Hospital Corpsman Sickcall Screener's Handbook
BUMEDINST 6550:9A
Naval Hospital Great Lakes
1999

Eye Lid Problems:

1. Blepharitis — the most common inflammation of the eyelids caused by seborrhea or bacteria (staph infection) — frequently associated with conjunctivitis.


S: Burning irritation, itching and redness of the eyelid.
O: Scaly or granular matter clinging to the eyelashes with red-rimmed eyes, pruritus
A: Blepharitis
P: Remove scales with warm compresses and gentle scrubs.
Treated with Erythromycin Ophthalmic Ointment (Ilotycin) apply to lids 2-4 x QD. Refer to MD/PA if not improved.


2. Hordeolum (sty) and Chalazion.

 

1. Horeolum is an acute lesion at the eyelid margins usually in the sebaceous glands caused by a staph infection. If a sty becomes chronic it may evolve into a chalazion, an enlargement of the meibomian gland due to a blockage of the duct. A hordeolum is painful, a chalazion is painless.

Hordeolum
S: Painful swelling of the eyelid, a "foreign body" sensation, no vision changes.
O: tender, swollen lesion along the lid margin with a small center of induration, and erythema. If seen later a yellowish spot indicating the localization of the infection into a small abscess, and /or purulent drainage may be seen.
A: Hordeolum (sty)
P: warm compresses three or four times a day for 10 — 15 minutes.
Erythromycin Ophthalmic Ointment (Ilotycin) 3 or 4 times daily.
If systemic antibiotics are indicated because of cellulitis refer to MD/PA.

Chalazion
S: Hard, non-tender swelling of the eyelid possibly proceeded by sty.
O: Firm, cystic swelling of the eyelid, conjunctiva, may be red in the region of the chalazion.
A: Chalazion
P: Refer to MD/PA for referral to Ophthalmologist for excision.

Eye Inflammation Problems

1. Conjunctivitis An inflammation of the conjunctiva, a mucous membrane that lines the inner portions of the eyelids (palpebral) and covering the anterior surface of the eyeball (bulbar or bulb), may be due to bacteria, viral, or allergic causes.

S: Sensation of burning, itching or foreign body with irritation, photophobia, tearing, and a discharge that may cause the eyelids to stick together.
O: Red, injected conjunctiva, clear cornea, pupils react normally. Discharges as follows:

1. Bacterial — profuse purulent exudate (true Pinkeye).

2. Viral — mucupurulent discharge (minimal amount) with profuse tearing.

3. Allergic — minimal mucoid watery discharge with severe itching

A: Conjunctivitis
P: Check and document visual acuity.

If indicated check for foreign body or corneal abrasion by staining eye with a Fluor Strip. Do not patch the eye!

Bacterial:

1. Sodium sulfacetamide (sulamyd) ointment or solution. (Note: Solution needs refrigeration).
   Solution: one-gtt q 4-6 hours into lower conjunctival sac.
   Ointment: q.i.d. and at bedtime or HS

2. Gentamicin (Garamycin) ophthalmic solution and ointment: instill one gtt q 4 hours or small amount ointment 2-3 x qd, or

3. Erythromycin Ophthalmic Ointment (Ilotycin) q.i.d.

Viral: No treatment, self-limiting lasting about 10 days. Usually treated with one of the bacterial medications to prevent bacterial infection.

Allergic: Antihistamine orally may help. (Dimetapp, CTM or Sudafed).
Vasocon-A, (for allergic conjunctivitis) one to two gtts 2-4 x qd.

2. Iritis (acute Uveitis) An acute inflammation of the iris characterized by pain, photophobia and blurring of vision, a red eye without purulent discharge and a small pupil, -contracted (miosis); it is thought to be a hypersensitivity reaction to some other infection in the body probably bacterial or fungal. In this condition a dilation medication is used to prevent the adherence of the iris to the lens. In conjunctivitis vision is not blurred, pupillary responds normal, a discharge is present and there is no pain or photophobia.

   S: Acute onset of pain, redness, photophobia and blurred vision.
   O: Pupil is miotic (constricted) small and may be irregular. Decrease in visual acuity due to blurred vision, eye is diffusely red, no discharge.
   A: Iritis (uveitis)
   P: Immediate referral to MD/PA. Consult to ophthalmology.

   Treatment:

   Analgesic ASA for pain, dark glasses for photophobia
   Mydriatic drugs: Keep pupil dilated with Atropine Ophthalmic solution 1-2 gtts up to four times a day. Ophthalmic Corticosteroids for inflammation will be give. This condition is not that common — but one that can not be missed!

3. Corneal Abrasion: One of the most common conditions seen, associated with contact lens misuse and foreign bodies. Part of the epithelium of the cornea is removed producing severe pain and tearing. Motion of the eye and blinking increase the pain and the foreign body sensation. Examination should be made after a drop of topical anesthetic is instilled. Identification of the defect is with fluorescein strip. In the presence of a corneal abrasion the upper lid should always be looked at for a foreign body. If present remove with a gentle wipe with a moistened "Q" tip.
   S: Foreign body sensation, increased tearing and irritation
   O: Injected conjunctiva, tearing (lacrimation), foreign body seen in the eye or obvious corneal defect with Fluor-staining of the eye.
   A: corneal abrasion
   P: Test and document visual acuity.
   Removal of foreign body (MD/PA)
   Bacitracin, Garamycin or Emycin ointment should be instilled into the conjunctival sac, Pressure patch the eye for 24 hours and recheck.

Note: To patch an eye place a folded oval patch over the closed eye then place an open pad on top of the eye and apply tape above the brow and bring it down diagonally across the patch to the cheek.