painful red eye

Question 1

chalazion (stye)

Answer 1

inflammation of the meiobiam gland
causes lumps in the eyelids

signs- eyelid swelling, redness, pain
mx: self limited. topical abx and surgical removal (if necessary)

Question 2

opthalmic zoster (shingles)

Answer 2

painful condition caused by the herpes zoster infection
opthalmic nerve and trigeminal nerve can become affected

painful, blister like lesion
cornea, uvea inflammed

tx: anti viral meds, analgesia

Question 3

dacryocystitis (inflammation of lacrimal sac)

Answer 3

secondary to obstruction of the lacrimal duct
tender, red, tense swelling at the medial canthus

mx: warm compress, oral abx, draining tear sac removl

Question 4

orbital cellulitis

Answer 4

life-threatening infection of the soft tissues behind the orbital septum. more common in children

symptoms- fever, pain, visual impairment
signs- unilateral, tender, warm, red periorbital lid edema, proptosis, painful ophthalmoplegia, optic nerve dysfunction

ix: CT scan - thickened periocular tissues.
mx: admission and IV abx therapy

Question 5

rhabdomyosarcoma

Answer 5

highly malignant orbital tumor of striated muscles in children

symptoms- unilateral eye pain
signs- reduced vision, progressive exopthlamos or proptosis. buldging / protrusin of the eye ball. red eye

mx: referral to an oncologist for exenteration, radiotherapy, chemo

Question 6

conjunctivitis (bacterial)

Answer 6

inflammation fo the conjunctiva (mucous membrane which covers the white of the eye and inner surface of the eyelid)

bacterial- red sticky eyes, usually bilateral, red eyes with purulent discharge, no corneal or anterior chamber involvement. systemically well.

mx: regular hygine, minimise secretion build up topical abx 5 days

referral - if vision is affected. if no improvement after treatment after 2 days. or if worsens after treatment 5 days.

Question 7

conjunctivitis (viral)

Answer 7

recent eye or URTI symptoms (kids) contagious.

symptoms- burning sensation, watery discharge (not purulent exudate). begins with one eye and can spread to the otehr. pre auricular lymphadenopathy.

red eye, watery. swollen conjunctiva.
mx: self resolving. cool compress, lubriants, abx drop if indicated.

Question 8

allergic conjunctivitis

Answer 8

symptoms- itchy eyes, red and sore
signs- eyelid swelling, papillae (tiny elevation on the plpebral conjunctiva)
pmhx: atopy (asthma, eczema)
mx: remove allergens, topical anti histamines, cool compress
refer if not better in 3 days

Question 9

episcleritis

Answer 9

• sectoral episcleritis
• diffuse episcleraitis
  inflammation of episclera (outmost layer of the sclera)
  symptoms: mild discomfort, tender, watery
  signs: sectoral / diffuse redness
  mx: topical steorids, self limiting

Question 10

scleritis

Answer 10

inflammation of the sclera *!scleral necrosis
symptoms- eye pain that radiates to the head, wakes the patient up at night
signs- red eye, visible sclera nodules, necrotic patch
sclera may be disclolored and tender to palpation

pmhx: RA, vascular or connective tissue disease
mx: same day referral to opthalmologist
topical / systemic corticotherapy

Question 11

keratitis

Answer 11

keratitis is corneal inflammation from various agents (virus, bacteria, fungi, parasite)

symptoms- sore, red eye *contact lens / trauma

viral keratitis
bacerial keratits
fungal keraitits
parasitic keratitis

mx: urgent referral to opthalmologist for corneal scrape and intensive topical abx / antiviral / antifungal tehrapy
keratoplasty (corneal graft) when cornea is perforated

Question 12

uveitis

Answer 12

inflammation of the ‘uveal tract’ (ciliary body, choroid, iris)

symptoms- photophobia, red eye, sore eyes, vision can be affected
signs- anterior chamber appears cloudy
mx: mydriasis – intensive steroid therapy

Question 13

glaucoma- acute angle closure glaucoma

Answer 13

sudden increase in IOP due to closed anterior chamber angle which prevents aqeuous drainage.

symptoms- painful eye with systemic symptoms including headache, nausea and vomiting
signs: red eye, tender, hard on palpation. cornea is hazy in appernace. anterior chamber is shallow wiht irregular semi dilated pupil

mx: same day referral. topical PILOCARPINE
pilocarpine is an aqeuous inhibitor and beta blocker- lower hte IOP. laser iridotomy / trabeculectomy
cataract extraction

Question 14

blepharitis

Answer 14

Very common nonspecific generalized inflammation of the eyelids.

mx: Treat with daily lid hygiene, low dose
tetracyclines/doxycycline, lubrication as required with routine referral.

Question 15

ectropion

Answer 15

lid turns outwards with exposure of the conjunctival sac. Eye may be sore and watery.

Routine referral and may require surgery

Question 16

Entropion

Answer 16

Lids turning inwards and eyelashes may abrade cornea - check condition of cornea with fluorescein.

If corneal staining, tape the back eyelid away from the cornea and refer same day

Question 17

trichiasis

Answer 17

ingrowing eyelashes - epilate when touching cornea,
lubricate with routine referral

Question 18

Pterygium

Answer 18

A raised white/yellowish fleshy lesion at the limbus that may become
painful and red if inflamed.

Treatment: lubrication and sunglasses.
Routine ophthalmological referral for further management

Question 19

corneal erosion

Answer 19

symptoms- trauma/foreign object in the eye, sore, watering
signs: red eye, watery
the corneal epithelium is not intact - does not stain with fluorescein

mx: check no foreign body, topical abx, can pad eye although this does not help to heal

see if pain or vision worsens,

Question 20

herpes simplex keratitis

Answer 20

symptoms- sore red eye, not sticky
signs: abnormal corneal epithelium in dendrite pattern which stains with fluroescein

mx: !!!! avoid topical steroids. topical aciclovir.
opthalmology r/v following day

Question 21

bacterial corneal infection

Answer 21

symptoms- red eye, sore, contact lens
signs: white area on cornea (peripheral / central)
mx: urgent referral to opthalmolgoist.

Question 22

marginal keratitis

Answer 22

Symptoms: sore red eye, may be sticky, may or may not have blurry vision

Signs: white areas on the periphery of cornea which may be thinner than normal usually associated with blepharitis

Management: refer to ophthalmologist same day

Question 23

hyphema

Answer 23

red eye, severe loss, trauma
non accidental injury in children

signs- eye has visible blood inside and cornea may also bestained. sore if raised IOP

mx: bed rest, eye pad . uregnt same day asssessment by opthalmologist

Question 24

dry eyes

Answer 24

common chronic ocular condition which is often caused by, or coexists, with other ocular diseases

symptoms- gritty, sore, worse in the evening.
ix: poor tear film. fluorescein staining

mx; lubricants. preservative-free drops 4 per day. ointment on eyeball before sleep

refer if no improvement

Question 25

hypopyon

Answer 25

visible accumilation of white cells inferiorly in severe uveitis
same day referral