacteria
• Management of unknown ulcer.
○ Sterilise with intensive antibiotics.
Ciprofloxacin
Chloramphenicol
• Management.
○ Minimal wiped debridement.
○ Aciclovir ointment.
Five times a day for two weeks.
○ Rehabilitate eye.
Contact lens
Corneal transplant.
Acute Glaucoma.
• Due to high pressure in the eye.
• Aqueous humour unable to drain.
• Symptoms.
○ Very severe pain.
○ Nausea & vomiting
○ Profound loss of vision.
• Signs.
○ Stony, hard eye.
○ Minimal pupil reaction
○ Pupil mid – dilated.
Often difficult to spot.
○ Shallow anterior chamber.
On slit light exam
Difficult to spot.
• Management.
○ Break the attack.
Diamox IV
Pilocarpine 2%
Later
• Oral glycerol
• Mannitol
○ Prevent further attacks.
Iridotomy
Drop treatment
Drainage surgery.
Episcleritis.
• Clinical picture.
○ Segmental redness.
○ Pain
○ Vascular markings not obscured.
Scleritis.
• Clinical picture.
○ Segmental redness
○ Vascular markings not obscured.
○ Severe pain
○ Associated with connective tissue disease in 50% of cases.
• Management.
○ Urgent treatment with.
Steroids
NSAIDs.
• Management.
○ Protect from the well meaning ignorant giving steroids.
○ Lubrication.
Lacrilube nocte
Viscotears qds.
• Hourly if
○ Watching TV
○ Reading
○ Driving
○ Using computers
○ Fucithalmic acid.
Good for staphylococcal causes.
○ Tetracycline for rosacea.
Doxycycline 100 mg.
Treat for 6 months,