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VISIT TWO > 6.1.7 Manages patients presenting with red eye/s. > Flashcards

6.1.7 Manages patients presenting with red eye/s. Flashcards

1
Q

What is subconjunctival heamorrhage?

A

small localised sleeping under the conjunctiva where posterior borders can be seen –> if there is not white = may be intracranial = emergency

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2
Q

Why do you get sub conj?

A
  1. idiopathic
  2. Tramatic
  3. Recent eye surgery
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3
Q

why can eye surgery casue a sub conj?

A
  1. When adjusting the eye tissue it may rupture a small blood vessel under the conjunctiva
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4
Q

How long does sub conj last?

A

normally around 2 weeks - self resolving

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5
Q

What to do if a px does have a sub conj?

A

measure Blood pressure ,
make sure u can see white
if recurrent refer to gp

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6
Q

What is a ptergium?

A

This is fibrovacular tissue - being wing shaped fold

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7
Q

What casues pyterigium?

A

UV / hot + dusty enviroments

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8
Q

why does uv cause pterygium ?

A

Uv damages DNA = mutations + abnormal growth of the conj tissue

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9
Q

why does dusty enviroments cause pyterigum?

A

particles get trapped under eyelids = inflammation - ongoing / longterm = promotes grwoth of ptergium by initating inflammatory pathways

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10
Q

what are the signs of it

A

often bilateral
starts with scarring –> thickening of the bulbar conj –> small grey opacity near the limbus –> conj overgrows the opacties+ gorwths onto the cornea

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11
Q

when do we refer this?

A

affecting the visual pathway

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12
Q

what is a pingueculua?

A

yellow/white deposite on the conj

due to a degeneration of collagen fibres of the conjunctival stroma
uv protection / ocular lubricants / cold compress

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13
Q

What is epislceritis?

A

This si idiopathic inflammation of the vascular connective tissue (episclera) under the sclera + conjunctiva

may be linked to systemics like RA, Lupus , crohns disease

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14
Q

why does episcleritis have an acute onset?

A

Rapid as it is due to rapid localised immune responses. –> when the body realises there is a threat it will quickly send cytokines, prostgandins ect

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15
Q

why is there mild ache / burning?

A

irriation of the nerve endings inn the episcleral tissues to inflammation

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16
Q

Why is it recurrent?

A

oNCE IS HAS INFLAMMED –> it makes it more susceptble ot more redidual changes in the future

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17
Q

Does episcleritis blanch with phenlyephrine?

A

Yes - becasue the blood vessels will vasoconstrict (narrow) –> if it does not then the bleed it deeper then episclera –> scleritis

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18
Q

what is simple episcleritis?

A

NO nodule - diffuse or sectoral

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19
Q

What is nodular episcleritis

A

Presence of a nodule –> this is more painful

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20
Q

Why is the Ac quiet and clear in episclertisis?

A

the inflammation does not involve the anterior chamber of the eye.

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21
Q

how to resolve episcleritis/

A
  1. self limiting 7-10 days and reassurance andd apply cold compress
    nodule - refer as may need steroids
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22
Q

what is scleritis?

A

this is inflammation of the sclera and it is 50% of the time bilateral.H

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23
Q

Why is there pain on eye movmenrts of scleritis?

A

the sclera is more denser / innervated then the episclera. movement of the inflammed sclera tissue = more pain

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24
Q

does pain disturb sleep in scleritis?

A

yes it does lol

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25
Q

is slceritis a more graual onset or quick?

A

It is more gradual as the inflmmation builds up slowly – episclera = thin = inlfmmaed quick …. sclera = thick = slower

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26
Q

why is the globe tender with scleritis

A

the inflammation is wide spread in comparision to episclera

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27
Q

why do you get blue sclera affect?

A

becasu the sclera is now thin –> can see more of the uvea whihc is rich in melanin = blue sclera effect –> once inflmmation has occoured

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28
Q

what is necrotising scleritis?

A

this is the most sever form and can lead to imaairment

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29
Q

What is bacterial conjunctivitis caused by?

A

staplococcus epidermidi/ aurus

30
Q

what are the symtoms?

A
  1. acute onset
  2. redness
  3. gritty
  4. discomfort
  5. mucous discharge
  6. crusting
    bilaterl
31
Q

What are the signs?

A
  1. crusting
  2. conjunctival redness
  3. discharge

5-7 resolve with anything
clean with wipes and advice contagious no lens wear
chloramphenicol if needed after 7 days

32
Q

What is viral conjunctivis caused by?

A

adenvirus

33
Q

What does the px normall have?

A

a cold or a lung infection

34
Q

why is viral water discharge ?

A

irritation + inflam = lacrimal gland makes more tears –> serous not thick and bright

35
Q

why do you get follciels with viral conjuncitvitis?

A

white small nodules - LYMPOD tissues

36
Q

can viral conj cause corneal involment?

A

somtimes –> superfical keritisi small lesions

37
Q

can viral conjuncitvits casue pseudo-membrane on trasal plate

A

yes - this is when andeo virus type 8 + 19 cause intesne inflmmation

this psudeo memerbane is filled with fibrin + inflam cells

38
Q

management

A

high contagous
self resolving

if corneal = emergency / psudo membrane

39
Q

what hypersensivity reaction causes allergic conjuncitvitis?

A

type 1
SEASONAL - POLLEN
PERENNIAL - DUST

40
Q

WHAT ARE THE SYMPTOMS

A
  1. re , itchy eyes
  2. watery eyes
  3. sneezing
41
Q

what happens to the lids in allergic conjunc?

A

they become swollen

42
Q

what happens to the conj?

A

becomes red

43
Q

is the cornea involved in type 1 allergic conjunctiis?

A

no - if it does then it is atopic / vernal keratoconjunctivis

44
Q

what is vernal conjucntivitis?

A

this is commoen in young males and most liekly if the px is atopic –> the px has a GENTIC tendacy to developallergic diseases - bilaterl bu asym

45
Q

why do vernal keratoconjucntivs get blepharospams?

A

this is a protective attempt by the eye to reduce exposure ot the enviroemtns irriative nature

46
Q

why do you get papillae on the tarsal plate ?

A

this is 1mm and flat topped and due to severe form on inflammation

47
Q

what does the limbus look like in venous kertaconjunct?

A
  1. thickening
  2. Trantas dots
  3. neovas
48
Q

what happens to the cornea?

A
  1. punctate epithelium erson
  2. plaques of fribrin
  3. mucous
49
Q

why do you get punctate epithelium ersoins?

A
  1. direct inflmmation
  2. Rough eyelids = secondary trauma
50
Q

Why does a macro erosion occour?

A

larger areas of ersoin - more suceptible to infection

51
Q

WHy do you fibrin later / mucous forming sheild ulcer?

A

chronic inflammation -> lead to a formation of a sheild ulcer

52
Q

why do you get a ring shaped subepi scar?

A

healing responses in the cornea –> they will form under the cornea and can lead to distortion in visionHWa

53
Q

what is a secondary complicaiton?

A

keratoconus –> rubbingof the eyes

54
Q

atropic vs vernal

A

atopic –> lower taral and vernal is at the top –> atopic ~ 50 years

55
Q

is herpes simplex commmon?

A

yes - but latent

56
Q

what does the px feel?

A
  1. pain - cornea nerves = sensitive - inflammation
  2. burning - inflammation
  3. photophobia - cornea inflammed
  4. redness
    5 . unilateral - localised virus in one eye
  5. reduced va = corneal oedma
57
Q

why do you get dendriform pattern?

A

becasue the virus will replicate and infect the next cell and so on - this occours in the epithlium

58
Q

what is a geographc ulcer?

A

this happens late stage - large / map like and irregular – geographic as shape is like a map

59
Q

what happens to the stromaa?

A

this can be invaded and cell death occours

60
Q

can u get stomal infiltrates with herpee sismplex?

A

yes - stromal infiltrates

61
Q

Can you get KP in herepes simplex?

A

yes - inflam deposits

62
Q

what is disciform keratitis?

A
  1. oedma in the stroma
  2. Stromal thickening
  3. folds in descemets membranes
  4. KPs
63
Q

herpes simplex ..

A

1 week urgent and emergency if stromal / infant

64
Q

what is herpes zoster?

A

this is when the chciken pox infection stays dormant –> manifest as shingles –> 60/70 years old but also immunosuppressed px

65
Q

what are the signs?

A

unilateral, painful and red.

66
Q

what are the signs of herpes zoster virus

A

rash on the forhead/upper eyelid –> corresponds to the trigeminal nerve

67
Q

when does crusting occour in herpe zoster?

A

2-3 weeks

68
Q

why does periorbital oedma occour?

A

inflmamtion / lymphatic obstruction

69
Q

What is hutchinson sign?

A

lesion on the nose –> following the trigenminal nerve –> more risk of ocular compliation

70
Q

what corneal signs >

A
  1. Kp
  2. pseudodendrites - more central + broader
  3. puncate staining
  4. desciment membrane folds
71
Q

if zoster is deep = emergency

A

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