Acute red eye

Question 1

what is blepharitis

Answer 1

inflammation of the eyelid margins

Question 2

what is anterior vs posterior blepharitis

Answer 2

anterior is lid margin and not deeper lid whereas posterior is further back n eyelid

Question 3

what are symptoms of blepharitis

Answer 3

gritty eyes / dry / mild discharge (can feel like conjunctivitis)

Question 4

what can blepharitis be associated with

Answer 4

conjunctivitis, keratitis and episcleritis

Question 5

what types of anterior blepharitis are there

Answer 5

seborrheic (scale on lashes) vs staph (infection of lash follicle)

Question 6

what are symptoms of anterior seborrheic blepharitis

Answer 6

red lid margin, scale and dandruff (no ulceration and unaffected lashes)

Question 7

what are symptoms of anterior staph blepharitis

Answer 7

red lid margin, distorted lashes, stys and ulcers, corneal staining

Question 8

what causes posterior blepharitis

Answer 8

meibomian gland dysfunction (MGD)

Question 9

what are symptoms of MGD

Answer 9

lid margin and lashes unaffected / swelling in upper eyelids / dried secretion at gland opening / meibomian cysts

Question 10

what is MGD associated with

Answer 10

acne rosacea (50%)

Question 11

how do you manage blepharitis

Answer 11

lipid hygiene / tear drops / oral doxycycline for 2-3 months

Question 12

what infective causes of conjunctivitis are there

Answer 12

viral, bacterial, chlamydial

Question 13

what are common non-infective causes of conjunctivitis

Answer 13

ALLERGIC, chemical, eczema

Question 14

what are symptoms of viral conjunctivitis

Answer 14

red eye / gritty sensation / discharge (sticky vs watery) / itch / oedema / UNaffected vision

Question 15

what are symptoms of bacterial conjunctivitis

Answer 15

red sticky eye / papillae (chlamydia) / start in one eye and spread to the other

Question 16

what causes bacterial conjunctivitis

Answer 16

staph A, strep pneumonia, H influenza, chlamydia

Question 17

how do you treat bacterial conjunctivitis

Answer 17

chloramphenicol (not pseudomonas)

Question 18

wha causes viral conjunctivitis

Answer 18

adenovirus, H simplex, H zoster (secondary to mollucusm contagiosium - pox virus)

Question 19

what are the layers of the cornea from anterior to posterior

Answer 19

epithelium - stroma - endothelium

Question 20

what are infective causes of corneal ulcers

Answer 20

viral, fingal, bacterial, acanthamoeba (contact lenses)

Question 21

what are systemic causes of corneal ulcers

Answer 21

RA, hypersensitivity, rarely small vessel vasculitis

Question 22

what are symptoms of corneal ulcers (5)

Answer 22

pain (needle like and severe) / photophobia / profuse lacrimation / red eye/ reduced vision

Question 23

what are signs of corneal ulcers (5)

Answer 23

circumcorneal redness / corneal reflex / corneal opacity / hypopyon / dendritic ulcers (HSV)

Question 24

what vitamin deficiency can cause corneal ulcers

Answer 24

Vit A

Question 25

how would you treat corneal ulcer depending on the cause

Answer 25

corneal scrape for culture --> bacterial: ofloxacin / herpetic: acyclovir / autoimmune: steroids and anti-inflamm

Question 26

what is anterior uveitis

Answer 26

inflammation of anterior uvea which consists of ciliary body, iris and choroid (in-between retina and sclera all around the eyeball) - aka iritis

Question 27

what are common causes of anterior uveitis

Answer 27

usually autoimmune but can be infective, traumatic, ischaemic or malignant

Question 28

what autoimmune causes can cause anterior uveitis

Answer 28

HLA B27 conditions: annk spondy, IBD, RA, sarcoidosis

Question 29

what infective and malignant causes can cause anterior uveitis

Answer 29

SYPHILLIS, TB, H simplex/ zoster, leukaemia

Question 30

what are symptoms of anterior uveitis (4)

Answer 30

dull, achy pain / photophobia / affected vision / excessive tears

Question 31

what are signs of anterior uveitis (5)

Answer 31

ciliary injective vessels around cornea / cells and flares in ant chamber / hypopyon / keratic precipitates (spots in front of pupil in cornea) / synechia (irregular pupil shape)

Question 32

how do you manage anterior uveitis

Answer 32

steroids (pred 4-6 weeks) / mydiatrics (cyclopentolate) / immunosuppression (DMARDS)

Question 33

what is episleritis

Answer 33

inflammation of the epislera - outermost layer of sclera just below conjunctiva

Question 34

what are symptoms of episleritis (5)

Answer 34

unilateral / normally patch of redness in one part of lateral eye/ mild pain, watering of eye / dilated episclera vessels

Question 35

how do you manage episcleritis

Answer 35

self-limiting and superficial - lubricants/ topical NSAIDs / mild steroids

Question 36

what is scleritis

Answer 36

serious inflammation of whole sclera

Question 37

what is scleritis associated with

Answer 37

RA, SLE sarcoidosis and GPA

Question 38

what are symptoms of uveitis

Answer 38

VV painful, pain on movement, injected deep vessels, photophobia

Question 39

how do you identify and treat scleritis

Answer 39

phenylephrine test - oral NSAIDs, topical steroids