acute red eye

Question 1

causes of a painless red eye

Answer 1

conjunctivitis (more itchy/gritty)
episcleritis
subconjunctival haemorrhage

Question 2

which chemical burns to the eye are worse acid or alkali?

Answer 2

alkali - easier penetration, scars badly

Question 3

signs of bacterial conjunctivitis

Answer 3

purulent discharge
worse in morning - eyes stuck together
highly contagious - usually spread to other eye

Question 4

signs of viral conjunctivitis

Answer 4

clear discharge
dry cough, sore throat, blocked nose

tender preauricular lymph nodes (infront of ear)

Question 5

bacteria to be suspicious of in neonatal conjuntivitis

Answer 5

neisseria gonorrhoea

Question 6

common causative organism in bacterial conjunctivitis

Answer 6

staph aureus

gonorrhoeae in neonates

Question 7

treatment of bacterial conjuntivitis

Answer 7

usually topical chloramphenicol

unresponsive in chlamydial

avoid in aplastic anaemia + allergy

Question 8

commonest cause of conjunctivitis

Answer 8

adenoviral - watery discharge, preauricular lymph nodes

Question 9

HSV conjunctivitis

Answer 9

purulent vesicles around eye

Question 10

herpes zoster (shingles) conjunctivitis

Answer 10

V1, if gets in eye then conjunctivitis

Question 11

chlamydial conjunctivitis

Answer 11

younger, bilateral, recurrent, subtarsal scarring
vaginitis, urethretis

• not responsive to chloramphenical*
• -> oral azithromycin

Question 12

management of chlamydial conjuntivitis

Answer 12

oral azithromycin

Question 13

gonococcal conjunctivitis presentation + treatment

Answer 13

really extra, oozing pus

ceftriaxone IM

Question 14

anterior uveitis presentation

Answer 14

dull painful red eye
ciliary flush (ring of red round iris out)
abnormal shaped pupil

photophobia
pain on movement
hypopyon

Question 15

which group of conditions is assoc with anterior uveitis

Answer 15

HLA B27

Question 16

presentation of episcleritis

Answer 16

segmental lateral redness
foreign body sensation
watery eye

conservative + safety net

Question 17

subconjunctival haemorrhage

Answer 17

often post strenuous activity - constipated, lifting, coughing
patch of red blood under conjunctiva

resolves 2 weeks ish

Question 18

scleritis vs episcleritis

Answer 18

scleritis = pain on movment, full thickness, more serious

Question 19

assoc conditions of scleritis

Answer 19

RA
SLE 
IBD
sarcoidosis
granulomatosis polyangiitis

Mx = treat underlying, NSAIDs

Question 20

scleritis presentation

Answer 20

pain, pain on eye movment
photophobia
tenderness on palpation

abnormal pupil reaction to light

Question 21

commonest causative organism in a contact lenses wearer with keratitis

Answer 21

acanthamoeba

treat with antiseptic - not responsive to antibiotics

Question 22

most common cause of keratitis

Answer 22

herpes keratitis

Question 23

presentation of herpes keratitis

Answer 23

painful red eye
*dendritic corneal ulcer
vesicles around eye
loss of sensation on cornea

recurrent

Question 24

treatment of herpes keratitis

Answer 24

topical ganciclovir, acyclovir

Dont give steroids - cornea perforation

Question 25

fungal keratitis classic presentation

Answer 25

working in garden + shrub brushed their eye white fluffy region

Question 26

treatment of contact lens keratitis

Answer 26

polyhexamethylene biguanide chlorhexadine scar even once resolved

Question 27

entropion

Answer 27

inward turning eyelash

Question 28

diagnosis of corneal abrasion

Answer 28

1st = fluorescein stain slit lamp

Question 29

blepharitis

Answer 29

inflammation of eyelid margins gritty, itchy, dry sensation dysfunction of meibromian glands - responsible for secreting oil onto eye hot compress + gentle cleaning

Question 30

which gland is affected in chalazion?

Answer 30

meibomian - under eyelid, behind muscle can lead to preseptal celluliti

Question 31

gland affected in styes?

Answer 31

Zeis or Moll - infront of muscle ``` Zeis = sebaceous gland at base of eyelashes Moll = sweat gland at base of eyelashes ```

Question 32

why might newborns be more prone to orbital infections?

Answer 32

septum in adults is barrier for superfical infections | --> not developed in newborns

Question 33

how to distinguish preseptal and orbital cellulitis

Answer 33

CT | pain on movement = orbital

Question 34

complication of orbital cellulitis

Answer 34

potential thrombosis to cavernous brain

Question 35

causative organism of endophthalmitis

Answer 35

staph epidermis

Question 36

management of endophthalmitis

Answer 36

intravitreal antibiotics

Question 37

toxoplasmosis

Answer 37

eating undercooked meat pregnant can pass it to baby burnt out macula

Question 38

toxocara canis (worm)

Answer 38

cats + dogs larvae can migrate into retina --> can causee granulomas which cause irreversible visual loss

Question 39

diagnosis of toxoplasmosis + toxocara

Answer 39

serology

Question 40

diagnosis of bacterial keratitis

Answer 40

corneal scrapes

Question 41

Mx of anterior uveitis

Answer 41

urgent review by ophth cycloplegics -> dilates pupil to relieve photophobia (cyclopentolate, atropine) steroids ?drops