FB sensation problem in ophthalmology.pdf

FB sensation in the eye PowerPoint presentation

1. Case 1:
Foreign body sensation
Professor Dr
Osama Shalaby

2. A 45 years old male male patient presents to the outpatient clinic
complaining of:
FB sensation, lacrimation, with pricking sensation, & inability to
open right eye in the light.
(Saying that he has the sensation that a nail or pin is moving inside
his eye)
This complaint for about two weeks of duration.
He used antibiotic eye drops without improvement.

3. FB sensation
Pricking pain in the eye
What is the chief complaint of this patient?

4. ➢Foreign body
➢Rubbing lashes
➢Trichiasis
➢Conjunctivitis
➢Corneal ulcer
What are the possible causes of the main complaint ??

5. ➢Past medical history
oDM
oHypertension
➢History of trauma: occupational or exposure
➢Medications received
➢Modifying factors
➢Other associated symptoms e.g. vision affection
What additional history questions can you ask to distinguish between
the different possible causes?

6. •No history of trauma
•No history of occupational exposure
•No history of DM or hypertension
•The condition is not associated with vision affection or redness of the eye
Results of History Taking

7. ➢Eye lid
➢Conjunctiva (evert eye lid)
➢Cornea
➢Fluorescinstain
What are the components of the physical examination
should you perform?

8. Eye lid is examined for:
Position
Margin
Function
What are the components of the physical examination
should you perform?

9. We found normal position & function.
Maldirectedlashes were projecting and
rubbing against the ocular surface
What are the components of the physical examination
should you perform?

10. What are the components of the physical examination
should you perform?
The conjunctiva was examined:
Bulbar part
Palpebral part

11. Fluorescein dye staining:
to exclude presence of corneal ulcer or
abrasion
The cornea was found to be clear & sensitive,
without fluorescein staining
Is there is any additional test needed?

12. Rubbing lashes
or
Trichiasis
What is the diagnosis ???

13. Rubbing lashes: when one to three lashes are maldirectedto rub
against the cornea
or
Trichiasis: when more than four lashes are maldirectedto rub against
the cornea
What is the diagnosis ???

14. Is an acquired condition in which more than
four eyelashes are distorted backwards, with
the lid margin remaining in its normal
position.
Trichiasis

15. Cicatrizing conditions of the conjunctiva or the eyelid:
1.Trachoma
2.Chemical burn
3.Thermal burn
4.Cicatrizing conjunctivitis
5.Post traumatioc
Trichiasis
Etiology

16. •Symtoms:
•Foreign body sensation
•Photophobia
•Lacrimation
•Reflex blepharospasm
Trichiasis

17. •Signs & sequelae:
•Backward direction of lashes touching the corneal
surface.
•The increased friction will cause:
•Conjunctival hyperemia, with chronic conjunctival
inflammation
•Corneal ulcers from corneal abrasions.
Trichiasis

18. •When???
•In presence of corneal or conjunctival
inflammation
•Lack of facility for other procedures.
•Bed ridden patient
•Preoperative.
Trichiasis
Treatment Options
Temporary Measure
Epilation
(recurrences within few weeks)

19. •Electrolysis:Chemical reaction at the root of the lashes.
•Diathermy: Thermal destruction.
•CryotherapyFreezing destruction.
•Laser ablation (Argon) ……. for few scattered lashes
•Surgery……. for localized crop resistant to other methods
Trichiasis
Treatment Options
Permanent Measure

20. Electrolysis
•Chemical coagulation
•The lash will be destroyed by
protein denaturation at the root
of the follicle.
•3 milli ampere for 30 seconds

21. Diathermy/Radiofrequency
•Achieves heating by passing an electric current through the
root of the lash.
•30 milli ampere for 3 seconds

22. Cryotherapy
•Destruction by cold: generation of
temperature of -20 to -30 C.
•A frost-ball will form.
•Clinical whitening indicates adequate follicle
destruction.
•It is effective for large, confluent areas of
trichiasis.

23. Laser ablation
•Argon laser
•Setting:
•Power of 1000-1500 mW
•Spot size of 50-100 µm
•Duration of 0.1-0.2 s.
•A total of 10-30 shots are needed per lash.

24. •In large crop of lashes
•In distichiasis: congenital condition in which there is an extra
raw of lashes is present.
Surgery

25. •Division into anterior and posterior lamellae
•Cryotherapy to posterior lamella
•Reappositionof lamellae
Surgery

26. •Upper lid: Van Mellingen'soperation.
Surgery

27. •Lower Lid: Webester'soperation
Surgery

28. Review Questions
1.Enumerate (3,4,5) causes of foreign body sensation.

29. 1.Enumerate 3 causes of rubbing lashes.
Review Questions

30. 1.Enumerate (Mention) (3 treatment options of rubbing lashes.
Review Questions

31. a.When the number is less than four
b.When the lashes are close together
c.In presence of acute corneal ulcer
d.In cases of high refractive error.
Epilation of maldirectedlashes is indicated in:
Review Questions

32. a.Localized group or extra raw of trichiasis of the upper eye lid.
b.Trichiasis and entropion of the upper eye lid.
c.Two rubbing lashes of the upper eye lid.
d.Paralytic entropion of the lower eye lid.
Van Millengen’sis an operation used for the correction of:
Review Questions

33. a.Snellen’s operation.
b.Lid splitting and cryoapplication.
c.Epilation
d.Van Millengenoperation
A patient has about 10 maldirectedlocalized lashes of the lower
eye lid. The treatment of choice is:
Review Questions

34. a.Laser ablation
b.Epilation
c.Cryotherapy
d.Weiss procedure.
A bed ridden patient has upper lid rubbing lash causing corneal &
conjunctival inflammation. The appropriate best treatment for
this condition is:
Review Questions

35. a.Electric current
b.Thermal action
c.Chemical reaction
d.Mechanical action
Electrolysis destroys rubbing lashes by:
Review Questions

36. a.Excimer laser
b.YAG laser
c.Diode laser
d.Argon laser
Laser type used for treatment of rubbing lashes is:
Review Questions