1. Caring for patients with inflammatory diseases of the eye.
Lecturer: Lilya Ostrovska

2. 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.

3. 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

4. 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

6. VISUAL FUNCTIONS: Peripheral vision (rods are response) includes:
Light sensitivity
Field of vision
Central vision (cones are response) includes:
Visual acuity
Colour vision

7. 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

8. EYELID ANATOMY
The eyelids layers: skin muscle tarsus conjunctiva

9. 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

10. 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

11. Complications: corneal epitheliopathy scarring marginal keratitis reccurent bacterial conjunctivitis chalazia styes loss of lashes (madarosis) misdirection (trichiasis)

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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.

18. Lacrymal system anatomy:
Larcymal productive part & Lacrymal excretory part

19. 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

20. 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

21. 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

22. 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

23. 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

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

25. + (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

26. 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

27. Causes The leading cause of a red, inflamed eye is viral infection
A number of different viruses can be responsible
Causes

28. Vary from moderate to severe
Signs & symptoms

29. Eye redness (hyperemia) is a common symptom 
Signs & symptoms

30. Swollen, red eyelids
Signs & symptoms

31. More tear production in the eyes than usual
Signs & symptoms

32. Make you feel as though there is something in the eye
Signs & symptoms

33. An itching or burning sensation
Signs & symptoms

34. Sensitivity to light (photophobia)
Signs & symptoms

35. 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

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

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

38. Prevention Highly contagious
Spread by direct contact with infected people
Prevention

39. Proper washing and disinfecting can help prevent the spread
Prevention

40. Wash your hands frequently, particularly after applying medications to the area
Prevention

41. Avoid touching the eye area 
Prevention

42. Never share towels or hankies
Prevention

43. Throw away tissue after use
Prevention

44. Change bed linen and towels daily if possible
Prevention

45. Disinfect all surfaces, including worktops, sinks and doorknobs
Prevention

46. Avoid shaking hands with person suffering from conjunctivitis
Prevention

47. If you are sick, then limit your contact with other people
Prevention

48. 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

49. To reduce pain from conjunctivitis use a cold or warm compress on the eyes
Easing Symptoms

50. 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?

51. Bacterial conjnctivitis

52. 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

53. Clinical Photograph of Episcleritis
From Dr Sanjay Shrivastava’s collection

54. Clinical Photograph of Episcleritis (under treatment)
From Dr Sanjay Shrivastava’s collection

55. Clinical Photograph of Scleritis
From Dr Sanjay Shrivastava’s collection

56. KERATITIS

57. Iritis

58. cyclitis

59. iridocyclitis

60. choroiditis

61. choroiditis

62. ANTERIOR UVEITIS

63. nodules

64. Synechiae posterior

65. 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)

66. 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.

67. 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.

68. THANK YOU FOR ATTENTION !