Eye disorders: illustrated

Presentations of eye disorders including adenoviral conjunctivitis, senile scleral translucency and pterygium.

Adenoviral conjunctivitis

ADENOVIRAL CONJUNCTIVITIS

Conjunctivitis is a very common condition, seen on a daily basis in general practice. In the past, a sticky eye led to an almost automatic prescription for topical antibiotics. It has been shown in recent years that most of these cases are actually viral in origin, often associated with URTIs. It is usually an adenovirus that causes this, and it can take some weeks to resolve. Rarely, steroid drops are recommended by ophthalmologists to provide symptomatic relief.

Chalazion

CHALAZION

A chalazion is a cyst caused by blockage of the duct of a Meibomian gland, which produces the secretions that help to lubricate the eye. The duct can easily block, then the cyst forms.This can become infected, causing significant swelling and inflammation. Topical antibiotics are usually used with warm compresses.

Ectropion

ECTROPION

As patients age, it is not unusual for deterioration of subcutaneous connective tissue to lead to a loss of tone, with drooping of the lower eyelid. The sensitive inner surface is exposed and can become inflamed and uncomfortable. Repeated courses of antibiotics may be required and some patients need surgical intervention, a lateral tarsorrhaphy, to tighten the lids. This patient had the operation, which was successful.

Senile scleral translucency

SENILE SCLERAL TRANSLUCENCY

Another manifestation of the ageing eye, this is also known as senile scleral plaque, and produces this rather alarming appearance. They are normally seen just in front of the insertions of medial and lateral rectus muscles.The dark area is caused by increased translucency, revealing the underlying ciliary body. It is quite benign and does not require treatment, although it could potentially lead to problems if this area were to be selected for intravitreal injections for glaucoma.

Foreign body eyelid

FOREIGN BODY EYELID

Many patients present with a sore, red eye. There may be a clear history of trauma, but not always. Careful examination is vital to assess the eye, including the simple procedure of everting the upper eyelid. Many GPs and patients seem reluctant to do this, but a foreign body like this shows clearly and can then be easily removed, providing instant relief. It is sensible to check the cornea for scratches with fluorescein as well.

Allergic conjunctivitis

ALLERGIC CONJUNCTIVITIS

This man presented with a sore, red, itchy eye following a cataract operation. It is not uncommon for patients to have problems with eyedrops, which contain additives and preservatives. Usually, stopping the drops settles the eye down. If treatment is required, preservative-free preparations may be needed.

Benign conjunctival papilloma

BENIGN CONJUNCTIVAL PAPILLOMA

This 39-year-old woman presented with a large lesion on the inside of her eyelid. Not surprisingly, it had been causing considerable discomfort and irritation. She was referred for excision, which confirmed its benign nature. No further action was required in this case, although up to 20% of these lesions may recur, especially if not fully excised at the first procedure. They are common in adults, but may also occur in children and adolescents, and can also be treated by cryotherapy.

Pterygium

PTERYGIUM

This is a fairly common problem seen in general practice. There appears to be growth of a membrane-like structure over the front of the eye. It can occur bilaterally and more commonly on the nasal aspect. It requires no treatment, unless the growth starts to be sufficiently extensive as to encroach on the vision. In these situations, the only option is surgery to remove the growing tissue. This condition may often be confused with another common condition, a pingueculum, which may be present in a similar position on the eye, but does not grow onto the cornea and hence requires no treatment.

  • Dr Phil Marazzi, GP, Surrey, UK

Click here to take a test on this article and claim a certificate on MIMS Learning

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

What medico-legal challenges will GPs face in 2019?

What medico-legal challenges will GPs face in 2019?

The MDU's head of advisory services, Dr Caroline Fryar, predicts which medico-legal...

GP practices providing online consultations doubled in 12 months, survey suggests

GP practices providing online consultations doubled in 12 months, survey suggests

The proportion of GP practices in England providing online consultations has almost...

Dr Nikita Kanani: Why peer support is the key to building a stronger general practice

Dr Nikita Kanani: Why peer support is the key to building a stronger general practice

NHS England's acting director of primary care Dr Nikita Kanani says connecting with...

Next-day GP appointments three times as likely to be missed as same-day bookings

Next-day GP appointments three times as likely to be missed as same-day bookings

Patients are nearly three times as likely to miss appointments booked with GP practices...

Outsourcing GP services overseas could be 'legal minefield', experts warn

Outsourcing GP services overseas could be 'legal minefield', experts warn

Using digital technology to outsource GP consultations overseas could leave the NHS...

RCGP sets out advice for GPs on prescribing cannabis

RCGP sets out advice for GPs on prescribing cannabis

GPs should warn patients hoping to access cannabis-based medicines that the process...