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Flashcards in Approach to the Red Eye Deck (24)
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1

How does enophthalmitis present?

Severe pain and loss of vision

Typically with hx of surgery or penetrating injury

2

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

3

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 

4

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

5

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

6

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

7

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 

8

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

9

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

10

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

11

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

12

What signs on examination point of acute closed angle glaucoma?

Mid-dilated pupil

Oedematous cornea

Shallow anterior chamber

IOP: 60mmHg

13

How do you examine a eye for ?foreign body?

Fluorescent dye

Lights out

Exam eye under blue light

14

Why might a patient complain of dry but watery eyes?

Reflex tears are produced in response to ocular surface irritation

15

What are the aetiological agents of keratitis?

Bacterial - Staph aureas, Strep pneumo, pseudo

Viral - HSV

Protozoan - amoeba

Fungal

Sometimes sterile

16

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

17

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

18

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)

19

What causes rust rings? How are they managed?

Metallic foreign body

 

Copious local anaesthetic and removal with needle bevel

20

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

21

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

22

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

23

What causes of a red eye are more likely to cause bilateral red eyes?

Conjunctivitis

Blepharitis

Dry eyes

24

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