Acute Red Eye Flashcards
(31 cards)
What are the two categories of haemorrhage?
Sub-conjunctival
Retrobulbar
What are the causes of Subconjunctival haemorrhage?
Trauma Hypertension Bleeding disorders (e.g thrombocytopenia) Whooping cough Medications (warfarin, NOACs, antiplatelets) Non-accidental injury Heavy lifting/coughing Heavy vomming (Ellie)
What is the management of Subconjunctival haemorrhage?
Nothing needed
What is the cause of retrobulbar haemorrhage?
iatrogenic (injection of anaesthetic)
Trauma - head injury or optic floor fracture
What is congestion?
Haemorrhage due to vascular engorgement
Can be generalised: conjunctivitis / keratitis / uveitis and acute glaucoma
Localised: episcleritis and phlyctenular conjunctivitis
What is conjunctivitis?
inflammation of the conjunctiva. The conjunctiva is a thin layer of tissue that covers to inside of the eyelids and the sclera of the eye. 3 types:
Bacterial
Viral
Allergic
What is the presentation of conjunctivitis?
Unilateral or bilateral Red eyes Bloodshot Itchy or gritty sensation Discharge from the eye
Does not cause pain, photophobia or reduced visual acuity.
What is the presentation of bacterial conjunctivitis?
Gritty eyes
Purulent discharge
Lymph node
What is the presentation of viral conjunctivitis?
Gritty eyes
Watery discharge
Follicles (lower fornix): small, dome shaped nodules
lymph nodes
What is the presentation of allergic conjunctivitis?
itchy eyes
stringy discharge
papillar (upper fornix) - cobblestone arrangement of flattened nodules with central vascular core
no lymph nodes
What is the management of conjunctivitis?
usually resolves without treatment after 1-2 weeks.
Advise on good hygiene to avoid spreading (e.g. avoid sharing towels or rubbing eyes and regularly washing hands) and avoiding the use of contact lenses. Cleaning the eyes with cooled boiled water and cotton wool can help clear the discharge.
If bacterial conjunctivitis is suspected then antibiotic eye drops can be considered: Chloramphenicol and fuscidic acid eye drops are both options.
BEWARE: young patients especially babies ?chlamydia
What is anterior uveitis?
anterior part of the uvea. The uvea involves the iris, ciliary body and choroid. The choroid is the layer between the retina and the sclera all the way around the eye. Sometimes anterior uveitis is referred to as iritis
What are the associations of anterior uveitis?
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
What is the presentation of anterior uveitis?
Unilateral symptoms
Dull, aching, painful red eye
Ciliary flush (a ring of red spreading from the cornea outwards)
Reduced visual acuity
Floaters and flashes
Sphincter muscle contraction causing miosis (constricted pupil)
Photophobia due to ciliary muscle spasm
Pain on movement
Excessive tear production (lacrimation)
Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
A hypopyon is a collection of white blood cells in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level
What is the management of anterior uveitis?
Referral to ophthalmology
Steroids
cyclopentolate or atropine eye drops. Cycloplegic means paralysing the ciliary muscles.
Immunosuppressants such as DMARDS and TNF inhibitors
Laser therapy, cryotherapy or surgery (vitrectomy) are also options in severe cases.
What is Episcleritis?
Episcleritis is benign and self-limiting inflammation of the episclera, the outermost layer of the sclera. The episclera is situated just underneath the conjunctiva.
What is the presentation of Episcleritis?
Episcleritis usually presents with acute onset unilateral symptoms:
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
What is the management of episcleritis?
if in doubt, refer to ophthalmology.
Episcleritis is usually self limiting and will recover in 1-4 weeks. In mild cases no treatment is necessary. Lubricating eye drops can help symptoms.
Simple analgesia, cold compresses and safetynet advice are appropriate.
More severe cases may benefit from systemic NSAIDs (e.g. naproxen) or topical steroid eye drops.
What is scleritis?
Scleritis involves inflammation of the full thickness of the sclera. This is more serious than episcleritis. It is not usually caused by infection
What conditions is scleritis associated with?
Rheumatoid arthritis Systemic lupus erythematosus Inflammatory bowel disease Sarcoidosis Granulomatosis with polyangiitis
What is the presentation of scleritis?
Scleritis usually presents with an acute onset of symptoms. Around 50% of cases are bilateral.
Severe pain Pain with eye movement Photophobia Eye watering Reduced visual acuity Abnormal pupil reaction to light Tenderness to palpation of the eye
What is the management of scleritis?
Management in secondary care involves:
Consider an underlying systemic condition
NSAIDS (topical / systemic)
Steroids (topical / systemic)
Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)
What are the causes of keratitis
Viral infection with herpes simplex
Bacterial infection with pseudomonas or staphylococcus
Fungal infection with candida or aspergillus
Contact lens acute red eye (CLARE)
Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropion)
What is the presentation of keratitis?
Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced visual acuity. This can vary from subtle to significant.
Staining with fluroscein will show you a dendritic corneal ulcer
Corneal swabs or scrapings can be used to isolate the virus using a viral culture or PCR
