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ENT Flashcards

1
Q

Causes of a painless red eye

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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2
Q

Causes of a painful red eye

A 
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasion or ulceration
Keratitis
Foreign body
Traumatic or chemical body
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3
Q

Red flags for a red eye

A

Impaired vision
Pain/photophobia
Lack of ocular discharge

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4
Q

Define conjunctivitis

A

Inflammation and redness of the conjunctiva -> covers the inside of eyelids and sclera

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5
Q

Symptoms of conjunctivitis

A 
Red eyes
Unilateral or bilateral
Vision unaffected
Bloodshot
Itchy or gritty sensation
Discharge from the eye
Does NOT cause pain, photophobia or reduced visual acuity
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6
Q

Symptoms of bacterial conjunctivitis

A

Purulent discharge -> pus
Eyes may be stuck together in morning
Highly contagious
Starts in one eye and spreads to other

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7
Q

Causative organisms for bacterial conjunctivitis

A

Staph
Strep
Haemophilus
Neisseria

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8
Q

Symptoms of viral conjunctivitis

A 
Clear discharge (serous)
Dry cough
Sore throat
Blocked nose
Preauricular lymph nodes (in front of the ears)
Recent URTI
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9
Q

Common cause of viral conjunctivitis

A

Adenovirus

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10
Q

Features of allergic conjunctivitis

A 
Most frequent
Watery and serous discharge 
Itch
Caused by contact with allergens
Type 1 hypersensitivity
Antihistamines (oral or topical) used to reduce symptoms
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11
Q

Treatment for conjunctivitis

A

Reassurance (resolves after 1-2 weeks) + hygiene

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12
Q

Treatment for bacterial conjunctivitis

A

Chloramphenicol

Fuscidic acid

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13
Q

Features of chlamydial conjunctivitis

A

Trachoma is on the leading causes of blindness in the world

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14
Q

What is ophthalmia neonatorum

A

Conjunctivitis in the first three weeks of life

Purulent discharge

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15
Q

Causes of ophthalmia neonatorum

A

Chlamydia
Herpes simplex
Gonorrhoea
Staph/strep

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16
Q

Tests for ophthalmia neonatorum

A

Swab and microscopy

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17
Q

Treatment for ophthalmia neonatorum

A

Chlamydia - erythromycin/azithromycin

Gonorrhoea - cefotaxime and chloramphenicol

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18
Q

Define episcleritis

A

Thin vascular layer between sclera and conjunctiva

Common in young women

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19
Q

Symptoms of episcleritis

A 
Acute onset
Unilateral (bilateral in 30%)
Typically not painful
Segmental redness
Dilated episcleral vessels
Watering of eye
NO discharge
Visual acuity is normal
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20
Q

What is episcleritis associated with

A

Rheumatoid arthritis
Rheumatic fever
SLE
PAN

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21
Q

Treatment for episcleritis

A

Self-limiting and will recover in 1-4 weeks
Artificial tears
Topical or systemic NSAIDs (e.g. naproxen)

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22
Q

Define subconjunctival haemorrhage

A

Small blood vessel within the conjunctiva ruptures and releases blood into the space between the sclera and the conjunctiva

They often appear after episodes of strenuous activity such as heavy coughing, weight lifting or straining when constipated

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23
Q

Causes of subconjunctival haemorrhage

A

Hypertension
Bleeding disorders (e.g. thrombocytopenia)
Whooping cough
Medications (warfarin, NOAC’s, antiplatelets)
Trauma

24
Q

Symptoms of subconjunctival haemorrhage

A

Sudden onset
Painless - does not affect vision
Bright red covering white

25
Management of subconjunctival haemorrhage
Resolves spontaneously - 2 weeks
26
Define scleritis
Inflammation of the full thickness of the sclera | More serious than epscleritis
27
What is the most severe type of scleritis
Necrotising scleritis | Causes visual impairment, can lead to perforation of sclera
28
Associated conditions with scleritis
``` Rheumatoid arthritis SLE IBD Sarcoidosis Granulomatosis with polyangiitis ```
29
Symptoms of scleritis
``` Constant, severe dull ache Severe pain Pain with eye movement Photophobia Eye watering -> no discharge Reduced visual acuity Headache Abnormal pupil reaction to light Tenderness to palpation of the eye ```
30
Management of scleritis
Urgent referral within 24 hours Oral NSAIDs Oral high dose prednisolone Treat underlying condition - methotrexate for RA
31
Define anterior uveitis
Inflammation in the anterior uvea which comprises of the iris and ciliary body
32
Causes of anterior uveitis
``` Ankylosing spondylitis IBD Reactive arthritis Sarcoidosis Syphilis Lyme disease TB Herpes simplex Behcet's disease ```
33
Symptoms of anterior uveitis
Unilateral Dull, aching painful red eye Ciliary flush (ring of red spreading from cornea outwards) Reduced visual acuity - blurred visual Photophobia Pain on movement Lacrimation Floaters and flashes Sphincter muscle contraction causing miosis (constricted pupil) Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
34
Ask about in a history for anterior uveitis
``` Headaches Mouth ulcers (Behcet's) Joint problems Chest and skin disease GU symptoms ```
35
Investigations for anterior uveitis
Slit lamp with dilated pupil to visualise inflammatory cells | Fundus fluorescein and indocyanide green-angiography
36
Treatment for anterior uveitis
Urgent same day referral to ophthalmologist Topical prednisolone Cyclopentolate or atropine (to dilate pupil) DMARDs and TNF inhibitors for immunosuppression Laser therapy/surgery (vitrectomy) in severe cases
37
Define keratitis
Inflammation of the cornea Breakdown of the epithelium = corneal ulcer
38
Causes of keratitis
Viral - herpes simplex Bacterial - psuedomonas or staph Fungal infection with candida or aspergillus Contact lens acute red eye (CLARE) Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropian)
39
Symptoms of herpes simplex keratitis
``` Painful red eye Photophobia Vesicles around the eye Watery discharge Foreign body sensation Reduced visual acuity ```
40
Investigations for herpes simplex keratitis
Staining with fluorescein - shows dendritic corneal ulcer Slit lamp examination Corneal swabs or scrapings
41
Management for herpes simplex keratitis
Aciclovir (topical or oral)
42
Symptoms of bacterial keratitis
Painful red eye Loss of vision Hazy cornea with central abscess
43
Management of bacterial keratitis
Requires specialist | Intense antibiotics
44
Define corneal abrasions
Scratches or damage to the cornea
45
Causes of corneal abrasions
``` Contact lenses - may have psuedomonas infection Foreign bodies Finger nails Eyelashes Entropion (inward turning eyelid) ```
46
Symptoms of corneal abrasions
``` History of contact lenses/foreign body Painful red eye Foreign body sensation Watering eye Blurring vision Photophobia ```
47
Diagnosis of corneal abrasions
Staining with fluorescein -> yellow/orange colour | Slit lamp examination in more severe cases
48
Management of corneal abrasions
``` Same day referral Analgesia - paracetamol Lubricating eye drops Antibiotic eye drops - chloramphenicol Cyclophentolate eye drops - dilate pupil - improves photophobia ``` Usually heals over 2-3 days
49
Bacterial causes of corneal ulcers
Pseudomonas
50
Fungal causes of corneal ulcers
Candida | Aspergillus
51
Protozoal causes of corneal ulcers
Acanthamoeba
52
Vasculitic cause of corneal ulcers
Rheumatoid arthritis
53
Management of corneal ulcers
Refer Chloramphenicol drops (gram +ve) Ofloxacin (gram -ve)
54
Cause of herpes simplex corneal ulcers
Keratitis manifestation
55
Symptoms of herpes simplex corneal ulcers
Pain Photophobia Watering
56
Diagnosis of herpes simplex corneal ulcers
Slit lamp - fluorescein -> look for dendritic ulcers
57
Treatment for herpes simplex corneal ulcers
Aciclovir

Phase 3b (18 decks)

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