Transcript 01 Caring for patients with inflammatory diseases of the eye

Caring for patients with
inflammatory diseases of
the eye.
Lecturer: Lilya Ostrovska
Visual organ consists from:
1) peripheral part – eyeball with ocular adnexa;
2) guiding pathway – optic nerve, chiasm, optic tract;
3) undercortex centers – lateral geniculare nucleus and
optic radiation;
4) higher visual centers in the occipital cortex.
Structure of Visual Analisator
1 - retina,
2 - optic nerve (non-crossed fibers),
3 - optic nerve (crossed fibers),
4 - optic tract,
5 - lateral geniculare nucleus,
6 - radiatio optici,
7 - lobus opticus
EYEBALL
I. External (structural) layer – cornea & sclera;
II. Middle (vascular) layer – iris, ciliary body & choroid;
III. Internal layer – retina.
Internal nucleus of the eye includes: lens, vitreous & aqueous
humor, which fill in eye chambers.
The eyes lie within two bony cavities, or orbits.
OCULAR ADNEXA :

Lacrimal gland & excretory system

Oculomotor apparatus

Eyelids

Conjunctiva
OPTICAL SYSTEM of the EYE:

Cornea

Aqueous humor

Lens

Vitreous
VISUAL FUNCTIONS:
Peripheral vision (rods are response) includes:
Light sensitivity
Field of vision
Central vision (cones are response) includes:
Visual acuity
Colour vision
Visual acuity transcription
20 feet equivalent 6 meter equivalent 5 meter equivalent
(USA)
(Great Britain)
(Ukraine)
20/20
20/25
6/6
6/7.5
1,0
0,8
20/40
20/60
6/12
6/18
0,5
0,3
20/200
6/60
0,1
EYELID ANATOMY
The eyelids layers:
skin
muscle
tarsus
conjunctiva
BLEPHARITIS
very common chronic inflammation of the eyelid margins
Classification: divided into anterior &
posterior forms: the former may be
staphylococcal or seborrhoeic; a mixed
picture is typical, however.
Causative factors:
staphylococcal: chronic infection of the
bases of the lashes – common in patients
with eczema
seborrhoeic: usually associated with
seborrhoeix dermatitis – involves excess
lipid production by eyelid glands,
converted to fatty acids by bacteria
posterior: dysfunction of the meibomian
glands of the posterior lid margins –
common in patients with acne rosacea
Clinical features: usually worse in the morning,
include grittiness, burning and redness, stickiness
and crusting of the lids.
SIGNS:
staphylococcal: dandruff-like scaling, mainly around
the eyelash bases;
seborrhoeic: greasy debris around the lashes
causing them to adhere to one another;
posterior: frothy tear film and pluggung of the
meibomian gland orifices
All types usually manifest hyperaemia of the lid
margins and conjunctiva, and tear film instability
Complications:
corneal epitheliopathy
scarring
marginal keratitis
reccurent bacterial conjunctivitis
chalazia
styes
loss of lashes (madarosis)
misdirection (trichiasis)
Management:
 lid margin hygiene using a weak solution or baby
shampoo
 tear substitutes (e.g. hypromellose, carbomers)
 antibiotic ointment (e.g. fusidic acid,
chloramphenocol) rubbed into the lid margins
 systemic tetracycline
Meibomian cyst (chalazion)
a lesion consisting of lipogranulomatous inflammation
centred on a dysfuctional meibomian gland
Clinical features:
Extremely common,
particularly in patients with
posterior blepharitis.
A chronic, usually solitary,
painless, firm swelling in the
tarsal plate;
Management: spontaneous
Can follow an acute
resolution may occur, although
meibomian gland infection.
usually only if the lesion is
May be assosiated with a
small. Surgical incision and
secondary conjunctival
curettage is often required
granuloma
INTERNAL HORDEOLUM (acute chalazion)
an acute bacterial meibomian gland infection
Clinical features:
Management:
An inflamed swelling within the
Topical antibiotic ointment
tarsal plate which may be
and systemic antibiotic
associated with (mild)
(e.g. flucloxacillin) for
preseptal cellulitis
preseptal cellulitis.
Hot bathing may promote
discharge.
Incision and curettage
Incision and curettage
may be required for a
large abscess, or for
secondary chronic lesion.
EXTERNAL HORDEOLUM (stye)
a small abscess of an eyelash follicle
Management:
Removal of the associated
lash, and hot bathing.
Topical antibiotic ointment.
Large lesions may require
incision
Clinical features:
An acute painful inflamed
swelling on the anterior lid
margin, usually pointing
through the skin
Cysts of Zeis and Moll
Clinical features:
A cysts of Zeis is a small, whitish,
chronic, painless opaque
nodule on the lid margin
A cysts of Moll is similar but
translucent
Management:
simple excision
MOLLUSCUM CONTAGIOSUM
Clinical features: single or multiple, small, pale, waxy
umbilicated nodules, which may cause a secondary
chronic ipsilateral follicular conjunctivitis. These virally
transmitted lesions are common and more severe, in
AIDS patients.
Management: expression or cautery.
Larcymal productive part &
Lacrymal excretory part
Lacrymal system anatomy:
Investigation of lacrymal system
Functional ability of lacrymal
excretory system – 1%
Fluorecsein is dropped into
conjunctival cavity
Positive canalicular test –
disapearing of S. Fluorecsein
from conjunctival cavity till 5
minutes, usually 1-2 minutes
Positive nose test – appering of
S. Fluorecsein in 5 minutes
Shirmer test
Reveals hyposecretion of lacrymal
gland – wetting of filter paper less then
15 mm
DACRYOADENITIS –
inflammation of lacrymal gland
Clinical features: hyperemia, oedema and pain in upper-external
part of orbit
Eyeball can be dislocated down and nasally
Prearicular lymph nodes are increased and painfull
Increased body temperature
Key sign – S-like form of rima ophthalmica
Management: systemically antibiotics, sulfanilamids, salicilates
In abscess – incision and
DACRYOCYSTITIS –
inflammation of lacrymal sac
Ethiology: in infants – atresia of lower part of nasolacrymal duct;
in adults – stenosis of nasolacrymal duct
Clinical features: exess tearing, pus discharge usually from one
eye
Key sign – pus discharge from lower lacrymal point in palpation of
area of lacrymal sac
Management: in infants – massage of lacrymal sac
Syringing of lacrymal excretory ways
Dreanage of lacrymal excretory ways
Chonic in adults – surgical - dacryocystorhinostomy
Orbital cellulitis
Signs:
eyelids oedema
chemosis
proptosis
limiting of eye movements
decreasing of visual acuity
general intoxication (headacke,
increased temperature, brain signs).
Optic neuritis, papilloedema, central
vein occlusion may occur with
outcome in optic atrophy.
Management:
incision of orbit with drainage
antibiotics systemically
osmotherapy
Tumour, haematoma, foreign body in the area of fissura
orbitalis
superior usually causes:
Fissura
orbitalis
superior
syndrome
Proptosis
Ptosis
Ophthalmoplegy
Mydriasis
Paralysis of accomodation
Decreasing of corneal sensitivity and skin
sensitivity in the area of innervation of I branch
n.trigeminus
TYPES of INJECTION of EYEBALL:
1. Superficial or conjunctival;
2. Deep or ciliary or pericorneal;
3. Mixt
DIFFERENTIAL DIAGNOSIS of
INFLAMMATORY DISEASES OF EYE ANTERIOR SEGMENT
Sign
red eye
conjunctivitis
+
(superficial
injection)
keratitis
+
(deep or mixt
injection)
iridocyclitis
+
(deep or mixt
injection)
corneal
syndrome
+
+
+
pain
-
+
+
(in daytime)
(at night, incresing in
lighting & palpation)
decreased
visual acuity
-
+
+
peculierities
discharge
corneal infiltrate
keratic precipitates,
posterior synechiae,
miosis, vitreous
opacities
 Madras eye
 Pink eye
 Eye flu
Conjunctivitis
It is redness &
inflammation of the
membranes
covering the whites
of the eyes and on
the inner part of the
eyelids.
 The leading cause of a red,
inflamed eye is viral infection
 A number of different viruses
can be responsible
Causes
 Vary from moderate to severe
Signs & symptoms
 Eye redness (hyperemia) is
a common symptom
Signs & symptoms
 Swollen, red eyelids
Signs & symptoms
 More tear production in the
eyes than usual
Signs & symptoms
 Make you feel as though
there is something in the
eye
Signs & symptoms
 An itching or burning
sensation
Signs & symptoms
 Sensitivity to light
(photophobia)
Signs & symptoms
Creamy white or
thick yellow
Signs
&
symptoms
drainage that causes
the eyelids to be
red,
puffy, or stick
together in the
morning may
indicate a bacterial
infection
A doctor can
usually diagnose
Diagnosis
conjunctivitis by its
distinguishing
symptoms
However a slit
lamp examination
may be required
Persistent
When conjunctivitis means something more
conjunctivitis can
be a sign of an
underlying illness
in the body
Highly contagious
Spread
by direct
Prevention
contact with
infected people
Proper washing and
disinfecting can
Prevention
help prevent the
spread
Wash your hands
frequently,
Prevention
particularly after
applying
medications to the
area
Avoid touching the
eye area
Prevention
Never share towels
or hankies
Prevention
Throw away tissue
after use
Prevention
Change bed linen
and towels daily if
Prevention
possible
Disinfect all
surfaces, including
Prevention
worktops, sinks and
doorknobs
Avoid shaking
hands with person
Prevention
suffering from
conjunctivitis
If you are sick, then
limit your contact
Prevention
with other people
 Viral conjunctivitis has
no treatment - you just
have to let the virus
run its course, which is
usually four to seven
days
 Bacterial conjunctivitis
is treated with
antibiotic eye drops,
ointment or tablets to
clear the infection
Treatment
 To reduce pain from
conjunctivitis use a
cold or warm compress
on the eyes
Easing Symptoms
 Conjunctivitis is
infectious from around
the time symptoms
appear until the time
when the symptoms
have resolved
How long its contagious?
Bacterial conjnctivitis
EPISCLERITIS AND SCLERITIS
1. Episcleritis
• Simple
• Nodular
2. Anterior scleritis
•
•
•
•
Non-necrotizing diffuse
Non-necrotizing nodular
Necrotizing with inflammation
Necrotizing without inflammation
( scleromalacia perforans )
3. Posterior scleritis
Clinical Photograph of Episcleritis
From Dr Sanjay Shrivastava’s collection
Clinical Photograph of Episcleritis
(under treatment)
From Dr Sanjay Shrivastava’s collection
Clinical Photograph of Scleritis
From Dr Sanjay Shrivastava’s collection
KERATITIS
Iritis
cyclitis
iridocyclitis
choroiditis
choroiditis
ANTERIOR UVEITIS
nodules
Synechiae posterior
CLINICAL FEATURES of ENDOPHTHALMITIS:




+


red eye (mixt injection);
corneal syndrome;
reducing of visual acuity;
pain
hypopion (pus in the anterior chamber);
abscess of vitreous (yellow fundus reflex)
CLINICAL FEATURES of PANOPHTHALMITIS:






+


red eye (mixt injection);
corneal syndrome;
reducing of visual acuity;
pain;
hypopion;
abscess of vitreous
imbibition of cornea by pus
purulent choroidoretinitis (with visual field defects & fundus patches if
seen)
LOCAL ANTIBACTERIAL TREATMENT:
drops - S.Sulfacili Na 30 %,
S.Dimexidi 10 %,
S.Gentamycini 0,3 %,
S.Laevomycetini 0,25 %,
S.Polymixini B 0,25 %,
S.Tobramycini 0,3 %,
S.Chlorhexidini 0,02 %,
S. Ciprophloxacini 0,3 %,
Сiloxani
Uniflox
Vigamox
Oftaquix etc.
ointments – Ung. Tetracyclini 1 %,
Ung. Tobramycini 0,3 %,
Ung. Erythromycini 1 %
“Floxal” etc.
LOCAL ANTIVIRAL TREATMENT:
drops -Interferoni,
Reaferoni,
Laferoni,
Viaferoni,
Interlok
IDU,
S. Florenali 0,1 %,
S. Oxolini 0,1 %,
S. tebrofeni 0,1 %
Virgan etc.
ointments – Ung. Florenali 0,5 %,
Ung. Oxolini 0,25 %,
Ung. Tebrofeni 0,5 %,
Ung. Acycloviri 5 % (or Zovirax or Verolex) etc.
THANK YOU FOR ATTENTION !