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Ophthalmology > 3. Red Eye > Flashcards

3. Red Eye Flashcards

1
Q

On presentation of a red eye what should be recorded in the Hx?

A
  • Onset (most important, was it chronic/acute)
  • Visual changes
  • Trauma/ contact lens use
  • Photophobia
  • Pain
  • Discharge
  • History of medical illness
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2
Q

List Ddx studied for the Red Eye?

A 
Conjunctivitis/ Blepharitis (Most common, viral, bacterial or allergic)
Corneal abrasion/ Foreign body (Very common +/- pain)
Subconjunctival haemorrhage
Keratitis/ corneal ulcer
Uveitis (Important diagnosis to make)
Acute glaucoma (Presents with pain)
Chemical burn
Scleritis
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3
Q

What is the most common cause of red eye?

A

Conjunctivitis

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4
Q

What are the signs of acute conjunctivitis?

A
  1. Red eye (conjunctival hyperaemia)
  2. Discharge
  3. Eye lid sticking
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5
Q

Which is more common bacterial or viral conjunctivitis?

A

Viral, bacterial less common

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6
Q

Which is more contagious, viral or bacterial conjunctivitis?

A

Bacterial

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7
Q

What are the signs of acute viral conjunctivitis?

A

Inferior palpebral conjunctival follicles
Tender palpable lymph node
Watery discharge/ pseudomembrane (more so with viral, if you lift the formed membrane no blood)
Punctate keratopathy
Infection in the cornea will cause extreme pain.

Recent upper respiratory tract infection

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8
Q

What is the Tx for viral conjunctivitis?

A
  • Can try antihistamines first. (Oxford) if not…
  • Treat with steroids (C/I in bacterial CJ)
  • Usually self-limiting within to 2 weeks but if in cornea can take months to years
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9
Q

In whom is bacterial conjunctivitis more common?

A

Children

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10
Q

What are the hallmarks of bacterial conjunctivitis?

A

Green discharge which can cause corneal infiltration.

Membranous CJ - Bleeds when membrane lifted

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11
Q

What are the common bacteria that cause conjunctivitis?

A

Staphylococci
Streptococcus Pneumonia
Haemophilis influenza

In sexually active person
Neisseria gonorrhoeae (which is hyperacute)
Chlamydial infection

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12
Q

What is the Tx for Bacterial Conjunctivitis

A

Supportive:
• Frequent hand washing (Highly contagious)
• Artificial tears, cold compresses, antibiotics sometimes (conservative to super bugs)

Topical antibiotic therapy
If no improvement in 2 weeks time: take a swab to rule out chlamydia or gonococcal infection.

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13
Q

What are the signs and symptoms of allergic conjunctivitis?

A
  • History of allergies (Asthma, Eczema)
  • Itching
  • Water
  • Chemosis (swelling)
  • Red oedematous eye lids
  • Conjunctival papillae (cobblestone, since swelling + attachment at base (>5mm diameter)
  • No lymph nodes enlargement
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14
Q

What is the Tx for allergic conjunctivitis?

A
  • Cool compresses
  • Artificial tears
  • Oral antihistamine
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15
Q

Large conjunctival papillae, shield ulcer, history of allergies, seasonal?

A

Vernal Conjunctivitis

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16
Q

What is keratitis?

A

Inflammation of the cornea

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17
Q

What are the characteristic of bacterial keratitis?

A 
Red Eye
Pain (very)
Decreased vision
Photophobia
Discharge
NB=History of contact lens or trauma
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18
Q

What are the signs of bacterial peritonitis on exam?

A

Focal white opacity (fluid level collection over plates)
If there is epithelial defect, stain with fluorescein=ulcer
Discharge
Anterior chamber cells & hypopyon (yellowish exudate in Acham

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19
Q

What are the most common bacteria causing keratitis?

A
  • Staphylococcus
  • Streptococcus
  • Pseudomonas (>60yo)
  • Morexella
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20
Q

What is the Tx for Bacterial keratitis?

A
  • Corneal scrapings
  • Contact lens & case culture (must change contact lenses anyway)
  • Topical hourly drops: fluoroquinolone
  • Or Ceftazidime + Vancomycin
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21
Q

What are the Ddx for bacterial keratitis?

A
  • Fungal
  • Protozoal (acanthamoeba)
  • Viral: herpes simplex, herpes zoster
  • Sterile ulcer
22
Q

What are the charateristics of fungal keratitis?

A

Same as bacterial but unresponsive to treatment.

Rare, More serious infection

23
Q

What is the common causative agent in fungal keratitis?

A

Protozoal: Acanthamoeba Keratitis

24
Q

In whom is fungal keratitis more common?

A
  • Common if history of Trauma from natural object
  • People using own saliva to clean lens
  • Swimming, using hot tub while wearing lenses is a risk factor
25
Q

What are the symptoms of Herpes Simplex Corneal Ulcer

A 
Usually dormant originates from dormant infection, first episode in childhood
•	Red eye
•	Pain
•	Photophobia
•	Decrease vision
•	Tearing
•	Recurrent
26
Q

What are the signs of HSV corneal ulceration?

A
  • Dendritic ulcer
  • Usually just one eye infected
  • Recurrence
27
Q

What is the treatment for HSV corneal ulceration?

A 
Fluorescence Highlighting to dx
Topical acyclovir ointment
Avoid steroid (can lead to giant corneal ulcer)
28
Q

What type of drugs are C/I in HSV Corneal Ulceration?

A

Steroids

29
Q

Vesicular skin rash in the first division of trigeminal nerve?

A

Herpes Zoster Ophthalmicus

30
Q

What are the symptoms of Herpes Zoster Ophthalmicus?

A
  • Dermatomal skin rash (not crossing dermatomal line, i.e. following a nerve)
  • Discomfort
  • Headache & general malaise
31
Q

What are the signs of Herpes Zoster Ophthalmicus?

A
  • Vesicular skin rash in the first division of trigeminal nerve
  • Hutchinson sign suggest corneal involvement (crust and inflammation over tip and dorsum of the nose suggests corneal involvement)
  • Corneal pseudodendrites
  • Very painful since infection of the nerve fibre itself
32
Q

What is the Tx for Herpes Zoster Ophthalmicus?

A
  • Oral acyclovir (within 72 hours) 800mmg Oral 5x Daily

* Warm compresses & erythromycin skin ointment

33
Q

What are the signs of corneal abrasion by foreign body?

A
  • Corneal epithelial defect stains with fluorescein

* Foreign body can be seen & removed

34
Q

What is the Tx for corneal abrasion by FB?

A
  1. AB Ointment.
  2. Nerve endings expose once epithelial tissue of cornea and severe pian therefore cover the eye for 24 hours to allow reepithelialisation of the eye.
  3. Cyclopentolate to counter spasm
35
Q

What are the common causes of subconjunctival haemorrhage?

A

Valsalva (coughing), traumatic, hypertension, idiopathic

36
Q

What is the Tx for subconjunctival haemorrhage?

A

No treatment required.
Painless
Should resolve in 2 weeks.
Blood reabsorbed.

37
Q

What are the symptoms of Uveitis?

A 
Pain
Redness
Photophobia
Tearing
Decrease vision
38
Q

What are the symptoms of Uveitis?

A
  • Cells & flare in the anterior chamber (due to iris barrier break-up)
  • Ciliary flush
  • Keratic preciptates KP (cells suspended in the, attempt to dilate the tissue results in the irregular iris margin due to cell deposits)
  • In severe cases: posterior synechiae (adherence of iris to the lens) & hypopyon
39
Q

What is the aetiology of Uveitis?

A
  • Idiopathic (sometimes med Hx e.g. spondylitis, facial disease, toxoplasmosis etc)
  • If recurrent must look for underlying cause
  • HLA-B27 associated uveitis: ankylosing spondylitis
  • Behcet disease
  • Sarcoidosis
  • Toxoplasmosis
40
Q

What is the Tx for Uveitis?

A

Cycloplegic to ease spasming in the mussle
Topical steroid mainstay, given hourly
Treat ideology

41
Q

In whom is Acute Angular Closure Glaucoma most common?

A

Usually >60yo, presenting during the evening

42
Q

When does AACG commonly present?

A

In the evening (Hx of pain during the evening)

43
Q

What are the symptoms of AACG?

A 
Coloured halos around lights
Blurred vision
Frontal headache
Pain
Nausea & vomiting
May present as an acute abdomen
Usually Hx of pain during the evening
44
Q

What are the signs for AACG?

A

Closed angle in the involved eye (check both eyes)
Increase intra ocular pressure
Corneal oedema
Narrow occludable angle in the fellow eye
Conjunctival injection
Fixed mid dilated pupil

45
Q

Describe the pathophysiology of AACG?

A
  • Pupillary block (prevents drainage of aquas causing pressure that pushes on the iris)
  • Normal IO pressure 10-20, can reach 40-60mmhg in AACG
  • Angle crowding: high peripheral iris
46
Q

What is the treatment for AACG?

A

Topical drops: Beta-blocker/ alpha agonist
IV Carbonic anhydrase inhibitor (acetazolamide) (inhibits the formation of aqueous huour, takes 30-40 mins to work)
YAG laser peripheral iridotomy, when the is quiet
20% Manntiol IV, High osmolality, wont cross eye? Barrier, therefoe draws fluid out.
Give steroid to make eye more?

47
Q

What is the Tx for a chemical burn?

A
  • Treatment IMMEDIATELY before checking the vision:

* Copious irrigation for 30 minutes

48
Q

What is episcleritis?

A 
Inflammation of the episclera
•	Patients tend to be younger
•	Red eye
•	Mild pain
•	No discharge
•	No change in vision 
•	Self limiting
49
Q

What is the Tx for Episcleritis?

A

Artificial Tears

50
Q

What is scleritis?

A

Inflammation of the sclera & episclera resulting in a severe and boaring eye pain.

51
Q

Describe the aetiology of scleritis?

A

50% of the cases have associated systemic (usually autoimmune) disease

Connective tissue disease (RA, Wegener granulomatosis, SLE, polyarteritis nodosa, rheumatoid arthritis)

Herpes zoster ophthalmicus

Syphilis

Postocular surgery

52
Q

What is the treatment for scleritis?

A

NSAIDs
Systemic steroid (since usually autoimmune in nature)
Immunosuppressive therapy

Ophthalmology (10 decks)

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