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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
EYEBALLI. 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 sensitivityField of vision
Central vision (cones are response) includes:Visual acuityColour vision
Visual acuity transcription
20 feet 20 feet equivalentequivalent
(USA)(USA)
6 meter 6 meter equivalentequivalent
(Great Britain)(Great Britain)
5 meter 5 meter equivalentequivalent
(Ukraine)(Ukraine)
20/2020/20 6/66/6 1,01,0
20/2520/25 6/7.56/7.5 0,80,8
20/4020/40 6/126/12 0,50,5
20/6020/60 6/186/18 0,30,3
20/20020/200 6/606/60 0,10,1
EYELID ANATOMY
The eyelids layers:skinmuscletarsusconjunctiva
BLEPHARITISvery 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: Clinical features: usually worse in the morning, usually worse in the morning, include grittiness, burning and redness, stickiness include grittiness, burning and redness, stickiness and crusting of the lids.and crusting of the lids.SIGNSSIGNS::staphylococcalstaphylococcal:: dandruff-like scaling, mainly around the eyelash bases;seborrhoeicseborrhoeic:: greasy debris around the lashes causing greasy debris around the lashes causing them to adhere to one anotherthem to adhere to one another;;posteriorposterior:: frothy tear film and pluggung of the frothy tear film and pluggung of the meibomian gland orificesmeibomian gland orifices
All types usually manifest hyperaemia of the lid margins and conjunctiva, and tear film instability
Complications:corneal epitheliopathyscarringmarginal keratitisreccurent bacterial conjunctivitischalaziastyesloss 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;
Can follow an acute meibomian gland infection.
May be assosiated with a secondary conjunctival granuloma
Management: spontaneous resolution may occur, although usually only if the lesion is small. Surgical incision and curettage is often required
INTERNAL HORDEOLUM (acute chalazion)an acute bacterial meibomian gland infection
Clinical features:An inflamed swelling within the
tarsal plate which may be associated with (mild) preseptal cellulitis
Management:Topical antibiotic ointment
and systemic antibiotic (e.g. flucloxacillin) for 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
Clinical features:An acute painful inflamed
swelling on the anterior lid margin, usually pointing through the skin
Management:Removal of the associated
lash, and hot bathing.Topical antibiotic ointment.Large lesions may require
incision
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.
Lacrymal system anatomy:Larcymal productive part &
Lacrymal excretory part
Investigation of lacrymal systemFunctional 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 nasallyPrearicular lymph nodes are increased and painfullIncreased body temperatureKey sign – S-like form of rima ophthalmicaManagement: systemically antibiotics, sulfanilamids, salicilatesIn 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 oedemachemosisproptosislimiting of eye movementsdecreasing of visual acuitygeneral intoxication (headacke,
increased temperature, brain signs).Optic neuritis, papilloedema, central
vein occlusion may occur with outcome in optic atrophy.
Management:incision of orbit with drainageantibiotics systemicallyosmotherapy
Fissura orbitalis superior syndrome
Tumour, haematoma, foreign body in the area of fissura orbitalis superior usually causes:
ProptosisPtosisOphthalmoplegyMydriasisParalysis of accomodationDecreasing of corneal sensitivity and skin sensitivity in the area of innervation of I branch n.trigeminus
TYPES of INJECTION of EYEBALLTYPES of INJECTION of EYEBALL::1.1.Superficial Superficial or conjunctivalor conjunctival;;2.2.Deep Deep or ciliary or pericornealor ciliary or pericorneal;;3.3.MixtMixt
DIFFERENTIAL DIAGNOSIS of INFLAMMATORY DISEASES OF EYE ANTERIOR SEGMENT
SignSign conjunctivitisconjunctivitis keratitiskeratitis iridocyclitisiridocyclitis
red eyered eye + + (superficial (superficial injection)injection)
+ + (deep or mixt (deep or mixt injection)injection)
+ + (deep or mixt (deep or mixt injection)injection)
corneal corneal syndromesyndrome
++ ++ ++
painpain -- ++(in daytime)(in daytime)
++(at night, (at night,
incresing in incresing in lighting & lighting & palpation)palpation)
decreased decreased visual acuityvisual acuity
-- ++ ++
peculieritiespeculierities dischargedischarge corneal infiltratecorneal infiltrate keratic keratic precipitates, precipitates,
posterior posterior synechiae, miosis, synechiae, miosis, vitreous opacitiesvitreous opacities
Conjunctivitis
Madras eyePink eyeEye flu
It is redness & inflammation of the membranescovering the whites of the eyes and on the inner part of the eyelids.
Causes The leading cause of a red,
inflamed eye is viral infection A number of different viruses
can be responsible
Signs & symptoms 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 & symptomsCreamy white or
thick yellow drainage that causes the eyelids to be red,puffy, or stick together in the morning may indicate a bacterial infection
DiagnosisA doctor can
usually diagnose conjunctivitis by its distinguishing symptoms
However a slit lamp examination may be required
When conjunctivitis means something morePersistent
conjunctivitis can be a sign of an underlying illness in the body
Prevention Highly contagiousSpread by direct
contact with infected people
Prevention Proper washing and
disinfecting can help prevent the spread
Prevention Wash your hands
frequently, particularly after applying medications to the area
Prevention 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 possible
Prevention Disinfect all
surfaces, including worktops, sinks and doorknobs
Prevention Avoid shaking
hands with person suffering from conjunctivitis
Prevention If you are sick, then
limit your contact with other people
TreatmentViral 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
Easing SymptomsTo reduce pain from
conjunctivitis use a cold or warm compress on the eyes
How long its contagious?Conjunctivitis is
infectious from around the time symptoms appear until the time when the symptoms have resolved
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 ENDOPHTHALMITISCLINICAL FEATURES of ENDOPHTHALMITIS:: red eye red eye ((mixmixtt injection) injection);; corneal syndromecorneal syndrome;; reducing of visual acuityreducing of visual acuity;; painpain++ hypopionhypopion (pus in the anterior chamber) (pus in the anterior chamber);; abscess of vitreousabscess of vitreous (yellow fundus reflex) (yellow fundus reflex)
CLINICAL FEATURES of PANOPHTHALMITISCLINICAL FEATURES of PANOPHTHALMITIS:: red eye red eye ((mixmixtt injection) injection);; corneal syndromecorneal syndrome;; reducing of visual acuityreducing of visual acuity;; painpain;; hypopionhypopion;; abscess of vitreousabscess of vitreous++ imbibition of cornea by pusimbibition of cornea by pus purulent choroidoretinitis (purulent choroidoretinitis (with visual field defects & fundus with visual field defects & fundus
patches if seen)patches if seen)
LOCAL ANTIBACTERIAL TREATMENTLOCAL ANTIBACTERIAL TREATMENT::
dropsdrops - S.Sulfacili Na 30 %, - S.Sulfacili Na 30 %,S.Dimexidi 10 %,S.Dimexidi 10 %,S.Gentamycini 0,3 %,S.Gentamycini 0,3 %,S.Laevomycetini 0,25 %,S.Laevomycetini 0,25 %,S.Polymixini B 0,25 %,S.Polymixini B 0,25 %,S.Tobramycini 0,3 %,S.Tobramycini 0,3 %,S.Chlorhexidini 0,02 %,S.Chlorhexidini 0,02 %,S. CiprophlS. Ciprophlooxacini 0,3 %,xacini 0,3 %,ССiloxaniiloxaniUnifloxUnifloxVigamoxVigamoxOftaquixOftaquix etc. etc.ointments ointments – Ung. Tetracyclini 1 %,– Ung. Tetracyclini 1 %,Ung. Tobramycini 0,3 %,Ung. Tobramycini 0,3 %,Ung. Erythromycini 1 % Ung. Erythromycini 1 % ““FloxalFloxal”” etc. etc.
LOCAL ANTIVIRAL TREATMENTLOCAL ANTIVIRAL TREATMENT::
dropsdrops - -IInterferoni,nterferoni,RReaferoni,eaferoni,LLaferoni,aferoni,VViaferoni,iaferoni,IInterlok nterlok IDUIDU,,S. S. FlorenalFlorenali i 0,1 %0,1 %,,S.S. OOxolini 0,1 %xolini 0,1 %,,S. S. tebrofeni 0,1 % tebrofeni 0,1 % VirganVirgan etc. etc.
ointments ointments – Ung. – Ung. FFlorenallorenalii 0,5 %, 0,5 %,Ung. Ung. OOxolini 0,25 %xolini 0,25 %,,Ung. Ung. TTebrofeni 0,5 %,ebrofeni 0,5 %,Ung. Ung. AcycloviriAcycloviri 5 % (5 % (or or ZoviraxZovirax or or Verolex) etcVerolex) etc.
THANK YOU FOR ATTENTION !