Acute red eye

Question 1

What are the two main causes of red eye?

Answer 1

Haemorrhage:
Congestion which can be:
a) Localised
b) Generalised - conjunctival or ciliary

Question 2

What are the two types of haemorrhage that can cause red eye?

Answer 2

Subconjunctival (between conjunctiva and sclera)

Retrobulbar

Question 3

What is the most common type of haemorrhage that gives red eye?

Answer 3

Subconjunctival

Question 4

Describe the pathophysiology of a reterobulbar haemorrhage?

Answer 4

Bleeding behind the eye ball which tracks forward to lie under the conjunctiva

Question 5

How do the signs of subconjunctival haemorrhages differ with retrobulbar haemorrhages?

Answer 5

Subconjunctival haemorrhages –> the posterior edge of the blood patch is visible.

Retrobulbar haemorrhages –> and the posterior edge is not visible.

Question 6

What are the signs of reterobulbar haemorrhage?

Answer 6

No visible posterior edge + red vessels are not visible
Raised pressure (thus a protruding eye ball)
Restricted eye movements

(Ptosis, dilated pupil)

Question 7

What are the adverse outcomes of reterobulbar haemorrhage?

Answer 7

It is an EMERGENCY –>

optic nerve compression

blindness

Question 8

What are the potential causes of subconjunctival haemorrhage?

Answer 8

Occur after surgery

during increased pressure from coughing

Bleeding disorders or meds (aspirin or warfarin)

Trauma

Question 9

What are the signs of conjunctival haemorrhage?

Answer 9

Usually asymptomatic

Sharp pain can be felt at initial haemorrhage

Redness at sight of haemorrhage

Question 10

What are the main causes of reterobulbar haemorrhage causing red eye?

Answer 10

The main cause is iatrogenic (injection of anaesthetic)

The second main cause is trauma (head injury or optic floor fracture)

Question 11

What causes the redness in cogestion red eye?

Answer 11

Vascular engorgement

Question 12

What are the causes of localised congestion red eye?

Answer 12

episcleritis

and

phlyctenular conjunctivitis

Question 13

What are the causes of generalised congestion red eye?

Answer 13

conjunctivitis

keratitis (inflammation of cornea)

uveitis (inflammation of iris, ciliary body and choroid)

acute glaucoma

Question 14

What is the episclera?

Answer 14

It is the outermost layer of the sclera and is in contact with the conjunctiva. It is NOT scleritis.

Question 15

What are the potential underlying causes of episcleritis?

Answer 15

collagen vascular disease

and

rheumatoid arthritis

Question 16

What are the symptoms of episcleritis?

Answer 16

Mild pain

Note that sight is NOT affected

Question 17

What is the treatment for episcleritis?

Answer 17

NSAIDS drops (tablets may help too

or

steroidal eye drops if more severe (query scleritis)

Question 18

How can scleritis and episcleritis be differentiated?

Answer 18

Pain in scleritis is severe!

Question 19

What is Phlyctenular conjunctivitis?

Answer 19

localized noninfectious inflammatory/ hypersensitivity disorder

of the conjunctiva

With associated subepithelial nodules of the conjunctiva.

NOTE that “phlyctena” is the Greek word for “blister”

Question 20

Explain the signs and symptoms of uveitic red eye (aka ciliary/circumcorneal congestion).

Answer 20

Dusky redness predominantly around the cornea.

Question 21

How can ciliary/circumcorneal congestion (uveitis) be differentiated from conjunctival congestion (conjunctivitis).

Answer 21

ciliary/circumcorneal congestion (uveitis) will NOT blanch with vasoconstrictors, conjunctival congestion (conjunctivitis) will.

Question 22

Explain the signs and symptoms of conjunctival red eye (aka conjunctival congestion).

Answer 22

Bright redness predominantly in the conjunctival fornices (the extreme superior and inferior folds)

Question 23

What are the main causes of conjunctivits?

Answer 23

Viral
Bacterial
Allergic

Question 24

What are the signs of viral conjunctivitis?

Answer 24

gritty eyes

watery discharge

follicles (non-specific inflammation)

enlarged lymph nodes

More commonly bilateral

Question 25

What is the difference between follicles and papillae of the eye?

Answer 25

Follicles are due to collections of lymphocytes and are raised pink lesions due to viral conjunctivitis Papillae are collections of proliferating vessels covered by thickened epithelium. They are flat, white lesions due to allergic conjunctivits

Question 26

What are the signs of bacterial conjunctivitis?

Answer 26

gritty eyes purulent discharge enlarged lymph nodes More commonly unilateral

Question 27

What are the signs of allergic conjunctivitis?

Answer 27

itchy eyes watery-stringy (these are mucous strands) discharge papillae (non-specific inflammation) no enlarged lymph nodes More commonly bilateral

Question 28

What is the commenest cause of neonatal conjunctivits worldwide and in the western world?

Answer 28

Gonococcal worldwide. It is VERY serious. Chlamydia in the western world

Question 29

What is a common cause of viral conjunctivitis is adults?

Answer 29

adenovirus

Question 30

How does herpes simplex effect the eye?

Answer 30

It causes a branching dendritic ulcer on the cornea i.e. keratitis.

Question 31

How is HSV keratitis treated and managed and why.

Answer 31

It is treated with acyclovir ointment. It required management with steroids AND acyclovir as the body will keep mounting an immune response to the antigens which have been left behind. Acyclovir is used as if it is not the virus will come back down form the trigeminal nerve where it lays dormant and reinfects.

Question 32

What is a hypopyon?

Answer 32

A level of sterile pus (protein and cells) exuded from the iris It is due to toxins released from a bacterial ulcer on the cornea passing though the cornea. This builds in the anterior chamber and is visible to the naked eye.

Question 33

How can uveitic red eye and conjunctival red eye be told apart?

Answer 33

uveitic red eye - will NOT blanch with vasoconstrictor conjunctival red eye - WILL blanch with vasoconstrictor If there are folds of conjunctiva: uveitic red eye - the blood vessels will NOT move with these. conjunctival red eye - the blood vessels WILL move with these.

Question 34

Where does the red colour in uveitic red eye actually come from?

Answer 34

The redness comes from the deeper vessels of the uvea mainly the anterior ciliary vessels.

Question 35

Where does the red colour in conjunctival red eye actually come from?

Answer 35

The redness comes from the superficial vessels of the conjunctiva.

Question 36

How does the blood flow in uveitic red eye and conjunctival red eye differ?

Answer 36

Under magnification: uveitic red eye - centrifugal blood flow (from cornea outwards) can be seen conjunctival red eye - centripetal blood flow (from periphery in towards cornea) can be seen

Question 37

Which type of conjunctivitis is associated with crusting and matting of the eye lashes?

Answer 37

Bacterial conjunctivitis

Question 38

Which of the types of conjunctivitis require treatment?

Answer 38

Bacterial conjunctivitis