Acute red eye Flashcards
(114 cards)
1
Q
What are 8 causes of the acute red eye?
A
- conjunctivitis: bacterial, viral, allergic, chlamydia
- keratitis: bacterial, viral, marginal
- episcleritis/ scleritis
- Acute anterior uveitis/ iritis
- Angle closure glaucoma
- eyelid causes e.g. blepharitis, stye
- orbit causes
- trauma
2
Q
What are 7 diseases that can affect the eyelids causing the acute red eye?
A
- blepharitis
- Meibomian cyst
- stye
- herpes simplex
- molluscum contagiosum
- herpes zoster ophthalmicus
- entropion
3
Q
What is blepharitis?
A
chronic inflammation of the eyelid margins
4
Q
What are the 2 most common bacterial causes of blepharitis?
A
Usually staph aureus or epidermidis
5
Q
What is blepharitis commonly associated with that contributes to its cause?
A
skin disease: acne rosacea, seborrheic dermatitis
6
Q
What are the symptoms of blepharitis?
A
sore, gritty, and occasionally red eyes
7
Q
What are 4 things that examination will reveal in blepharitis?
A
- hyperaemic lid margins
- crusts on lashes
- blocked meibomian gland orifices
- meibomian cysts
8
Q
What is a stye?
A
= hordeolum, infected hair follicle
9
Q
What are 5 aspects of the treatment of blepharitis?
A
- lid hygiene
- warm compresses - gentle expression of lipids with cotton tipped applicator; gentle lid cleaning with a solution of sodium bicarbonate
- antibiotic ointment e.g. chloramphenicol onto lid margin
- lubricant
- low dose tetracyclines - antibiotics that are lipid soluble, protease inhibitors (e.g. doxycycline and tetracycline)
10
Q
What is entropion?
A
inturning of the lower lid
11
Q
What is ectropion?
A
eversion of the lower eyelid
12
Q
What is herpes zoster ophthalmicus?
A
shingles; in ophthalmic branch of trigeminal nerve which serves forehead/ top of face, eye, down to tip of nose on that side
13
Q
What are 5 types of conjunctivitis?
A
- cicratising
- bacterial
- viral
- allergic
- chlamydial
14
Q
What is are the 3 commonest causes of bacterial conjunctivitis?
A
usually staphylococcus, streptococcus or haemophilus species
15
Q
What symptoms will you get in bacterial conjunctivitis?
A
slight discomfort, red, sticky eyes (purulent discharge, eyelids sticking together), visual acuity not affected although slight blurring due to prurulent exudation, which clears when discharge blinked away
16
Q
What is the treatment of bacterial conjunctivitis?
A
Note: most self limiting and resolve in 5-7 days without treatment. Can do delayed antibiotic treatment
1. frequent antibiotic drops - chloramphenicol, 2-hourly for 2 days then 4-hourly for 5 days.
2. another option is chloramphenicol ointment 1%, 4x daily for 2 days then 2x daily for 5 days
3. fusidic acid 1% eye drops 2nd line, 2x daily for 7 days
general hygiene by not sharing towels etc.
17
Q
Symptoms of viral conjunctivitis
A
red, watery eyes, gritty, uncomfortable feeling
18
Q
What are 6 aspects of a viral conjunctivitis examination
A
- vision unaffected unless cornea involved
- generalised conjunctival infection with watery discharge
- follicles (lymphoid aggregates) in tarsal conjunctiva (covers inner surface of eyelids)
- petechial conjunctival haemorrhages
- enlarged pre-auricular lymph node
- associated upper respiratory tract infection
19
Q
Which type of conjunctivitis may have an associated upper respiratory tract infection?
A
Viral conjunctivitis
20
Q
Which lymph node may be enlarged in viral conjunctivitis?
A
pre-auricular lymph node
21
Q
What is a risk of viral conjunctivitis being highly contagious?
A
risk of epidemics, including nocosomial (originating in hospital) transfer
22
Q
how long may viral conjunctivitis last?
A
several weeks
23
Q
What is a possible complication of viral conjunctivitis?
A
small corneal opacities leading to photophobia and reduced vision (not seen in bacterial conjunctivitis)
24
Q
What is the treatment for viral conjunctivitis?
A
- nil, advise it’s self limiting; sterile saline or boiled and cooled water to bathe eye, cool compresses, lubricating eye drops
- ?antibiotic drops to prevent secondary antibiotic infection
- general hygiene not sharing towels, washing hands, avoiding close contact with others etc.
25
what is the classical presentation of chlamydial conjunctivitis?
unilateral conjunctivitis in a young male
26
What are 8 symptoms of chlamydial conjunctivitis?
1. red eye
2. watery eye
3. vision unaffected
4. gritty, foreign body sensation.
5. history usually for at least 2 weeks.
6. oedema, mechanical ptosis
7. sticky discharge
8. usually unilateral
27
What kind of illness could chlamydial conjunctivitis lead to and why?
chronic illness, due to follicular reaction
28
Who usually gets chalmydial conjunctivitis? 2 groups
1. usually young adults as is sexually acquired
| 2. neonates (ophthalmia neonatorum due to chlamydia in birth canal)
29
What is the treatment for chlamydial conjunctivitis?
systemic antibiotics: single dose of azithromycin or short course of doxycycline. liaison with GUM clinic and treat sexual partners, test for other STIs
30
What is the onset like of allergic conjunctivitis?
acute onset
31
What are the symptoms in acute conjunctivitis?
red, itchy eyes; chemosis (conjunctival oedema), vision unaffected
32
What kind of reaction is allergic conjunctivitis?
Type I hypersensitivity reaction; seasonal, perennial
33
How does allergic conjunctivitis often settle?
spontaneously/ removal of allergen
34
What is cicatrising conjunctivitis?
conjunctivitis that causes scarring
35
what are 3 physical causes of cicatrising conjunctivitis?
physical causes:
1. heat
2. ionising radiation
3. chemical injury
36
What are 2 types of drug-induced cicatrising conjunctivitis?
topical or systemic
37
What are 2 infectious causes of cicatrising conjunctivitis?
1. trachoma
| 2. membranous conjunctivitis (bacterial and viral)
38
What are 4 oculocutaneous disorders that can cause cicatrising conjunctivitis?
1. stevens-johnson syndrome
2. toxic epidermal necrolysis
3. mucous membrane pemphigoid
4. chronic atopic kerato-conjunctivitis
39
What are 2 types of tumours that could cause cicatrising conjunctivitis?
squamous and sebaceous cell carcinomas
40
What are 6 broad types of causes of cicatrising conjunctivitis?
1. physical causes
2. infectious causes
3. oculocutaneous causes
4. systemic disorders
5. tumours
6. drug-induced
41
What are 4 systemic disorders that are associated with cicatrising conjunctivitis?
1. acne rosacea
2. sjögren's syndrome
3. inflammatory bowel disease
4. immune complex disease
42
What are the three broad types of keratitis?
1. autoimmune
2. bacterial
3. viral
43
What is bacterial keratitis?
bacterial infection of the cornea - ophthalmic emergency
44
What is the cause of bacterial keratitis?
large range of gram positive (pseudomonas, staphylococcus or streptococcus) or negative organisms
45
What are 4 predisposing factors to bacterial keratitis?
1. corneal abrasion
2. contact lenses (usually soft extended wear)
3. topical steroids
4. corneal anaesthesia e.g previous herpes zoster ophthalmicus
46
What are the clinical symptoms of bacterial keratitis?
red, sticky eye, pain, reduced vision, photophobia
47
What 3 things will you find on examination in bacterial keratitis?
1. conjunctival injection with purulent discharge
2. corneal abscess (yellow/white area on cornea)
3. may be activity (cells) in anterior chamber
48
What are three possible complications of bacterial keratitis?
1. severe sight-threatening intraocular infection (endophthalmitis)
2. corneal perforation
3. loss of eye
49
What is the treatment for bacterial keratitis? 4 key aspects
1. Admit
2. Perform corneal scrape
3. Gram stain, culture and sensitivities.
4. First, sterilisation phase of management and then healing phase
50
What happens during the sterilisation phase of management of bacterial keratitis?
- hourly antibiotic, usually monotherapy with a fluoroquinolone day and night for 2 days
- hourly antibiotics by day for 3 days
- cycloplegics to paralyse the ciliary muscle of the eye
- intraocular hypotensives
- sub-conjunctival injections to be avoided
51
What happens during the healing phase of bacterial keratitis treatment?
healing retarded in persistent inflammation; judicious use of topical glucocorticoids, treat ocular surface disease (dry eye, entropion, blepharitis)
52
What is the commonest cause of viral keratitis?
herpes simplex type I
53
What are the symptoms of viral keratitis?
reduced vision, unilateral red eye, pain, photophobia
54
What would you find on an examination in viral keratitis? 3 key findings.
1. conjunctival injection
2. classical branching dendritic (epithelial) ulcer staining with fluoroscein
3. reduced corneal sensation
55
What are 5 possible complications of viral keratitis?
1. corneal scarring
2. may affect deeper corneal layers e.g. stroma (disciform keratitis)
3. corneal perforation
4. secondary bacterial infection
5. ulcer
56
Why musn't you use steroids in viral keratitis?
geographical ulceration
57
What is the treatment for viral keratitis?
antiviral ointment e.g. ganciclovir 0.15% gel - tapering over a few weeks. dilate pupil
58
What are the causes of autoimmune keratitis?
idiopathic or related to systemic diseases
59
What kind of keratitis do you get if it is autoimmne?
dry eye and ulcerative keratitis
60
What are 2 causes of ulcerative autoimmune keratitis?
1. systemic vasculitides - rheumatoid arthritis, SLE, PAN, GPA
2. dermatological conditions - acne rosacea, topical kerato-conjunctivitis
61
What are 3 causes of scleritis?
1. Idiopathic:
2. Infective: herpes zoster
3. Systemic disease: collagen vascular disease (e.g. rheumatoid arthritis, ankylosing spondylitis, SLE, GPA, polyarteritis nodosa), IBD, sarcoidosis, gout
62
What is scleritis?
inflammation of the outer (white) coat of the eye and can be a severe destructive, sight-threatening disease
63
What kind of scleritis is commonest?
anterior scleritis is commonest but posterior involvement also occurs
64
What 3 groups is anterior scleritis sub-divided into?
1. diffuse
2. nodular
3. necrotising
65
what is the most common cause of scleritis?
idiopathic
66
What proportion of scleritis is associated with a connective tissue or vasculitis disease and what is the commonest?
25%; rheumatoid arthritis
67
What are 4 types of infections that can cause scleritis?
1. herpes zoster
2. varicella zoster
3. acanthamoeba
4. bacterial endotoxins
68
What are the symptoms of scleritis?
pain (may be so severe it wakes patient up at night), red eye(s), may be recurrent
69
What are 3 possible findings on examination of scleritis?
1. deep red colouration of anterior sclera - may be diffuse or localised
2. visual acuity may be normal
3. scleral thinning associated with bluish/black discolouration from underlying uveal tissue
70
What is the treatment of scleritis?
oral NSAIDs for mild cases, topical steroids as supplementary therapy, oral prednisolone/ pulsed immunosuppression for severe cases, biologics e.g. TNF-alpha inhibitors, refer to rheumatologist if necessary. investigate for/treat underlying cause
71
What are the 2 kinds of intraocular infection?
endophthalmitis
| uveitis
72
What is acute anterior uveitis (iritis)?
inflammtion of the iris
73
What is generally the cause of acute anterior uveitis?
majority unknown; as 50% of patients are HLA B27 positive think there's an association with ankylosing spondylitis
74
What are the symptoms of acute anterior uveitis? (5 key things)
1. red eye (usually unilateral)
2. acute pain
3. blurred vision (due to precipitates in aqueous)
4. photophobia
5. lacrimation (no discharge, not sticky)
75
What is the only way uveitis can be accurately diagnosed?
with the aid of a slit lamp
76
What are 6 things that might be found on examination in acute anterior uveitis (consult images)
1. circumcorneal conjunctival injection (due to ciliary congestion)
2. keratic precipitates (inflammatory cells) on corneal endothelium
3. flare (albumin leakage from iris vessels)
4. inflammatory cells in anterior chamber - hypopyon if severe
5. miosis (due to iris spasms and adhesions)
6. posterior synechiae (adhesions between iris and lens)
77
what are three potential complications of anterior uveitis?
1. may be associated with raised IOP
2. may become chronic and develop secondary cataract with/without macular oedema leading to reduced vision
3. likely to recur in either eye
78
What is the treatment of acute anterior uveitis? 3 aspects
1. dilate pupil to prevent ciliary spasm and break posterior synechiae.
2. intensive topical steroids, initially 1-2 hourly then gradually reduce over the next 3-6 weeks.
3. in severe cases a subconjunctival injection of steroid with/without mydicaine (dilating agent) is necessary
79
What are the 2 types of raised IOP?
1. some secondary glaucomas
| 2. angle-closure glaucoma
80
What is usually the presentation of acute angle closure glaucoma?
usually sudden (hours) painful visual loss
81
What are the primary and secondary causes of AACG?
primary: hypermetropia (commonest)
secondary: hypermature (swollen) cataract
82
What are 5 things you would find on examination in AACG?
1. reduced vision
2. red eye(s)
3. corneal oedema
4. mid-dilated, oval pupil
5. closed aqueous drainage angle (on gonioscopy)
83
What is a possible complication of AACG?
blind eye(s)
84
What is the approach to treatment of AACG?
initially medical treatment to lower IOP then laser or surgery is required to allow aqueous outflow
85
What is the medical treatment of AACG? 3 aspects
acetazolamide oral/IV, pilocarpine drops, IV hypertonic mannitol
86
What kind of laser treatment can be given in AACG?
YAG laser/ iridotomy
| prophylactic laser/surgery also performed on unaffected eye to prevent an attack occurring at a later date
87
What kind of surgery can be done in AACG?
surgical peripheral iridectomy, lensectomy
88
What are 2 kinds of disease you can get in the orbit?
1. orbital inflammatory disease
| 2. orbital cellulitis
89
How dangerous is orbital cellulitis?
life-threatening i.e. very
90
What will orbital cellulitis present like? 7 key features
1. red oedematous conjunctiva
2. reduced eye movements,
3. PROPTOSIS,
4. reduced vision (optic nerve involvement).
5. unwell patient
6. often associated with adjacent sinusitis
7. (colour vision reduced and RAPD present in severe cases)
91
What is post-septal cellulitis?
affects the whole orbit
92
What is the treatment of orbital cellulitis?
admit, blood tests which may include microbial culture, IV antibiotics, urgent CT scan, ENT opinion
93
What are 2 kinds of trauma that can affect the eye
chemical and mechanical
94
What are 3 examples of surface injuries in eye trauma?
1. sub-conjunctival haemorrhage
2. abrasions
3. foreign bodies
95
What can sub-conjunctival haemorrhage be a clue for?
serious underlying problem (but not serious in itself)
96
What are 3 possible things that could be underlying sub-conjucntival haemorrhge?
1. intraocular haemorrahges in non-accidental injury of childhood
2. foreign bodies - may lodge on the tarsal surface of the upper lid
3. Perforation underlying haemorrhage
97
What is an abrasion on the eye?
loss of corneal epithelium from a foreign object e.g. child's finger nail
98
When should you suspect penetration of the eye globe?
if no foreign body seen especially after drilling with power tools, even if minor/ no symptoms and normal vision
99
What investigation should you do if you suspect penetration of the eye globe?
X-ray to exclude radio-opaque intraocular foreign body
100
What can the location of conjunctival injection (redness) tell you about the location of the problem?
intensity of injection around periphery suggests conjunctival inflammation whereas injection around cornea suggests corneal or intra-ocular injection (ie. not conjunctivitis)
101
What is the common pathogenic cause of viral conjunctivitis?
Adenovirus
102
What must the treatment of chlamydial conjunctivitis be and why?
Immediate treatment as needed to preserve eye sight, sight-threatening if not
103
What can a possible treatment for allergic conjunctivitis be?
May respond to antihistamines
104
what are 4 more specific groups of causes of anterior uveitis?
1. Seronegative arthropathies: ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis, Reiter's syndrome
2. Infection: TB, syphilis, HIV, herpes zoster, toxoplasmosis, toxocariasis
3. Autoimmune: sarcoidosis, Behcet's
4. Maliganncy: non-Hodgkin's lymphoma, leukaemia, retinoblastoma, ocular melanoma
105
What is the anterior uvea?
coloured iris and ciliary body
106
What is the key test that can be used to diagnose anterior uveitis/iritis on examination?
Positive Talbot's test - pain when eyes converge + pupil constricts while focusing on object e.g. finger moving towards nose
107
What are the symptoms of scleritis?
severely deeply boring pain that wakes patient at night, lacrimation, photophobia
108
What is episcleritis?
superficial irritation and inflammation of the episclera, a thin layer of tissue covering the sclera of the eye
109
What are the causes of episcleritis?
idiopathic, collagen vascular disorder (RA)
110
What are the symptoms of episcleritis?
asymptomatic or mild pain
111
What is the management of episcleritis?
self-limiting in 1-2 weeks or topical corticosteroid eye drops to help resolve symptoms quicker
112
What is another name for a style?
Hordeolum
113
What is another name for a meibomian cyst?
Chalazion
114
What is the difference between a hordeolum and a chalazion?
Hordeolum=stye, causes you infection, usually painful and occurs along outer rim of eyelid (but sometimes inner). Chalazion = meibomian cyst, usually not painful
