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Flashcards in Approach to the Red Eye Deck (24)
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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



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?



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


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?



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