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Y2 Ophthalmology > Acute red eye > Flashcards

Acute red eye Flashcards

1
Q

What is conjunctivitis

A

Inflammation of the conjunctiva

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2
Q

Conjunctivitis can be caused by

A

Bacterial
Viral
Allergic

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3
Q

Most common noninfectious cause of conjunctivitis

A

Allergic

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4
Q

Most common infectious cause of conjunctivitis

A

Viral

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5
Q

What are the causative pathogens of viral conjunctivitis

A

Adenovirus
Herpes simplex
Herpes zoster
Molluscum contagiosum

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6
Q

Most common cause of viral conjunctivitis

A

Adenovirus

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7
Q

What are the general symptoms of viral conjunctivitis

A

Red eyes
WATERY discharge
Grittiness in the eye
NO change in visual acuity / photophobia
NO pain

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8
Q

What specific symptoms does herpes simplex conjunctivitis cause

A

Vesicles on the eyelids and on the skin around the eyes

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9
Q

What specific symptoms does herpes zoster conjunctivitis cause

A

shingles rash

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10
Q

Viral conjunctivitis is usually unilateral / bilateral

A

Unilateral

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11
Q

Patients with viral conjunctivitis often also have

A

Viral URTI

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12
Q

Management of viral (non-herpes) conjunctivitis

A

Self limiting
Cold compress
Lubricating eye drops
Prevent spread by washing hands and avoid sharing towels

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13
Q

How long are patients with viral conjunctivitis infective for

A

up to 14 days

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14
Q

Management for herpetic conjunctivitis (HSV and herpes zoster)

A

Antiviral - ganciclovir

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15
Q

Bacterial conjunctivitis mostly affects

A

Children
Elderly

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16
Q

What are the causative pathogens of bacterial conjunctivitis in neonates

A

S aureus
Chlamydia trachomatis
Neisseria gonorrhoea

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17
Q

What are the causative pathogens of bacterial conjunctivitis in children-elderly

A

Strep pneumoniae
S aureus
H influenza (esp in children)
Chlamydia

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18
Q

What is the name for conjunctivitis in neonate

A

Ophthalmia neonatorum - conjunctivitis occurring in first 28 days of life

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19
Q

Chlamydia can cause ophthalmia neonatorum. How does this occur

A

Contamination from the maternal genital tract

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20
Q

What are the general symptoms of bacterial conjunctivitis

A

Red eyes
YELLOW PURULENT discharge
Grittiness
“eyelids being stuck together in the morning”
NO change in visual acuity / photophobia

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21
Q

When should you suspect chlamydia as the cause of bacterial conjunctivitis

A

Bilateral conjunctivitis in young adults
May have symptoms of vagnitis / urethritis
Unresponsive to treatments

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22
Q

Management of bacterial conjunctivitis

A

Lubricating eye drops and cool compression
Prevent spread
Topical antibiotics if indicated
Swab and culture if unresponsive

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23
Q

When are topical antibiotics indicated in bacterial conjunctivitis

A

If symptoms do not resolve withn 3 days of onset

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24
Q

What topical antibiotics are used for bacterial conjunctivitis

A

Topical chloramphenical
Topical fusidic acid (second line)

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25
Q

Which bacteria is not treated by chloramphenicol

A

Pseudomonas aeruginosa

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26
Q

What can be used to treat bacterial conjunctivitis caused by pseudomonas aeruginosa

A

Gentamicin

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27
Q

Contact lens wearers with a diagnosis of bacterial conjunctivitis should be treated with

A

Topical gentamicin / levofloxacin

These are topical antibiotics effective against gram -ves

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28
Q

Management of chlamydial conjunctivitis

A

Topical oxytetracycline
Oral azithromycin for genital infection
Contact tracing

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29
Q

Allergic conjunctivitis is caused by which type of hypersensitivity

A

Type 1

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30
Q

Symptoms of allergic conjunctivitis

A

Seasonal onset
Red eyes
WATERY discharge
Pruritus
grittiness

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31
Q

Management of allergic conjunctivitis

A

Avoid triggers
Topical lubricants and Cool compresses
Topical antihistamines
Topical mast cell stabiliser once control achieved

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32
Q

When is topical mast cell stabiliser used for allergic conjunctivitis

A

As maintenance therapy after symptoms have been controlled

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33
Q

Example of topical mast cell stabiliser used for allergic conjunctivitis

A

Sodium cromoglycate

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34
Q

When should you refer patients with conjunctivitis to ophthalmology

A

Reduced visual acuity
Photophobia
Conjunctivitis in neonate
Infection w Herpes virus
Soft contact lens users with corneal symptoms (photophobia)

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35
Q

Which symptoms suggests corneal involvement

A

Photophobia

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36
Q

What is scleritis

A

Full thickness inflammation of the sclera

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37
Q

What is episcleritis

A

Inflammation of the episclera

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38
Q

Difference between scleritis and episcleritis

A

Episcleritis affects more superficial part

Scleritis causes severe pain whereas episcleritis causes mild pain

Scleritis causes pain on eye movement whereas episcleritis does not

Scleritis pain worse at night

Episcleral vessels blanch when pressed with a cotton bud whereas scleral vessels do not blanch

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39
Q

Scleritis is associated with which conditions

A

RA
SLE
GPA
IBD
Sarcoidosis

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40
Q

Symptoms of scleritis

A

Severe pain
Diffuse redness
Pain with eye movement
Pain worse at night
Eye watering
Reduced visual acuity
Photophobia
Systemically ill with rheumatological conditions

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41
Q

What may be seen in severe scleritis

A

Bluish tinge to the white of the eye due to scleral thinning

BUT very severe scleritis may appear white due to necrosis

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42
Q

Investigations for scleritis

A

Urine dipstick
Bloods, LFTs
Autoantibodies

Because scleritis is associated with rheumatological conditions

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43
Q

Management of scleritis

A

Oral NSAID for mild scleritis
Oral steroids +/- steroid sparing for severe scleritis

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44
Q

Which steroid is used for scleritis

A

Oral prednisolone / pulsed IV methylprednisolone

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45
Q

Episcleritis is associated with

A

IBD
RA

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46
Q

Symptoms of episcleritis

A

Mild pain / no pain
A patch of redness at lateral sclera (instead of diffuse redness)
Grittiness
Dilated episcleral vessels
Vessels are blanching
Watering of eyes

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47
Q

Management of episcleritis

A

Self limiting
Lubricants
Cold compresses

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48
Q

What is keratitis

A

Inflammation of the cornea

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49
Q

Causes of keratitis

A

Bacterial
Fungal
Amoebic
Parasitic
Viral
Environmental

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50
Q

Why do we need to urgently refer patients with suspected keratitis

A

Due to risk of blindness

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51
Q

What are the common causative organisms in bacterial keratitis

A

S aureus
Pseudomonas aeruginosa

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52
Q

Which bacteria is the most common cause of bacterial keratitis

A

S aureus (except in contact lenses wearer)

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53
Q

Which bacteria is the most common causative organism in keratitis in contact lens wearer

A

Pseudomonas aeruginosa

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54
Q

Which viruses can cause keratitis

A

Herpes simplex
Adenovirus

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55
Q

Which amoeba can cause keratitis

A

Acanthamoebic

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56
Q

Acanthamoebic keratitis is most commonly seen in

A

Contact lens wearers

57
Q

What parasite can cause keratitis

A

onchocercal “river blindness”

58
Q

Why is onchocercal keratitis called river blindness

A

Because the parasites lives and breeds near streams and rivers

59
Q

What are the environmental causes of keratitis

A

Welder’s arc eye
Exposure keratitis
Contact Lens Acute Red Eye (CLARE)

60
Q

What is welder’s arc eye

A

Inflammation of the cornea due to bright UV light

61
Q

What is exposure keratitis

A

Inflammation of the cornea due to dryness caused by incomplete eyelid closure

62
Q

Symptoms of keratitis

A

Red eye
Pain
Photophobia
Grittiness
Corneal ulcer

63
Q

Investigations for keratitis

A

Examination
Fluorescein - may see corneal ulcer
Corneal scrape for gram stain and culture
Contact lenses and lens solution for culture

64
Q

What is special about herpetic keratitis

A

Very painful
Can be recurrent (since HSV can establish latent infections)
Recurrences can result in reduced sensation

65
Q

What can be seen on fluorescein in herpetic keratitis

A

Corneal ulcer with dendritic tail

66
Q

What can be seen in bacterial keratitis

A

Central bacterial corneal ulcer
Hypopyon - accumulation of white cells at lower portion of the eye

67
Q

Management of bacterial keratitis

A

Same day referral to ophthalmologist
Hourly topical quinolone (antibiotic)
Cycloplegic for pain relief
Stop wearing contact lenses

68
Q

What are the topical antibiotic drops used in bacterial keratitis

A

Topical quinolones - Ofloxacin

69
Q

What is the cycloplegic mydriatic drop used for bacterial keratitis and what is it used for

A

Cyclopentolate
Atropine

To relief pain

70
Q

Management of herpetic keratitis

A

Topical ganciclovir - antiviral
DO NOT TREAT WITH STEROIDS

71
Q

Why shouldn’t you treat herpetic keratitis with steroids

A

Can cause corneal melt and perforation of the cornea

72
Q

What is special about acanthoamoeba keratitis

A

Very painful

73
Q

What is anterior uveitis

A

Inflammation in the anterior part of the uvea - iris and ciliary body

74
Q

Which eye structures are part of the anterior urea

A

Iris and Ciliary body

75
Q

What gene is anterior uveitis associated with

A

HLA B27

76
Q

What are the conditions anterior uveitis is associated with

A

Ankylosing spondylitis
Reactive arthritis
Behcet’s disease
IBD
Sarcoidosis

77
Q

Symptoms of anterior uveitis

A

Pain
Red eye - ciliary flush
Blurred vision
Photophobia
Small pupil (irregular pupil)

78
Q

What is the onset of symptoms of anterior uveitis

A

Acute, spontaneous
May occur with a flare of associated disease

79
Q

What are the signs of anterior uveitis

A

Hypopyon
Ciliary flush (ciliary injection) - ring of red spreading outwards
Synechiae - small / irregular pupil
Keratic precipitates

80
Q

What do keratic perecipitates look like

A

Visible small white spots which are collections of inflammatory cells

81
Q

Management of anterior uveitis

A

Urgent review by ophthalmology
Cycloplegics to relieve pain and photophobia
Steroid eye drops

82
Q

What are the cycloplegic mydriatic drops used in anterior uveitis? What are cycloplegia used for

A

Atropine
Cyclopentolate

Dilates the pupil which helps to relieve pain and photophobia

83
Q

What are the contraindications of cycloplegic mydriatic drops

A

Patients with closed angle glaucoma / increased intraocular pressure

84
Q

What is acute angle closure glaucoma

A

When the iris bulges and seals off the trabecular meshwork which prevents aqueous humour from being drained away = builds up = raised intraocular pressure

85
Q

What are the factors that predispose patients to acute angle closure glaucoma

A

Long sightedness
Pupillary dilatation
Lens growth with age (so pushes iris forwards)

86
Q

Symptoms of AACG

A

Severe pain
Nausea
Decreased visual acuity
Symptoms worse with mydriasis (dilated pupils)
Hard eye
Semi-dilated pupil
Cloudy cornea

87
Q

What causes cloudy cornea

A

Corneal oedema

88
Q

What activities can worsen the pain in AACG

A

Watching TV in the dark - due to dilation of pupils in the dark

89
Q

Investigations for AACG

A

Tonometry - measures the IOP
Gonioscopy - special lens for slit lamp that allows visualisation of the angle (angle between iris and cornea)

90
Q

Management of AACG

A

Urgent referral to ophthalmologist
Lower the IOP first
Then definitive laser surgery treatment

91
Q

What agents are used to reduce the IOP in AACG

A

Topical Pilocarpine
Topical Timolol (beta blocker)
IV acetazolamide

92
Q

Why is IV acetazolamide used for initial management in AACG

A

It reduces aqueous secretions

93
Q

Why is pilocarpine used for management in AACG

A

It causes the contraction of ciliary body -> opens the trabecular meshwork

94
Q

Cellulitis is the infection of

A

lower dermis and subcutaneous tissue

95
Q

What are the 2 types of cellulitis of the eye

A

Preseptal cellulitis
Orbital cellulitis

96
Q

What is preseptal cellulitis (periorbital)

A

Infection of the eyelid and surrounding skin anterior to orbital septum - eyelids, skin and subcutaneous tissue of the face

97
Q

What is orbital cellulitis

A

Infection of the orbital tissues posterior to orbital septum

98
Q

What are the causes of preseptal cellulitis

A

Spread of infection from local facial trauma - insect bites
Spread from sinusitis / resp tract

99
Q

What are the common causative pathogens of preseptal cellulitis

A

S aureus
Staph epidermidis
Streptococci

100
Q

Which age group is most commonly affected by preseptal cellulitis

A

Children under 10

101
Q

Preseptal cellulitis is more common in winter. Why is that

A

Because winter is usually when children get resp tract infections. These infections can then spread to preseptal part

102
Q

Symptoms of preseptal cellulitis

A

Acute red, warm, swollen eye

103
Q

investigations for preseptal cellulitis

A

Bloods
Swab
CT with contrast if suspect orbital cellulitis

104
Q

Management for preseptal cellulitis

A

Referred to secondary care
Oral antibiotics - co-amoxiclav
May need admission

105
Q

Complication of preseptal cellulitis

A

Spreads into orbit -> orbital cellulitis

106
Q

Causes of orbital cellulitis

A

Infection spreading from respiratory tract
Infection spreading from sinuses
Post-operative

107
Q

What are the causative pathogens of orbital cellulitis

A

S aureus
Streptococci
H influenza

108
Q

Risk factors of orbital cellulitis

A

Children
Previous sinus infection
Lack of H influenza type B vaccination
Recent eyelid infection (preseptal cellulitis)
Recent ear / facial infection

109
Q

Symptoms of orbital cellulitis

A

Severe pain
Pain with eye movements
Reduced visual acuity
Proptosis
Redness and swelling

110
Q

Differences between orbital and preseptal cellulitis

A

Orbital cellulitis causes
- reduced visual acuity
- pain on eye movement
- proptosis
whereas preseptal cellulitis does not

111
Q

Investigations for orbital cellulitis

A

Bloods - raised WCC and inflammatory markers
CT with contrast
Blood culture

112
Q

Management for orbital cellulitis

A

Urgent hospital admission
IV antibiotics
- IV Co-amoxiclav
- IV clindamycin + ciprofloxacin if penicillin allergic

113
Q

What is blepharitis

A

Chronic inflammatory condition affecting the margin of eyelids

114
Q

What are the 2 types of blepharitis

A

Anterior blepharitis
Posterior blepharitis

115
Q

What is anterior blepharitis

A

Inflammation of the base of eyelashes - anterior margin of eyelid

116
Q

What is posterior blepharitis

A

Inflammation of the meibomian gland

117
Q

What are meibomian glands

A

A type of sebaceous gland located along the edge of the eyelids (upper and lower). They secrete meibum

118
Q

Function of meibum

A

Prevent evaporation of the eye’s tear film
Prevent tears from spilling onto the cheek - trap between the oiled edge and eyeball

119
Q

What are the causes of anterior blepharitis

A

Seborrheic dermatitis
Bacterial - staphylococci

120
Q

Which bacteria is the most common causative pathogen of anterior blepharitis

A

Staphylococci blepharitis

121
Q

Which skin conditions are associated with blepharitis

A

Seborrheic dermatitis
Rosacea (more common in patients with rosacea)

122
Q

Cause of posterior blepharitis

A

Meibomian gland dysfunction

123
Q

Which type of blepharitis is more common

A

Posterior

124
Q

Symptoms of blepharitis

A

Bilateral
Crusting of the eyelids
Grittiness
Dry eyes
Sticky eyes in the morning
Recurrent Styes and Chalazions
Symptoms worse in the morning

125
Q

Clinical signs of blepharitis

A

Anterior: Lid margin redder than deeper part of lid
Posterior: Deeper part of lid is redder and lid margin looks normal

126
Q

What are chalazions

A

Cyst in eyelid due to blocked meibomian gland

127
Q

What eye conditions are common in patients with blepharitis

A

Styes
Chalazions

128
Q

Management of blepharitis

A

HOT compresses
removal of debris from lid margins
Artificial tears for dry eyes

129
Q

What are the techniques recommended for removing debris due to blepharitis

A

Use cotton buds dipped in cooled boiled water + baby shampoo

Sodium bicarbonate in cooled boiled water

130
Q

Pathophysiology of chalazion

A
  1. Obstruction of meibomian glands
  2. Glands enlarge and rupture, releasing lipid contents into surrounding eyelid soft tissue
  3. Triggers inflammatory reaction

(NOT DUE TO INFECTIONS, this is sterile)

131
Q

Risk factors of chalazions

A

Blepharitis
Pregnancy
Seborrheic dermatitis

132
Q

Symptoms of chalazions

A

Firm, localised eyelid swelling
Becomes painless and non-tender over time
Slow development

133
Q

Management of chalazions

A

Warm compresses
May take weeks / months to resolve

134
Q

What are styes (hordeolum)

A

Acute infection of the eyelid margin due to staph infection

135
Q

Where can styes be located at

A

External - on eyelid margin
Internal

136
Q

Cause of internal styes

A

Infection of meibomian gland

137
Q

Cause of external styes

A

Infection of eyelash follicle

138
Q

Symptoms of styes

A

Acute, painful, localised swelling
Develop over days (quicker than chalazions)

139
Q

Management of styes

A

Warm compresses
Resolves within 5-7 days once the stye has ruptured / drained

Y2 Ophthalmology (8 decks)

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