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61. Prevention of Ophthalmia Neonatorum

with conjunctival erythema, edema of the eyelids and ocular discharge? Causes of ON can be chemical, viral or bacterial? This guideline focuses on Ophthalmia Neonatorum caused by Chlamydia trachomatis and Neisseria gonorrhoeae and discusses best evidence-based practice to prevent, diagnose, and manage ON caused by these two pathogens? This document is intended for use by physicians, midwives, nurse practitioners, acute care and public health nurses who provide health care to newborns in British Columbia (...) for Chlamydia trachomatis and Neisseria gonorrhoeae? Currently erythromycin 0?5% ointment is the only ocular prophylactic agent approved in Canada and needs to be administered within one hour after birth? 3 Procedure to Administer 0.5% Erythromycin Ointment 1? Use gloves when administering erythromycin? 2? To prevent cross contamination, use a single-use tube of 0?5% erythromycin and discard remainder of tube after administering to both eyes? 3? Before administration, wipe each eyelid gently with sterile

2018 British Columbia Perinatal Health Program

63. Ciclosporin (Verkazia) - Conjunctivitis, Keratitis

by an inflammation of the conjunctivitis with corneal involvement and tissue remodelling including papillae formation. It was first described by Arlt in 1846 who reported 3 cases of perilimbal swelling in young patients. The association with springtime (vernal) reflects the seasonal increase in signs and symptoms of the condition, particularly the high prevalence in hot, arid environments. Affected individuals have disease flares frequently during spring months, but can have signs and symptoms year round (...) in line with the Note for Guidance on non-clinical local tolerance testing on medicinal products (CPMP/SWP/2145/00). Two of these studies used a CsA formulation with BAK and two used the CKC formulation. Briefly, 0.25, 0.5 and 1 mg/ml CsA eye drops were well tolerated in rabbits receiving multiple daily instillations (50 µL) at 4-hour and 90-minute intervals for 28 days. Slight signs of irritation mainly in nictitans membrane and eyelids were noted in all treated animals, as well as in animals

2018 European Medicines Agency - EPARs

64. Conjunctivitis medicamentosa

Conjunctivitis medicamentosa is a condition in which a drug applied to the eye as drops or ointment, a cosmetic or some other substance reaching the eye surface, causes an irritative or allergic reaction. Some drugs are more likely than others to create this problem, including some antiglaucoma agents and some antibiotics. It can also be caused by preservatives in the medication. The patient notices redness, stinging or burning and possibly eyelid swelling and/or blurred vision. Once recognised (...) , but individual susceptibility to conjunctivitis medicamentosa varies widely Symptoms Initial improvement in the original condition requiring treatment Then apparent deterioration despite proper compliance with regimen Irritation, ocular pain, stinging, burning, photophobia Ocular redness Lid swelling Blurred vision Signs Diffuse punctate staining of cornea and/or conjunctiva Chronic epithelial defects (due to toxic inhibition of epithelial healing) Sometimes: corneal oedema pseudodendrites disciform stromal

2019 College of Optometrists

65. Conjunctivitis (acute allergic)

provoking an immediate (Type I) IgE-mediated response Common in children Allergens include: grass pollen, animal dander Predisposing factors History of allergic disease; can also occur without such history Symptoms Sudden eyelid swelling Ocular itching May be unilateral (if a direct contact response) Signs Lid oedema and erythema Conjunctival chemosis (oedema): may bulge over lid margin or limbus Watery or mucoid discharge (mild) Usually no papillae No corneal involvement Differential diagnosis Seasonal (...) A, Sastre J, Montoro J, Jáuregui I, Dávila I, Ferrer M, Bartra J, Mullol J, Valero A. Allergic Conjunctivitis and H1 Antihistamines. J Investig Allergol Clin Immunol. 2009;19,Suppl.1:11-18 Lay summary Acute allergic conjunctivitis is an allergic reaction of the eyes, which causes a sudden swelling and redness of the eyelids and conjunctiva (the membrane covering the white of the eye), often associated with itching. It usually occurs in predisposed individuals, typically following exposure to grass

2019 College of Optometrists

66. Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD)

and respond to changes in respiration and circulation that may occur as a result of unintentional intravascular injections. Identification of a successful SGB is made by diagnosing temporary Horner’s syndrome occurring within 15 minutes of the procedure – a constricted pupil, weak and droopy eyelid, decreased sweating, and potential inset eyeball – which is recommended to be quantitatively graded by a third-party medical professional. 46 Regulation, Guidance, and Advocacy for SGB Ropivacaine (...) and emesis, paresthesia during needle positioning, pain at the injection site, varying rates of drowsiness, dizziness, or hoarseness based on the anesthetic used, increased pain, headache, dysphagia, hematoma, dyspnea, shivering, cold feeling, face swelling, mouth numbness, and blurred vision. The most prevalent complaint was pain at the injection site. Due to the small size of the included studies, Cochrane review authors could not draw conclusions regarding the safety of sympathetic blockades. WHO

2017 Veterans Affairs Evidence-based Synthesis Program Reports

67. Gonorrhoea

check in females • Pre-termination of pregnancy (TOP) • Pre-intrauterine device (IUD) insertion • Routine sexual health check in man who has sex with other men (MSM) • Signs or symptoms suggestive of gonorrhoea – Females: Vaginal discharge/dysuria/lower abdominal pain/abnormal bleeding/anal pain or discharge – Males: Urethral discharge/dysuria/testicular pain or swelling/anal pain or discharge Note: Most laboratories are automatically performing multiplex NAAT testing for chlamydia & gonorrhoea (...) Guidelines https://stipu.nsw.gov.au/wp-content/uploads/ STIGMA_Testing_Guidelines_Final_v5.pdf. Conjunctivitis • Culture is the recommended test. • Collect specimen by wiping a culture swab over the lower eyelid. • Collect an additional conjunctival chlamydia NAAT swab (gonorrhoea result may be given with dual chlamydia/gonorrhoea NAAT). Management • Dual therapy is recommended to delay anti-microbial resistance to gonorrhoea. • It is essential to check the susceptibility profile of the isolate to ensure

2017 New Zealand Sexual Health Society

68. Chlamydia

in last year – OR has had an STI in past 12 months – OR has a sexual contact with an STI • Pregnant • Increased risk of complications of an STI, e.g. pre-termination of pregnancy (TOP) • Signs or symptoms suggestive of chlamydia: – Females: Vaginal discharge / dysuria / lower abdominal pain/ abnormal bleeding / anal pain or discharge – Males: Urethral discharge / dysuria / testicular pain or swelling / anal pain or discharge • Requesting a sexual health check Note: Most laboratories are automatically (...) commonly has no signs or symptoms. Symptoms are non-specific. Females • Vaginal discharge, dysuria, lower abdominal pain, abnormal bleeding, anal pain or discharge. • Mucopurulent cervicitis with easily induced bleeding and/or signs of PID. • Urinalysis may show sterile pyuria. Males • Urethral symptoms including discharge, dysuria, urethral irritation, testicular pain or swelling, anal pain or discharge. • On examination, urethral discharge may be visible. • Signs or symptoms of epididymo-orchitis

2017 New Zealand Sexual Health Society

69. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

). Assess for lymphadenopathy, facial or distal extremity swelling (may be signs of drug-induced hypersensitivity syndrome [DIHS]/drug reaction with eosinophilia and systemic symptoms [DRESS]). Assess for pustules or blisters or erosions in addition to areas of “dusky erythema,” which may feel painful to palpation. To assess for a positive Nikolsky sign, place a gloved finger tangentially over erythematous skin and apply friction parallel to the skin surface. Nikolsky sign is positive if this results (...) in the nares, sores or discomfort in the oropharynx, odynophagia, hoarseness, dysuria, sores or discomfort in the vaginal area for women or involving the meatus of the penis for men, sores in the perianal area, or pain with bowel movements. ○ Physical examination: include vital signs and a full skin examination specifically evaluating all skin surfaces and mucous membranes (eyes, nares, oropharynx, genitals, and perianal area). Assess for lymphadenopathy, facial or distal extremity swelling (may be signs

2018 American Society of Clinical Oncology Guidelines

71. Conjunctivitis: Bacterial, Viral and Allergic

eyelashes A) Bacterial Warm compresses to unstick eyelids in morning Irrigate with sterile saline or eye wash to remove secretions and provide relief B) Viral Cold compresses to relieve irritation, redness C) Allergic Allergen avoidance if possible Avoid rubbing eyes Sunglasses reduce exposure outdoors Cold compresses over eye to relieve pruritus, swelling 2) Pharmacologic – OTC options Lubricating drops or ointments for all types A) Acute Bacterial Polymyxin B-gramicidin eye drops, 4-6 times per day (...) Conjunctivitis: Bacterial, Viral and Allergic Conjunctivitis: Bacterial, Viral and Allergic - medSask Home - College of Pharmacy and Nutrition - University of Saskatchewan Toggle Menu Search the U of S Search Conjunctivitis: Bacterial, Viral and Allergic Infectious or non-infectious Inflammation of the conjunctiva of one or both eyes The conjunctiva is the translucent covering of the sclera (white area) of the eye (bulbar area) and the undersurface of the eyelids (palpebral area) Infectious

2018 medSask

72. Ophthalmia neonatorum

of local lymphoid tissue at birth Predisposing factors Infection of the maternal birth canal as the result of sexually-transmitted disease This infection may be asymptomatic, especially in the case of C. trachomatis Symptoms (Usually described by mother): redness discharge (may be profuse in gonococcal infection) swelling of lids (may be severe) symptoms usually bilateral Signs Lids oedema (may impede examination of ocular surfaces) Conjunctival features mucopurulent conjunctivitis – discharge may (...) to prevailing socio-economic conditions, health education and maternal healthcare. The baby’s eyes are red, the eyelids and the whites of the eyes are swollen and there is watering or a discharge. Usually both eyes are affected, but one may be worse than the other. One of the dangers of gonorrhoeal infection is that it may affect the cornea also. Early diagnosis is important and for this reason, the optometrist is advised to refer all cases immediately to the on-call ophthalmologist. Swabs will be taken

2018 College of Optometrists

73. Trauma (blunt)

be vocational (e.g. boxing) Symptoms Pain varies from mild to severe Epiphora Visual loss (variable) Photophobia Possible diplopia Signs Mild cases (usually with good corrected vision) eyelid swelling (oedema), ecchymosis (bruising) conjunctival chemosis, subconjunctival haemorrhage unexplained subconjunctival haemorrhages in babies and young children may indicate non-accidental injury corneal abrasion Severe cases (usually with some loss of visual function) infraorbital nerve anaesthesia (lower lid, cheek (...) , side of nose, upper lip, teeth) may indicate orbital floor fracture disturbance of ocular motility: restriction or diplopia due to tissue swelling or muscle tethering by orbital (‘blow-out’) fracture enophthalmos (sunken eye) may also indicate orbital fracture among paediatric patients, orbital floor blow-out fractures may occur with minimal soft-tissue signs (‘white-eyed blow-out fracture’) nasal bleeding (direct trauma, or could indicate skull fracture) corneal oedema or laceration AC: hyphaema

2018 College of Optometrists

74. Blepharitis

including blurred vision and contact lens intolerance Signs Anterior blepharitis (staphylococcal) lid margin hyperaemia lid margin swelling crusting of anterior lid margin (scales at bases of lashes) misdirection of lashes loss of lashes (madarosis) recurrent styes and (rarely) chalazia conjunctival hyperaemia secondary signs include: punctate epithelial erosion over lower third of cornea; marginal keratitis; phlyctenulosis; neovascularisation and pannus; mild papillary conjunctivitis Anterior (...) J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628 Koo H, Kim TH, Kim KW, Wee SW, Chun YS, Kim JC. Discomfort and Demodex: Effect of Tea Tree Oil Eyelid Scrub in Demodex Blepharitis. J Korean Med Sci 2012;27:1574-9 Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews 2012, 5: CD005556 Preferred Practice Patterns. Blepharitis. American Academy of Ophthalmologists 2013 (http

2018 College of Optometrists

75. Nasolacrimal duct obstruction

Guideline on ) iatrogenic (e.g. repeated probing, eyelid surgery) secondary to ectropion or punctal eversion Mechanical (trauma, tumours, obstruction by lashes or foreign matter, e.g. dacryoliths [calcium stones], punctal/canalicular plugs) Infection of canaliculi (canaliculitis) rarely, due to Actinomyces (Streptothrix sp.) – a Gram-positive bacillus such cases usually unilateral pouting’ punctum typical Local infection (chronic sinusitis, dacryocystitis) Predisposing factors Age: congenital in babies (...) for size (normally 0.2 to 0.3 mm diameter) apposition to the globe and marginal tear strip contact with opposite lid on eye closure Differential diagnosis Congenital Congenital glaucoma (acute) Punctal atresia (congenital absence or abnormal narrowing of puncta) Acquired Rule out inflammation or infection (pain, discharge, swelling, redness, mucus reflux on syringing in adults, history of sinusitis): canaliculitis (chronic mucopurulent conjunctivitis, punctum expresses chalky concretions, redness

2018 College of Optometrists

76. Dacryocystitis (acute)

Tender swelling over lacrimal sac (anatomically located just below the medial palpebral ligament) Epiphora Fever (raised temperature) Signs Red, tender swelling centred over lacrimal sac and extending around the orbit Purulent discharge expressible from one or both puncta when pressure is applied over the lacrimal sac (NB likely to be painful for patient) Sac may discharge on to skin surface (NB important to distinguish between acute dacryocystitis, in which sac is full of pus, and mucocoele in which (...) sac is filled with mucoid material in the absence of infection) Frequently, patients may present with conjunctivitis and preseptal cellulitis. Rarely, the infection extends behind the septum, causing orbital cellulitis Differential diagnosis Facial cellulitis, preseptal cellulitis, orbital cellulitis (check ocular motility and look for proptosis) (Refer to Clinical Management Guideline on ) Acute frontal sinusitis (inflammation involves the upper eyelid) Infection following superficial trauma

2018 College of Optometrists

77. Dacryocystitis (chronic)

result from a previous acute infection and from blockage of the tear duct leading from the tear sac to the inside of the nose. Finger pressure over the sac sometimes causes white mucus to appear at the openings of the tear passages at the inner corners of the eyelids; this may help in reaching a diagnosis. Patients usually complain of swelling and sometimes tenderness over the tear sac, plus watering of the eye. If the condition results in repeated episodes of acute infection, antibiotics are given (...) History of recurrent or chronic unilateral conjunctivitis Previous acute dacryocystitis Chronic nasolacrimal duct obstruction Facial fracture Foreign bodies (e.g. punctal or canalicular plugs) Symptoms One or more of the following: recurrent episodes of epiphora, plus swelling, tenderness and redness at medial canthus persistent redness at medial canthus persistent painless swelling at or below the medial canthus chronic epiphora Signs Recurrent episodes similar to, but less severe than, acute

2018 College of Optometrists

78. Hordeolum

These infections are usually staphylococcal Predisposing factors Chronic blepharitis Symptoms Tender lump in eyelid Epiphora Local redness of eye and lid Signs External hordeolum Tender inflamed swelling of the lid margin. May point anteriorly through the skin Occasionally, multiple abscesses involve entire eyelid Internal hordeolum Tender inflamed swelling within the tarsal plate. More painful than a stye. May point anteriorly through the skin or posteriorly through the conjunctiva Differential diagnosis (...) of the eyelid. An internal hordeolum affects the Meibomian (oil) glands within the eyelids whereas an external hordeolum (commonly referred to as a stye) affects the glands associated with the eyelashes. Both conditions cause red and tender swellings of the eyelid. Traditional remedies such as hot spoon bathing and/or warm compresses may relieve symptoms. In some cases, treatment with antibiotic drops or ointment is needed to speed up recovery. In the case of a severe infection, antibiotic tablets may

2018 College of Optometrists

79. Ectropion

Ectropion Ectropion submit The College submit You're here: Ectropion Ectropion The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care. Share options Aetiology Outward rotation of the eyelid margin (usually lower). Occurs in approx. 4% of the population over 50 (bilateral in 70%). Various causes: involutional (age-related degeneration) most common horizontal lid (...) laxity weakness of pretarsal part of orbicularis oculi muscle weakness of medial and lateral canthal tendons Cicatricial: scarring +/- contracture of skin and underlying tissues trauma burns skin tumours actinic skin changes due to prolonged sun exposure Paralytic (refer to Clinical Management Guideline on Facial Palsy) Mechanical tumour at or near the lid margin lid swelling due to inflammation from infection or allergy Congenital rare bilateral condition Predisposing factors Lid laxity increases

2018 College of Optometrists

80. CL-associated conditions (CLAPC)

summary Contact lens-associated papillary conjunctivitis (CLAPC) is an inflammatory condition affecting the transparent membrane which lines the back of the upper eyelid (tarsal conjunctiva). It can occur in people wearing soft or rigid contact lenses or an ocular prosthesis (artificial eye). People suffering from this condition experience eye irritation, which may lead them to abandon contact lens wear. The vision may be blurred intermittently. The eyes are often red and the underside of the upper (...) lid shows minute cobblestone-like swellings called papillae. Treatment for CLAPC initially consists of improving contact lens hygiene and replacing lenses more frequently. Eye drops such as anti-histamines or mast cell stabilisers are often required to relieve symptoms and improve clinical signs. In more severe cases it may be necessary to use steroid eye drops for short periods. CL-associated Papillary Conjunctivitis (CLAPC) Giant Papillary Conjunctivitis (GPC) Version 7 Date of search 21.04.17

2018 College of Optometrists

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