Acute red eye Flashcards
(132 cards)
1
Q
What is bacterial conjunctivitis?
A
Inflammation of the conjunctiva (Outer layer of the eye, surrounding sclera) caused by bacterial infection
2
Q
What is the most common cause of acute red eye?
A
Conjunctivitis
3
Q
What are some causes of bacterial conjunctivitis in neonates?
A
- Staphylococcus aureus
- Neisseria gonorrhoea
- Chlamydia trachomatis
4
Q
What are some bacterial causes of conjunctivitis in children and adults?
A
- Staphylococcus aureus
- Streptococcus pneumoniae
- Haemophilus influenza (Especially in children)
5
Q
How does bacterial conjunctivitis present?
A
- Inflammation (swelling, redness, pain, heat)
- Gritty irritation/itchiness
- Morning crusting
- Copious mucopurulent yellow discharge
- Does not cause pain, photophobia or reduced visual acuity
- Abrupt onset
- Spreads to both eyes within 48 hours
- Papillae
6
Q
How is bacterial conjunctivitis investigated?
A
If suspect infective aetiology, swab for culture - bacterial, chlamydial, viral
7
Q
How should bacterial conjunctivitis be managed initially?
A
Topical broad spectrum antibiotic - Chloramphenicol
Treats most bacteria except pseudomonas
8
Q
How is bacterial conjunctivitis managed if unresponsive to topical broad spectrum antibiotics?
A
Staph. aureus - Fusidic acid
Coliforms and pseudomonas - Gentamicin
9
Q
What is viral conjunctivitis?
A
Inflammation of the conjunctiva (Outer layer of the eye, surrounding sclera) caused by viral infection
10
Q
What are some causes of viral conjunctivitis?
A
- Adenovirus (most common)
- Herpes simplex
- Herpes zoster
11
Q
How does viral conjunctivitis present?
A
- Inflammation (Swelling, redness, pain, heat)
- Gritty irritation/itchiness
- Does not cause pain, photophobia or reduced visual acuity
- Sudden onset, rapidly progressive
- Typically bilateral, often manifests in one eye before spreading to the other
- Some patients will have associated URT - dry cough, sore throat and blocked nose
12
Q
How does adenovirus conjunctivitis present?
A
Watery discharge
13
Q
How does herpes simplex conjunctivitis present?
A
Cutaneous vesicles develop on the eyelids and on the skin around the eyes
14
Q
How does herpes-zoster conjunctivitis present?
A
Shingles rash
15
Q
What is shown?
A
Viral conjunctivitis - Adenovirus
16
Q
What is shown?
A
Viral conjunctivitis - Herpes simplex
17
Q
What is shown?
A
Herpes-Zoster (Shingles)
18
Q
How is viral conjunctivitis investigated?
A
If suspect infective aetiology, swab for culture - bacterial, chlamydial, viral
19
Q
How is adenovirus conjunctivitis managed?
A
Lubrication, cold compress (self-limiting)
20
Q
How is herpes (Zoster or Simplex) managed?
A
Antivirals e.g. ganciclovir
21
Q
What is a possible complication of herpes simplex conjunctivitis?
A
Dendritic ulcer (50% of patients)
22
Q
How will chlamydial conjunctivitis present?
A
- Often chronic history unresponsive to treatments
- Suspect in bilateral conjunctivitis in YAs
- May or may not have symptoms of urethritis, vaginitis
23
Q
How can chlamydial conjunctivitis be passed?
A
From mother to newborn
24
Q
How is chlamydial conjunctivitis managed?
A
- Topical oxytetracycline
- Adults may need oral azithromycin for genital chlamydia infection
- Need contact tracing
25
What is a possible complication of chlamydial conjunctivitis?
Subtarsal scarring
26
What are some causes of allergic conjunctivitis?
Most cases seasonal as a result of pollen allergy, can occur due to allergens e.g. animal dander
27
How does allergic conjunctivitis present?
- Watery, itchy eyes
- Bilateral and symmetrical ocular involvement with global injection and chemosis
28
How is allergic conjunctivitis managed?
- Avoid triggers
- Cool compresses, oral/topical antihistamines for symptomatic relief
- Once control achieved - maintenance with a mast cell stabiliser (e.g. sodium cromoglycate)
29
What is scleritis?
Full thickness inflammation of the sclera; more serious than episcleritis
30
What are some associations with scleritis?
Autoimmune conditions - RA, SLE, IBD, Sarcoidosis, GPA
Surgery
Infection
31
How will scleritis present?
- Severe pain that progresses over several days
- Pain with eye movement
- Photophobia
- Eye watering
- Reduced visual acuity
- Abnormal pupil reaction to light
- Tenderness to palpation of the eye
32
What is shown?
Scleritis
33
How is scleritis managed?
- Oral NSAIDs
- Oral steroids + steroid sparing agents
34
What is the episclera?
The thin vascular sheet which lies between the conjunctiva and sclera
35
What is episcleritis?
Inflammation of the episclera; more superficial and less severe than scleritis
36
What causes episcleritis?
- Idiopathic (Usually therefore self-limiting)
- Systemic disease - IBD, RA, Sarcoidosis
37
How does episcleritis present?
- Typically not painful but there can be mild pain
- Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera.
- Foreign body sensation
- Dilated episcleral vessels
- Watering of eye
- No discharge
38
What is shown?
Episcleritis
39
How is episcleritis managed?
Self limiting - lubricants and cold compresses, topical NSAIDs, mild steroids
40
What is keratitis?
Inflammation of the cornea
41
What is a hypopiyn?
A hypopyon is an aggregation of inflammatory cells within the anterior chamber resulting in visible 'sediment' in front of the eye inferiorly
42
What is shown?
Hypopyon
43
What is shown?
Hypopyon
44
What types of organism can cause bacterial keratitis?
Both gram +ve and -ve bacteria
45
How does bacterial keratitis present?
- Photophobia
- Severe ocular pain and associated foreign body sensation
- Hypopyon
- Usually associated with other corneal pathology or contact lens wearing
46
What investigations are required in bacterial keratitis?
- Examination - anaethetics if photophobic, fluorescein, corneal reflex
- Corneal scrape for gram stain and culture
- In acanthamoeba ketatitis also culture contact lens
47
How is bacterial keratitis managed?
- Patient needs to be admitted for hourly antibiotic drops, patients require daily review
- Ofloxin - treats most gram negatives
- Gentamicin and cefuroxime - treats most gram positive and gram negative organisms
48
What is adenovirus keratitis?
Inflammation of the cornea caused by adenovirus
49
How does adenovirus keratitis present?
- Bilateral inflammation
- Following URTI or conjunctivitis
- May affect vision
50
What is shown?
Adenoviral keratitis
51
How is adenovirus keratitis managed?
- Normally self-limiting
- Can require steroids if chronic
52
What are some causes of viral keratitis?
Adenovirus
Herpes-Simplex virus
53
How does herpetic keratitis present?
- Dendritic ulcer
- Very painful
- Can be recurrent
- Recurrences eventually result in reduced sensation
54
What is shown?
Dendritic ulcer - Herpetic keratitis
55
How is herpetic keratitis managed?
- Treated with topical antiviral (ganciclovir)
- DO NOT treat with steroids - can cause corneal melt and perforation of the cornea
56
How does fungal keratitis present?
- Often chronic history
- Seen in those who work outside or have ocular surface disease
- Often corneal lesions more defined than its bacterial counterpart
- Often diagnosed late
57
What is shown?
Fungal keratitis
58
How is fungal keratitis managed?
Topical anti-fungals
59
What causes acanthamoeba keratitis?
Acanthamoeba
60
How does acanthamoeba keratitis present?
- Most often seen in contact lens wearers
- Often extremely painful
- Can be diagnosed late
61
What is shown?
Acanthamoeba keratitis
62
How is acanthamoeba keratitis managed?
Anti-amoebic drops
63
What is anterior uveitis?
Inflammation in the anterior part of the uvea; the uvea involves the iris, ciliary body and choroid
64
How does anterior uveitis occur?
Inflammation and immune cells in the anterior chamber of the eye, usually caused by:
- Autoimmune process
- Infection
- Trauma
- Ischaemia
- Malignancy
65
What are some autoimmune causes of anterior uveitis?
- Reiter's
- Ulcerative colitis
- Ankylosing spondylitis
- Sarcoidosis
66
What are some infective causes of anterior uveitis?
- TB
- Syphilis
- Herpes simplex, herpes zoster
67
What is a malignancy that can cause anterior uveitis?
Leukemia
68
What are some other causes of anterior uveitis?
- Idiopathic
- Traumatic
- Secondary to other eye disorders
69
What are some symptoms of anterior uveitis?
- Unilateral and spontaneous
- Flare of associated disease
- Dull, aching, painful red eye
- Vision reduced
- Photophobia
70
What are some clinical signs of anterior uveitis?
- Circumcorneal red eye
- Ciliary injection
- Keratic precipitates
- Hypopyon
- Synechiae
- Cells and flare in anterior chamber
71
What is synechiae?
Small or irregular pupil due to adhesions pulling the iris into abnormal shapes
72
What is shown?
Anterior uveitis
73
What is shown?
Keratin precipitates - Anterior uveitis
74
What is shown?
Synechiae - Anterior uveitis
75
What is shown?
Flare in anterior chamber - Anterior uveitis
76
What is shown?
Cells in anterior chamber - Anterior uveitis
77
How is anterior uveitis managed?
- Topical steroids
- Mydriatics
- Investigate for systemic associations if recurrent or chronic
78
What is cellulitis?
Bacterial infection of the lower dermis and subcutaneous tissue
79
What are the 2 forms of cellulitis affecting the eye?
Pre-septal cellulitis
Orbital cellulitis
80
What is pre-septal cellulitis?
Infection of the eyelid and surrouding skin anterior to the orbital septum
81
What causes pre-septal cellulitis?
Usually caused by contiguous spread of infection from local facial or eyelid trauma e.g. insect bites
82
How does pre-septal cellulitis present?
Tenderness, warmth, swelling, redness of the eyelid
83
What is shown?
Pre-septal cellulitis
84
How is pre-septal cellulitis managed?
Antibiotics (can be outpatient if orbital cellulitis definitively excluded)
85
What is orbital cellulitis?
Infection of the orbital tissues posterior to orbital septum
86
How does orbital cellulitis occur?
- Direct extension from sinus
- Extension from focal orbital infection
- Post-operative
87
What are some causative organisms of orbital cellulitis?
- Staphylococci
- Streptococci
- Coliforms
- H. influenzae
- Anaerobes
88
What are some clinical features of orbital cellulitis?
- Painful, especially on eye movements
- Proptosis
- Often associated with paranasal sinusitis
- Pyrexial
- Sight threatening
89
What is shown?
Orbital cellulitis
90
What are some investigations required in orbital cellulitis?
- CT scan to identify orbital abscesses
- If any suggestion of muscle restriction or optic nerve dysfunction - CT scan
91
How is orbital cellulitis managed?
- Broad spectrum antibiotics and monitor closely
- Sometimes an abscess will require drainage
92
What is endophthalmitis?
Devastating infection inside of the eye that threatens sight
93
What causes endophthalmitis?
Post-surgical or endogenous
94
What are some causative organisms in endophthalmitis?
Often conjunctival commensal bacteria, most common causative organism is Staph. epidermidis
95
How does endophthalmitis present?
- Very painful
- Decreasing vision
- Very red eye
96
What is shown?
Endophthalmitis
97
What is shown?
Endophthalmitis
98
What investigation is required in endophthalmitis?
Aqueous/vitreous for culture
99
How is endophthalmitis managed?
Intravitreal amikacin/ceftazidime/vancomycin and topical antibiotics
100
What is blepharitis?
Common chronic inflammatory condition affecting the margin of the eyelids
101
When does blepharitis most commonly occur?
In middle-age
102
What are the 2 main forms of blepharitis?
Anterior
Posterior
103
What is anterior blepharitis?
Inflammation of the base of the eyelashes (located on the anterior margin of the eyelid)
104
What are some causes of anterior blepharitis?
- Bacteria - Staphylococcal blepharitis
- Seborrhoeic dermatitis - Seborrhoeic blepharitis
105
How can seborrhoeic and staphylococcal blepharitis be differentiated?
Seborrhoeic blepharitis has less inflammation but causes more excess oil or greasy scaling
106
What is posterior blepharitis?
Inflammation of the meibomian glands (often called meibomian gland dysfunction)
107
What are the meibomian glands?
- The meibomian glands are a set of glands that run along the posterior eyelid margin
- They produce a lipid secretion which provides the lipid layer of the tear film
108
What are some symptoms of blepharitis?
- Burning, itching and/or crusting of the eyelids
- Symptoms are worse in the mornings
- Both eyes are affected
- Recurrent hordeolum
- Contact lens intolerance
109
What are some signs of anterior blepharitis?
Lid margin redder than deeper part of lid
110
What are some signs of posterior blepharitis?
Redness is in deeper part of lid, lid margin often looks normal
111
How is blepharitis managed?
- Symptoms can usually be controlled with self-care measures such eyelid hygiene and warm compresses
- Treat associated condition e.g. supplementary tear drops for dry eye syndrome
112
How is blepharitis managed if it does not respond to symptom control methods?
Consider prescribing topical cloramphenicol for anterior blepharitis or oral doxycycline for posterior blepharitis
113
What are some complications of blepharitis?
- Stye (hordeolum)
- Chalazion
114
What is another name for a meibomian cyst?
Chalazion
115
What is a meibomian cyst?
Sterile, chronic, inflammatory granuloma of the eyelid caused by a foreign body reaction to sebum within a meibomian gland
116
What are some risk factors for meibomian cyst formation?
Pregnancy
Blepharitis
Seborrhoeic dermatitis
117
How do meibomian cysts form?
1. Gland obstruction
2. Enlargement of the gland
3. Rupture of the gland, causing the release of accumulated lipid contents into the surrounding tissue
4. Triggered inflammatory reaction
5. Cyst formation
118
How does a meibomian cyst present?
Firm, painless, localized eyelid swelling that has developed slowly over several weeks
119
What is shown?
Meibomian cyst
120
How is meibomian cyst managed?
- Warm compresses for several weeks
- Most meibomian cysts resolve spontaneously or with conservative managment, although this may take weeks or months
- Management of any co-existing risk factors to reduce risk of recurrence
121
What is another name for a stye?
Hordeolum
122
What is a stye?
Acute localized infection or inflammation of the eyelid margin, usually caused by staphylococcal infection
123
What are the 2 types of stye?
External
Internal
124
What is an external stye?
Appears on the eyelid margin, caused by infection of an eyelash follicle or associated gland
125
What is an internal stye?
Occurs on the conjunctival surface of the eyelid, caused by infection of a Meibomian gland
126
What are some risk factors for stye formation?
Chronic blepharitis
Acne rosacea
127
How does a stye present?
- An acute-onset painful, localized swelling (papule or furuncle) near the eyelid margin that develops over several days
- Usually unilateral but can be bilateral
128
What is shown?
External stye
129
What is shown?
Internal stye
130
How is a stye managed?
- Symptoms typically resolve within 5–7 days, once the stye has spontaneously ruptured or been drained
- Warm compresses can be used to encourage the stye to drain
131
What is an immune privilege site?
Areas in which foreign antigens can preside without immune detection, making them perfect sites for grafting or research
Corneal grafts therefore can be performed without systemic immunosuppression
132
What are some immune privilege sites?
Eye
Brain
