What are some causes of red eye?
Eye infections
Haemorrhage
Acute angle-closure glaucoma
What is the most common cause of red eye?
Conjunctivitis
What helps to defend the eye from infection?
Structures
Tear film (lacrimal fluid and mucus via Meibomian glands)
What do tears contain to help defend against infection?
Lysozymes
Immunoglobulins
Complement
What are symptoms you should ask about in an ophthalmic history?
Pain - grittiness, dryness, headache
Itch
Discharge
Photophobia
Visual loss
Which infection are people with contact lenses particularly prone to?
How is it treated?
Acanthaemoba
amoeba which colonises if you sleep, swim with your contact lenses in
Chlorhexidine
How are the eyes examined?
Front to back
How can you check IOP in an eye examination?
What piece of equipment can also estimate IOP?
Ballot the eyes
like kidneys in GI exam
Tonometer
blows air into the eye
What is blepharitis?
Inflamed eyelids
What symptom does blepharitis usually produce?
Dry, gritty eyes
What is the usual causal organism of anterior blepharitis?
What signs does it produce?
Staph. aureus
Distorted lashes, scaly, inflamed lids
What structure is diseased in posterior blepharitis?
Meibomian glands
which produce mucus
What does posterior blepharitis look like?
Swollen lump on eyelid
Dried secretions on lashes
What derm problem, common in middle aged women, is posterior blepharitis associated with?
Acne rosacea
facial flushing, pustules, rhynophyma
How is blepharitis treated?
Proper lid hygiene
Tear drops
Oral antibiotics for Staph e.g doxycycline
What causes conjunctivitis?
Bacteria
Viruses
Allergy
What type of conjunctivitis does chlamydia cause?
What else must be screened for?
Trachoma
STIs
Does conjunctivitis affect vision?
No
What are the symptoms of conjunctivitis?
Red eye
Gritty
Discharge (watery for viral, pus in bacterial)
Itch in ALLERGIC conjunctivitis
How is conjunctivitis treated?
Antibiotics
Antivirals
Anti-inflammatories
What indicates chlamydial conjunctivitis over viral or other bacterial causes?
Follicles on posterior eyelids
What indicates viral conjunctivitis over other types?
Pink eye
Watery discharge
Enlarged pre-auricular nodes
What indicates allergic conjunctivitis over other causes?
Itchy eye
Papillae on posterior eyelids
Chemosis
History of atopy
What is chemosis?
Conjunctival oedema
What would you see in a viral conjunctivitis caused by
a) Herpes simplex
b) Herpes zoster?
a) Cold sores (papules)
b) Dermatomal rash
If a patient has vertical scratches on their cornea, where should you examine?
Posterior eyelids for foreign bodies
“ice rink cornea”
What are the layers of the cornea?
Epithelium (hydrophobic)
Stroma (hydrophilic)
Endothelium (hydrophobic)
What stain can be used to identify corneal lesions?
Fluorescein
What is a sign of significant corneal disease?
Vascularisation
What microbes can cause corneal ulcers (i.e a keratitis)?
Viral (dendritic ulcers)
Fungal (rare)
Bacterial (hypopyon)
Acanthamoeba (contact lenses)
Corneal ulcers are an indicator of poor control of which type of disease?
Autoimmune disease
e.g RA
Are corneal ulcers painful?
Yes
What are the symptoms of corneal ulcers?
Pain
Photophobia
Profuse lacrimation
What are some signs of corneal ulcers?
Redness
Loss of corneal light reflex
Abnormal fluorescein staining
Hypopion
What type of corneal ulcer does proptosis e.g in thyroid eye disease cause?
Exposure keratitis
from cornea being too far out into external environment
In which autoimmune disease may profuse dryness cause corneal ulcers?
Sjogren’s syndrome
Which vitamin deficiency can cause corneal ulcers?
Vitamin A deficiency
remember retinol in rhodopsin is a Vitamin A derivative
How are corneal ulcers investigated?
Corneal scrape for culture
How often are bacterial corneal ulcers treated with antibacterials?
Hourly drops in hospital
How is autoimmune keratitis treated?
Anti-inflammatories
What is given alongside antivirals in viral keratitis?
Antibiotics
To prevent superinfection
What structures are inflamed in uveitis?
Iris
Cilary bodies
Choroid
Which type of disease is highly associated with anterior uveitis?
Autoimmune disease
e.g Reiter’s syndrome, UC, ANKYLOSING SPONDYLITIS, SARCOIDOSIS
What are the symptoms of anterior uveitis?
Pain
Reduced vision
Photophobia
Red eye
How does the cornea look in anterior uveitis?
Clear
What is seen in the anterior chamber in uveitis?
Flare
cells, protein, inflammatory stuff, debris…
Bacterial keratitis and anterior uveitis both cause a hypopyon.
How do you distinguish between them?
In anterior uveitis, cornea is clear
How is anterior uveitis treated?
Topical steroids
In glaucoma, drops are used to constrict the pupil.
What type of drops are used in anterior uveitis?
Mydriatic drops (dilate)
To relax the eye muscles are reduce pain
What is relatively common, self-limiting disease which is associated with gout?
Episcleritis
What is a painful disease of the deep sclera?
Scleritis
associated with RA, vasculitis
What does scleritis look like?
Deep injection of sclera
“violaceous hue”
How is scleritis treated?
Oral anti-inflammatories
so steroids, NSAIDs and DMARDs (azathioprine, methotrexate, ciclosporin)
Who tends to get acute angle-closure glaucoma?
MYOPIC, elderly patients
What are the symptoms of acute angle-closure glaucoma?
Sudden loss of peripheral vision
Painful, red eye
Headache
Nausea
Vomiting
What sign can be felt on balloting of the eye in acute angle closure glaucoma?
Stony hard due to raised IOP
How does the pupil look in acute angle-closure glaucoma?
Mid-dilated
How does the cornea look in acute angle-closure glaucoma?
Cloudy
