Eyes and Ears

Eyes and Ears

Eyes and Ears

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Conjunctivitis (Red Eye)

  • Common condition that causes redness and inflammation of the conjunctiva (layer of tissue that covers the front of the eye)

                                      Bacterial             Viral              Allergic

Eyes affected                 One or both         Both                Both

Discharge                       Purulent              Watery            Watery

Sensation                        Gritty feeling      Gritty feeling   Itching

Associated symptoms       None               Cold symptoms    Rhinitis

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Conjunctivitis: Treatment

  • Viral
    • Self-limiting - hygiene measures to prevent spread, e.g. washing hands, not sharing towels
  • Allergic
    • Mast cell stabilisers, antihistamines and sympathomimetics
  • Bacterial
    • Brolene and Golden eye - >12 years - 1-2 drops up to four times daily - if no improvement within 2 days see GP
    • Chloramphenicol eye drops/ointment - >2 years - drops: 1 drop every 2 hours for 48 hours, then 4 times daily for 5 days - ointment: apply 4 times daily if alone, or once daily at night if used with drops
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Blepharitis

  • Common conditions characterised by red, swollen eyelids
  • Itchy, sore eyelids
  • Crusty/greasy eyelashes
  • Gritty burning sensation
  • Abnormal eye lash growth or loss of lashes
  • Management - daily cleaning routine
    • use warm compress
    • massaging eyelid gently
    • cleaning eye lids (cooled boiled water and cotton buds)
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Dry Eye

  • Dry eyes occur when not enough tears are created or when tears evaporate too quickly
  • Symptoms
    • Dryness, grittiness or soreness
    • Burning and red eyes
    • Eyelids that stick together
    • Blurred vision which improves on blinking
    • Eye watering
  • Possible medication causes
    • Diuretics
    • Medicines with anticholinergic side effects, e.g. tricyclic antidepressants, antihistamines
    • Isotretinoin, SSRIs (Selective Serotonin Reuptake Inhibitors)
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Dry Eye: Treatment

  • Hypromellose & Carmellose
  • Wool fats
  • Polyvinyl Alcohol
  • Carbomers
  • Sodium Hyaluronate
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Ears

  • Sensory organ that controls hearing and balance
  • Three sections:
    • Outer ear
    • Middle ear
    • Inner ear
  • Outer, middle and inner ear are involved in hearing
  • Inner ear also involved in balance
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Ear Wax

  • A normal secretion from the ear canal from ceruminous glands
  • Purpose of ear wax
    • Protects tympanic membrane
    • Trap foreign particles and dust, protects lining of canal
    • Repel water
    • Bactericidal and fungicidal activity
  • Two main types
    • Wet, honey to dark brown
    • Dry, grey and flaky
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Excessive Ear Wax

  • One of the most common causes of temporary deafness
  • Wax normally migrates to outer ear - 'self-cleaning'
  • When it accumulates in the external auditory canal it can form a 'plug'
  • Ear wax can build up in all but especially:
    • People with lots of hair in the ear
    • Those with narrow ear canals
    • People who use hearing aids or ear plugs
    • Elderly - ear wax becomes drier
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Excessive Ear Wax: Symptoms

  • Discomfort
  • Feeling of fullness
  • Sensation that the ear is blocked
  • Gradual hearing loss (temporary) - wax affects sound passage (conductive hearing impairment)
  • Rarely
    • Itching
    • Pain
    • Tinnitus
    • Dizziness
  • Needs to be determined by examination
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Treatment - Cerumenolytics

  • Wax softening agents - can be used by all - no interactions - do not use cotton buds
  • Fixed and volatile oils (Olive oil, Almond oil, Arachis (peanut) oil, Earex, Cerumol)
  • Docusate sodium (Waxsol)
  • Sodium bicarbonate
  • Urea, hydrogen peroxide (Exterol, Otex)
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How to Use the Treatment

  • More comfortable if the drops are warmed to room temperature first
  • Hold in hands or place in warm (not hot) water
  • Lie down with the affected ear uppermost
  • Gently pull pinna back and up (pull down and back in children) to open the ear canal
  • Place correct number of drops into ear canal
  • Stay in position for about 5 minutes
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When to Refer

  • Trauma/history of surgery
  • Foreign body in ear canal
  • Where OTC treatments have failed - will need syringing
  • Ringing or dizzy sensation
  • Severe pain/earache
  • Fever and malaise in children
  • Presence of discharge
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Treatment - Irrigation

  • Syringing where drops alone do not clear ear wax
  • Body temperature water squirted into ear
  • Use ear drops 3-5 days to soften beforehand
  • Patients may feel dizzy after syringing
  • Contraindications
    • Perforated ear drum
    • Previous surgery for some ear problems
    • Unilateral deafness (deaf in other ear)
    • Grommets in place
    • Middle ear infection in previous 6 weeks
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Otitis Externa

  • Inflammatory condition of the pinna or outer ear canal - skin swells/tender to touch
  • Acute otitis externa symptoms
    • Pain
    • Discharge
    • Itch/irritation
    • External ear/canal appears red/swollen/eczematous
    • Deafness
    • No systemic symptoms
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Otitis Externa: Predisposing Factors

  • Ear trauma
  • Use of cotton buds/ear trauma
  • Syringing
  • Dermatitis
  • Chemicals (e.g. shampoo, hair dyes)
  • Excess moisture (e.g. frequent swimming)
  • Humid environments
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Otitis Externa

  • Acute localised (furunculosis)
    • Infected hair follicle in outer ear canal - swelling
  • Acute diffuse (<3 months)
    • 'Swimmer's ear'
    • More widespread inflammation of skin
    • Can have secondary bacterial/fungal infection
    • Contact dermatitis - irritant or allergen
  • Chronic (>3 months)
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Otitis Externa: Treatment

  • Diffuse Otitis External
    • Choline salicylate (Earex Plus)
    • Acetic acid, e.g. earcalm
  • Furunculosis 
    • Hot flannel
    • Oral analgesics
    • Oral antibiotics if severe
  • Referral criteria
    • Ear pain in children
    • Inflammation of pinna
    • Unsuccessful treatment
    • Impaired hearing
    • Mucopurulent discharge
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Otitis Media

  • Can affect one or both ears
  • 75% cases in children under 10 years
  • 1 in 4 children have Otitis Media before 10 years of age
  • Peak incidence: 3-6 years of age
  • Acute Otitis Media symptoms
    • Earache (otalgia)
    • Discharge (otorrhoea) if tympanic membrane perforates (sometimes relieves pain, heals naturally)
    • Children feel unwell
    • Hot, irritable, sleeplessness, ear pulling/rubbing, crying child - could be ear infection
    • Temporary deafness - conductive
    • Fever
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Otitis Media: Treatment

  • Most (80%) cases in children resolve within 3 days with no treatment
  • Aim is to reduce severity and duration of pain and other symptoms and prevent complications
  • Analgesia - e.g. paracetamol, ibuprofen
  • If severe or does not ease after 2-3 days may need antibiotics
  • Referral criteria
    • Recurrent infections
    • No improvement in 3 days
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