What is the most common cause of red eye?
Name some common causes of red eye?
Conjunctivitis Scleritis Keratitis Uveitis Acute Closed Angle Glaucoma
What are two rarer (but very important) causes of red eye?
Subconjunctival Haemorrhage Orbital Disease (Eg: Cellulitis)
What is conjunctivitis?
Inflammation of the conjunctiva
What is keratitis?
Inflammation of the cornea
What is uveitis?
Inflammation of the uvea Uvea is composed of iris, ciliary body and choroid
Describe subconjunctival haemorrhage? Symptoms? Pain? Who does this affect? Treatment?
This is bleeding under the conjunctiva Asymptomatic Painless Usually in elderly patients (weaker vessels) who sneeze/cough/strain Goes away by itself
Describe orbital cellulitis? How does this occur? Signs and symptoms? Who does this affect? Treatment?
Inflammation of the soft tissues around the eye Often following sinus infection Causes swelling, redness, proptosis of eye Loss of vision Common in children Can be sight threatening Needs IV antibiotics and admission
What are the ocular defences?
Lids (Blink to close eyes) Tears Conjunctiva
Which eyelid is more important?
Describe what can happen when lid disease causes the bottom eyelid to be pulled down constantly?
Causes dry and exposed eye Can lead to corneal ulcer
Describe the function/importance of tears?
Flows across eye to keep it lubricated Contains mucous to trap bugs Contains lysozyme which is antibacterial Contains immunoglobulin - IgG, IgA Complement is present
Where are tears produced?
Describe the examination of the front of the eye?
Facial Appearance Lids Conjunctiva Cornea Iris Pupil
What is Blepharitis? Types?
This is inflammation of the eyelids and eyelashes Divided into anterior and posterior (Anterior = Eyelashes, Posterior = Glands on eyelid)
Describe Anterior Blepharitis? Signs?
This can be sebhorreic (scales on the eyelashes) or staphylococcal (staph infection on the lash follicle) Causes a very red lid margin Staphylococcal may cause a sty
What is a sty?
Acute infection of a follicle Causes a yellow head, filled with pus Goes away after a few days
Describe posterior blepharitis? Signs?
This is caused by Meibomian gland dysfunction Lid and lashes are unaffected Dried secretion at meibomian gland opening called a Chalazion
What is a chalazion?
This is a small bump (cyst) caused by blocked meibomian gland May be painful or annoying but rarely serious
Which group of people are commonly affected by posterior blepharitis?
Those with acne rosacea
Treatment for blepharitis?
Hygiene - Bathing and hot compress Supplementary Tear Drops Oral Doxycycline
What are the two types of conjunctivitis?
Describe infective conjunctivitis?
Can be viral, bacterial or chlamydial
Describe viral conjunctivitis?
Most likely caused by adenovirus Usually follows a preceding upper respiratory tract infection
Describe chlamydial conjunctivitis?
This is conjunctivitis caused by chlaymdia trachomatis Commonly seen in the young Can come from genital infection
If you see chronic conjunctivitis in a young, sexually active person, what should you suspect?
Describe acute bacterial conjunctivitis? Signs? Treatment? Organisms?
This is very common Causes a red sticky eye (due to discharge) Is self limiting and will clear up in 14 days without antibiotics Chloramphenicol drops can be used Organisms: - Staph Aureus - Strep Pneumoniae - Haemophilus Influenzae
Describe the signs and symptoms of conjunctivitis?
Red Eye Discharge Foreign Body Sensation Papillae or Follicles Subconjunctival Haemorrhage Oedema (Chemosis) Pre-aurical glands tender (in viral)
What is chemosis?
This is oedema of the conjunctiva
Describe papillae and follicles? - When are they seen (Which type of conjunctivitis) - Appearance
Papillae - seen in allergic and bacterial conjunctivitis Follicles - Seen in viral and chlamydial Papillae - Cone shaped elevations, red in the middle Follicles - Grains of rice
Describe follicular conjunctivitis?
This is conjunctivitis where follicles are seen This can be either viral or chlamydial Follicles look like grains of rice and are bigger than papillae They are not red in the middle Seen in the fornix (in lower eyelid)
Some people present with a viral conjunctivitis but there is no follicles.. Why?
Follicles take a week to develop This is why they may not be present
Describe Herpes Simplex Conjunctivitis? Where?
Inflammation of the conjunctiva caused by herpes simplex infection Causes red eye and vesicles Unilateral (one side only) CN V1 and CN V2 distribution
Describe Herpes Zoster Opthalmicus? Associated nerve?
This is re-activation of dormant herpes zoster Presents as a unilateral rash May have associated conjunctivitis or keratitis Ophthalmic Division of the trigeminal nerve
What is chronic conjunctivitis?
This is conjunctivitis that lasts for more than 4 weeks
What are some common conditions that can cause chronic conjunctivitis?
- Blepharitis - Chlaymdial Conjunctivitis - Keratoconjunctivitis Sicca (Dry Eyes) - Lacrimal Diseases
What is keratitis?
Inflammation of the cornea
What are the layers of the cornea?
Epithelium Stroma Endothelium
Does the corneal have high/low sensory supply (Is there a lot or not)
Cornea has the highest sensory supply of the eye Anaesthetic must be used for examination
Describe the vasculization of the cornea?
The cornea is not vasculized It should be clear
Is Oedema or cloudiness of the cornea normal?
No, this suggests dysfunction Cornea should be clear
What can cause corneal ulcers?
These can be caused by infective causes or autoimmune causes?
Describe location of corneal ulcers
Central = Infective Peripheral = Autoimmune
Describe some infective causes of corneal ulcers?
Viral (Eg: Herpes Simplex) Bacterial Fungal Acanthamoeba
Describe what type of patient you'd expect to have a bacterial corneal ulcer or one caused by acanthamoeba?
Young, contact lens wearer (Also bacterial is seen in elderly with dry eyes)
Describe what type of patient you'd expect to have a fungal corneal ulcer?
Describe some autoimmune causes of corneal ulcers?
Rheumatoid Arthritis Hypersensitivity Wegener's Granulomatosis
Symptoms of corneal ulcers?
Pain Foreign Body Sensation Photophobia Watery eyes (profuse lacrimation)
Signs of corneal ulcers?
Red Eye Corneal Opacity Hypopyon
What is hypopyon?
This is inflammatory cells in the anterior chamber of the eye Causes a fluid level
Describe a herpes simplex dendritic ulcer? How painful is this? Recurrence?
Classic presentation of Herpes Simplex Branching type ulcer Not that painful as patients often have reduced sensation in that eye Patients have a history of recurring ulcers in the same eye
Name some conditions that can lead to special corneal ulcers?
Thyroid Disease --> Exposure Keratitis Keratoconjunctivitis Sicca (Dry Eyes) --> Corneal Ulcers Vitamin A Deficiency ---> Corneal Ulcers
Treatment of corneal ulcers?
Corneal Scrape to identify cause - Antimicrobial for bacterial (Eg: Ofloxacin) - Antiviral for viral (Eg: Aciclovir) - Topical steroids if autoimmune
What is Anterior Uveitis?
Uvea = Iris, Ciliary Body and Choroid Uveitis = Inflammation of the uvea Anterior Uvieitis = Inflammation of the anterior uvea - either iris or iris and ciliary body
Describe some causes of anterior uveitis?
- Autoimmune: Ulcerative colitis, Sarcoidosis, Ank. Spond - Infective: TB, Syphyllis, Herpes Simplex - Malignancy: Leukaemia - Other: Trauma, Idiopathic
Symptoms of anterior uveitis?
Pain - often referred to eyebrow Achy pain Photophobia Red eye
Signs of anterior uveitis?
Cells and flares in the anterior chamber Hypopyon Keratic Precipitates Irregular Pupil
Management of anterior uveitis?
Topical Steroids: Prednisolone Mydriatics: Cyclopentolate
What are Mydriatics?
These are drugs used to dilate the pupil
What is Episcleritis? Treatment? Associated with...?
This is inflammation of the layer between the conjunctiva and the sclera (episclera) Self limiting Associated with gout
What is scleritis? Symptoms?
This is inflammation of the sclera This is very painful Violaceous Hue
Oral NSAIDs Oral Steroids
Describe acute closed angle glaucoma? Symptoms? Signs?
This is a medical emergency Caused by rapid raise in IOP Symptoms include pain, nausea and headaches Signs; Corneal cloudiness
Treatment of acute closed angle glaucoma?
IOP lowering medications (Topical Beta Blockers)