Eye Conditions

Nonpainful Red Eye

1. Infective conjunctivitis caused by bacterial, viral, or chlamydial microorganisms.
2. Allergic conjunctivitis.

Vitamin A Deficiency (Xerophthalmia)

1. (a) Cap of Vitamin A (Vit. A) should be administered immediately on diagnosis as mentioned below:

• <6 months of age – Three doses of oral Vit. A 50,000 IU each immediately on diagnosis, the next day and at least 2 weeks later.
• 6-12 months of age – Three doses of oral Vit. A 100,000 IU immediately on diagnosis, the next day and at least two weeks later.
• >12 months of age – Three doses of oral Vit. A 200,000 IU each immediately on diagnosis, the next day and at least 2 weeks later.
• Women of reproductive age with night blindness or Bitot’s spots – <10,000 IU Vit. A daily or weekly doses of <25,000 IU. Women of reproductive age whether or not pregnant with severe signs of active xerophthalmia (acute corneal lesions) – Three doses of oral Vit. A 200,000 IU each immediately on diagnosis, the next day and at least 2 weeks later.
  (b) Water miscible Vit. A preparation is given IM for children suffering from persistent vomiting, severe diarrhoea and intestinal parasites. If there is gross purulent discharge due to bacterial superinfection in keratomalacia.

2. Gentamicin/Tobramycin eye drops 14 mg/ml drops hourly.
3. Cefazolin 50 mg/ml drops 1 hourly till infection resolves. If corneal ulcer present (see section on corneal ulcer).

• Regular consumption of Vit. A rich foods particularly fresh dark green leafy vegetables which constitute very rich and cheap sources of Vit. A.
• Pregnant women and lactating mothers should also consume Vit. A rich diet regularly.
• Breast feeding including feeding of new borns with rich colostrum.
• High dose universal distribution schedule for prevention of Vit. A deficiency.
• Infants <6 months of age.
  - Non-breast fed infants – 50,000 IU orally.
  - Breast-fed infants whose mothers did not receive supplemental Vit. A
  - 50,000 IU orally.
• Infants 6-12 months of age – 100,000 IU orally every 4-6 months till 5 years of age.
• Children >12 months – 200,000 IU orally every 4-6 months till 5 years of age.
• Mothers – 200,000 IU orally within 8 weeks of delivery.
• Excessive consumption of Vit A can cause hypervitaminosis A.

Nutritional Blindness. In: Principles and Practice of Ophthalmology Vol 1-6, 2nd Edition, 2000. WB Saunders Co., pp 4760-4766.

Chalazion

1. Incision and curettage for large chalazia (>6 mm) or those who present for more than 3-4 month duration.
2. Excisional biopsy for recurrent and hard chalazia in elderly.

• The condition may recur at the same site or different site, involving any eyelid.
• Recurrence of chalazia at the same site may be harbouring malignant disease.
• Intralesional triamcinolone can cause steroid-induced glaucoma and hypopigmentation of skin.

1. Lid inflammations. In: Principles and Practice of Ophthalmology. Albert and Jakobiec Azar Gragoudas (eds), 2nd Edition, 2000. WB Saunders Co, pp 829-846.

Stye (Hordeolum Externum)

1. Gentamicin 0.3% eye drops 1 drop 6 hourly.
   Or
   Ciprofloxacin 0.3% eye drops 6 hourly.
   Or
   Ciprofloxacin eye ointment 2 times a day.
   Or
   Bacitracin eye ointment 2 times a day.
2. Systemic antibiotics if excessive oedema or cellulitis.
   Cap. Erythromycin 30-50 mg/kg in 4 divided doses for 5-7 days.
3. Tab. Ibuprofen 400 mg 3 times a day after meals.
   Exclude refractive error and diabetes mellitus in recurrent cases.

• Avoid rubbing of eyelids with dirty hands.
• Use glasses for refractive error.
• Maintain proper ocular hygiene to prevent recurrence.

Lid inflammations. In: Principles and Practice of Ophthalmology. Albert and Jakobiec Azar Gragoudas (eds), 2nd Edition, 2000. WB Saunders Co, pp 829-846.