Approach to the Red Eye Flashcards
How does enophthalmitis present?
Severe pain and loss of vision
Typically with hx of surgery or penetrating injury
What are the types of conjunctivitis? How do you tell the difference?
Bacterial - mucoprurulent discharge, more likely bilateral, may follow acute otitis media
Viral - mild watery discharge, more likely unilateral
Vernal (allergic) - discharge rare, bilateral, pruritis
What is a pterygium? What causes it? How is it managed?
Elevated, external, superficial conjunctival mass that form over the conjunctiva
Elastotic degeration of collagen and fibrovascular proliferation
Surgical removal if it causes significant pain, visual disturbance or altered cosmesis
What is Blepharitis? What causes it? How is it Mx?
Inflammation of the eyelids
Bacterial colonisation of the eyelid
Daily hygiene regimen and topical abx for refractory cases
How do you manage a chemical injury to the eye?
Copious amount of irrigation until the pH is normalised
Flip the eyelip for examination of the posterior surface
IV abx and local steroids
What is a chalazion? What causes them? How are they managed?
An inflammatory lesion of the eyelid that is generally hard and painless (as opposed to a hordeolum which is painful)
Granulomatous inflammation around lipid breakdown products usually from bacterial enzymes or retained sabeous gland secretions
Conservative, massage, heat, incision and drainage
What is scleritis? What causes it? How is it managed?
Inflammation of the sclera
Inflammatory conditions like
- RA, Wegener’s, relapsing polychrondritis, polyarteritis nodosa, SLE (rare)
Urgent ophthal refer
How does iritis present (Hx and Ex)?
Painful red eye with blurred vision and photophobia
Synechiae (iris adhering to the cornea) and pigment deposits on lens boarder
Dilation of ciliary vessel
Hypopyon
What is episcleritis? What causes it? How is it managed?
Inflammation between the sclera and conjunctiva
Often idiopathic, but is associated with some connective tissue disorder or vasculitis
Usually self resolving - may require ocular lubricants or topicals NSAIDs
If the patient has dry eyes and other dry membranes, what should you think of? ow do you investigate for it?
Sjogrens
Rheumatoid factor, ANA
What is periorbital cellulitis? How is it mx?
Infection of the skin and subcutaneous tissue of the eyelid but anterior to the orbital septum (thin fibrous tissue that originates in the orbital periosteum and inserts in the palpabrae tissue along the tarsal plates
Oral Abx - Augmentin duofort
What signs on examination point of acute closed angle glaucoma?
Mid-dilated pupil
Oedematous cornea
Shallow anterior chamber
IOP: 60mmHg
How do you examine a eye for ?foreign body?
Fluorescent dye
Lights out
Exam eye under blue light
Why might a patient complain of dry but watery eyes?
Reflex tears are produced in response to ocular surface irritation
What are the aetiological agents of keratitis?
Bacterial - Staph aureas, Strep pneumo, pseudo
Viral - HSV
Protozoan - amoeba
Fungal
Sometimes sterile
What is a subconjunctival haemorrhage? What causes it? How is it treated?
Haemorrhage of the small vasculature supplying the conjunctiva
Usually idiopathic but can be associated with base of skull fracture or warfarinisation
Usually self resolving
How do you differentiate periorbital and orbital cellulitis?
VA is usually retained in periorbital
VA is reduced in orbital
Inspection - red conjunctiva in orbital
Systemic symptoms more likely in orbital
What is iritis (aka anterior uevitis)? What causes it? How is it managed?
Inflammation of iris and anterior chamber
Infectious - HSV/HZV, TB, Syphilus, Lyme disease
Systemic inflammatory conditions - Ank Spond, juvenile idiopathic arthritis, UC, Crohn’s, Sarcoid, Behcets, Tubulointerstitial nephritis, IgA GN
Topical steroids, cycloplegic (paralysers of the ciliary muscles)
What causes rust rings? How are they managed?
Metallic foreign body
Copious local anaesthetic and removal with needle bevel
How do you differentiate episcleritis and scleritis clinically?
Scleritis will be more painful (may disturb sleep) with a tender globe. Vision may be affected too
Episcleritis will cause only mild discomfort, watering, and itch. Vision is not affected
What is endophthalmitis? What causes/precipitates it? How is it managed?
Inflammation of the vitreous humour or aqueous
Recent surgery or penetrating eye injury, or endogenous source
Find the source
Targeted antimicrobial therapy - potentially intraviteous
Surgery - Pars pana vitrectomy or enucleation
What is bacterial keratitis? How does it present? How is it managed?
Bacterial infection of the cornea (Staph a., Strep pneumoniae, pseudomonas)
Painful eye (unable to tolerate contact lens), blurred vision, foreign body sensation
Broad spectrum topical abx and consider systemic abx
What causes of a red eye are more likely to cause bilateral red eyes?
Conjunctivitis
Blepharitis
Dry eyes
What is orbital cellulitis? What causes it? How is it managed?
Infection of the orbital posterior to the orbital septum
Spread of bacteria (usually Staph a., S. pyogenes, H.i) from the sinuses into the orbit
CT, swab, admit, IV abx, ENT review, surgical drainage may be required
