Sore dry eyes & eyelids signs etc for professionals
Treatment copy and paste
treatment for dry eye
- Hyloforte hourly
- VitApos night
- get more from GP if help, reduce if eyes comfortable, increase if sore
- read page http://www.goodhopeeyeclinic.org.uk/sore%20dry%20eye.htm
- healthy diet, with vegetables, fish, and possibly Vitamin D
- reduce doses of omeprazole and lansoprazole
- very dry: there are many alternative drops, but thophthalmic eye outpatient clinic
- 1 drop of (1-) 2% fluorescein in medial canthus
- wait 3 minutes
- look at tear film for dry eye
- wait 13 minutes (10 more), dye should have cleared (no sac washout needed...patent)
- if eye sticky..cotton bud over lacrimal sac after fluorescein and look for seidels from canaliculus
- Symptoms. Gritty, dry, (Ache) sore, discharge, itch
- History..muco-cutaneous disease and other problems
- Symptoms questionnaire
- Pain , vision, how long, burning, what triggers the problem,
- sensitive to wind...hypoalgesia, light hurts..alodynia to light: bBoth are markers of neuropathic pain
- epression, anxiety, people with backache and other pains feel more eye pain
- orparicaine..rate pain when instilled..if reduded, indicates a corneal problem, if not,central pain mechanism
- In some persistent cases, think nerve dysfunction
- Nerve problem..patients need explanation
- Pain specialsit treatment pregabelin etc, tricyclic, tens..did help,
- nerve.... inject with steroid and anaesthetic..if peripheral nerve injury (eg lots of nasty surgery)
- Botulinum toxin: use migraine protocol forehead injections
- Emotional response to pain more in some people...cortical pathways difference, cbt, relaxation, etc
- pressure: Icare best, no anaesthetic , lights on,
- For lids
- schirmers before anaesthetic
- papillae..look under lid
- press on lid for secretions,
- if fluorescein negative lissamine green
- Culture all ulcers even tiny
- Canaliculitis causes recurrent conjunctivitis
- Deep set etc eyes giant fornix
- Lissamine green best conjunctival stain
- none invasive break up time, staining
- Interstitial keratits, infective and none infective
- the lipid layer is the anterior tear film
- look for parallel conjunctival folds in dry eye, common in dry eyes
- Meibomianitis is present in most dry eye patients
- Vitamin a deficiency?
- Ocular surface disease index questionnaire..ask patient to complete
- Blink rate
- Lid margin staining
- folds of conjunctiva (can surgicaly take a strip off)
- Shirmers no anaesthetic.tear break up time,
- floppy lids
- sleep apnea or still sore cover eyes at night with cling film or shield
- Mucous fishing syndrome: Lubricants steroids no fishing
- Optimal environment: no baby shampoo, use blepharaclean wipes, or plain water,
Hot bathing ,
- types: evaporative, aqueous deficient, or mixed 2019
- test for dry eye...no ptosis surgery if dry
- ice test..put ice on closed eyelid, for 2 minutes, in myasthenia (MG)the ptosis recovers
- if reduced eye movements..CPEO?
- Cogans twitch..look down for 20 secons...if ou look down for 20 seconds andt hen look up, lid overshoots for a second = MG
- test for dry eye...no ptosis surgery if dry
- tetracaine ...local anaesthetic for sac washout (SWO)
- inject tetracaine first as part of SWO
- any loss of sensation...?SOL
- 7th and 5th ? SOL
- loss of lashes ?BCC
- cannot look up..one of the first signs TED
- ? giant papillary conjunctivitislook down, see palpebral lacrimal gland
- obese/snore/sleep apnoea
- review BJO 16 : pain much greater than signs AJO 16
- chronic pain BJO 17 neuopathic pain Ophth 17 OS18
Dysfunctional pain 'pain without stain' ..there are two groups (Rauz OSM16)
- First group: there may be maladaptive pain, with treatment including counselling
- Second Group:
- the cornea shows sensory amplification due to aberrant nerve regeneration, collateral sprouting, branching tortuosity neuronal formation, beading, and this is seen on confocal micorsopy.
- treat as ocular surface pain
- treat the neuropathic element
- Therapeutic hard scleral lens does help
- Counselling, what's happening at home
- Drugs amitrytyline, duloxetine, gabapentin, pregablin
- Pain without stain
- Serum eye drops
|NHS Blood Transfusion Service|
This is a more serious condition, and an ophthalmologist should give you specific advice. The eye is prone to develop ulcers and infections.
- Punctal occlusion is essential, but scarring may cause this naturally.
- Some patients with severe filamentary keratitis need plugs and special contact lenses, see.
- Serum drops for severe cases. This should be considered in patients with severe ocular pemphigoid or alkali burns etc. Contact jean.harrison at nbs.nhs.uk.
- Blood orained from a finger prick with a lancet (as used to test blood sugar) can be very helpful (Eye17)
- Serum free eye drops Eye 18 College Guidelines
- Pilocarpine 5 mg once day increasing to 4-6 times a day may help.
- Spectacles increase humidity.
- Moisture googles will help: sealed chamber, steam.
- Check Vitamin A:
- Night blind... can you see stars, cinema, more prolonged.
- Poor countries supplement e.g. vit A in sugar has reduced corneal melting and ulcers lot.
- In developed world malnutrition, anorexia, autism, or malabsorption cirrhosis, cystic fibrosis, bariatric surgery, depression may cause or contribute to Dry eyes, and bilateral corneal melt.
- classified etiologically 35.5%, 20.6% and 39.9% of patients had evaporative, aqueous deficient and mixed type of DED, respectively. see 19