Eye problems: the painful red eye

Conjunctivitis is one cause of a painful red eye .

What you should know

Causes of painful red eye-

Conjunctivitis (Infective, Allergic)-

-Corneal ulcers

Kearatitis-

Glaucoma-

One or both eyes affected?

What is the appearance of the eye?

What are the symptoms – pain, gritty feeling, and photophobia?

Is vision affected?

Any discharge from the eye/s – purulent, watery?

Does the patient wear contact lenses?

Significance of questions and answers

Conjunctivitis

The term conjunctivitis implies inflammation of the conjunctiva,

which is a transparent surface covering the white of the eye. It can

become inflamed due to infection, allergy or irritation.

Infective conjunctivitis

-Both bacteria and viruses can cause conjunctivitis .

The symptoms are-

A painful gritty sensation and a discharge. The discharge is sticky an

purulent in bacterial infections and more watery in viral infections. It

nearly always affects both eyes .

Management. Infective conjunctivitis is treated with antibacterial eye drops and ointment. Both bacterial and viral infections are treated in the same way. In viral infections the drops will prevent secondary infections.

A typical course of treatment would be to use chloramphenicol -eye drops every 2 h for the first 24 h and then four times daily, with chloramphenicol eye ointment applied at night for the following week.

Allergic conjunctivitis

This produces irritation, discomfort and a watery discharge.( hay fever season.)

Management. In seasonal allergic conjunctivitis, decongestant and

antihistamine drops can be helpful and sodium cromoglicate (sodium

cromoglycate) eye drops is an effective .

Corneal ulcers

-The cornea is the transparent covering over the front of the eye

-These may be due to an infection or a traumatic abrasion. The main

symptom is that of pain.

Early diagnosis is important as the cornea can become permanently-

scarred, with loss of sight

Keratitis

) Inflammation or infection of the cornea (often presents with a unilateral, acutely painful red eye and the patient complaining of photophobia. It may be caused by HSV or occasionally, a bacterial infection.

Glaucoma

-it when the pressure of the fluids within the eye becomes abnormally high. This may either happen suddenly or develop slowly and insidiously; two different abnormalities are involve.

- It is the sudden onset type (acute closed-angle glaucoma that causes a sever painful red eye. Emergency hospital referral is necessary.

whereas 2% of people over 40 suffer from primary open-angle glau- (chronic simple glaucoma). This condition starts slowly and insidiously, without warning symptoms. As the intra -occular pressure builds up, the optic nerve is damaged, which leads to loss of visual field, and blindness if not treated.

- Chronic glaucoma can be detected by an examination at the optician. Regular check-ups are advised if there is a family history of glaucoma, especially in those over 40.

Contact lenses

-There are two main types of lens: hard (gas-permeable) and soft (hydrogel). Soft lenses are the most popular because of their comfort.

-patients keeping lenses in for longer periods of time. Extended wear involves much greater risks and increases the chances of complications such as ulcerative keratitis, Acanthamoeba keratitis and papillary conjunctivitis.

-One-day disposable lenses, which are worn once and require no maintenance or storage, are becoming increasingly popular.

-Contact lenses should not be worn if the patient has conjunctivitis or is using eye drops.

Common ear problems.

-We need examining the inside of the ear (with an auriscope or otoscop) and seeing how the ear looks. So referral to the doctor is therefore advisable. Ear problems that commonly present are described below

What you need to know

Wax / Otitis externa/ Otitis media/ Glue ear

One or both ears affected?

Symptoms – pain, itching

Is there any hearing loss?

Significance of questions and answers

Wax

Symptoms

Wax blocking the ear is one of the commonest causes of temporary deafness. It may also cause discomfort and a sensation that the ear is blocked.

Management

Ear drops. using ear drops e.g. olive oil. The drops should be warmed before use (ideally to body temperature). With the head inclined, five drop should be instilled. A cotton wool plug should be applied to retain the fluid and be kept in for at least 1 h or overnight. This procedure should be repeated at least twice a day for 3 days.

Otitis externa

Otitis externa (OE) involves inflammation and infection of the skin in the ear canal, it can be precipitated by ear trauma (scratching, swimming (especially in polluted water); chemicals (hairspray,); skin conditions (eczema, seborrhoeic dermatitis, psoriasis).

-OE is five times more common in swimmers than in non-swimmers. &more frequent in hot and humid environments and is ten times more common in summer .

Symptoms

The symptoms of OE are usually pain and discharge. Refer

-For people who are prone to recurrent OE the following advice is

Helpful

.Try not to let soap or shampoo get into your ear canal. While having-

a shower, you can do this by placing a piece of cotton wool coated in

soft white paraffin (e.g. Vaseline) in the outer ear.

-Silicone rubber earplugs may be helpful to keep the ears dry whilst

you swim.

Do not use corners of towels or cotton buds to dry any water that-

does get in the ear canal. This will push things further in. Let it dry

naturally

.Try not to scratch or poke the ear canal with fingers, cotton wool-

towels, etc

.Do not clean the ear canal with cotton buds. They may scratch and-

irritate, and push wax or dirt further into the ear. The ear cleans itself

and bits of wax will fall out now and then.

Otitis media

Otitis media is an infection of the middle ear compartment- .

-An infection typically starts with a common cold, especially in

children, which leads to blockage of the Eustachian tube and fluid

within the middle ear. The fluid can then be secondarily

infected by a bacterial infection

Symptoms

The symptoms of otitis media are pain and temporary deafness as with OE, referral is usually necessary.

Glue ear

Some children who are subject to recurrent otitis media develop glue

ear. This occurs because the fluid that forms in the middle ear does not

drain out completely. The fluid becomes tenacious and sticky. Refer

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