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

OPTICAL SYSTEM of the EYE: 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 (USA) 6 meter equivalent (Great Britain) 5 meter equivalent (Ukraine) 20/20 6/6 1,0 20/25 6/7.5 0,8 20/40 6/12 0,5 20/60 6/18 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; 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

Hot bathing may promote discharge. 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: Management: simple excision 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 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

Fissura orbitalis superior syndrome Tumour, haematoma, foreign body in the area of fissura orbitalis superior usually causes: Proptosis Ptosis Ophthalmoplegy Mydriasis Paralysis of accomodation Decreasing of corneal sensitivity and skin sensitivity in the area of innervation of I branch n.trigeminus Fissura orbitalis superior syndrome

TYPES of INJECTION of EYEBALL: Superficial or conjunctival; Deep or ciliary or pericorneal; Mixt

+ (superficial injection) + (deep or mixt injection) + - DIFFERENTIAL DIAGNOSIS of INFLAMMATORY DISEASES OF EYE ANTERIOR SEGMENT Sign conjunctivitis keratitis iridocyclitis red eye + (superficial injection) + (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 It is redness & inflammation of the membranes covering the whites of the eyes and on the inner part of the eyelids. Conjunctivitis

Causes 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 drainage that causes the eyelids to be red, puffy, or stick together in the morning may indicate a bacterial infection Signs & symptoms

A doctor can usually diagnose conjunctivitis by its distinguishing symptoms However a slit lamp examination may be required Diagnosis

When conjunctivitis means something more Persistent conjunctivitis can be a sign of an underlying illness in the body When conjunctivitis means something more

Prevention Highly contagious Spread 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 Prevention

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

How long its contagious? 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 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: 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 !