Eye infections: Orbital and Preseptal Cellulitis, Anterior Uveitis, Conjunctivitis, Blepharitis, Episcleritis and Scleritis, Keratitis Flashcards
Difference between orbital and preseptal cellulitis
Orbital - fat and muscle infection posterior to orbital septum
HIGH MORTALITY
Preseptal - superficial infection anterior to orbital septum from superficial tissue injury
CAN PROGRESS TO ORBITAL
Orbital cellulitis
-risk factors
-presentation
Child (7-12)
Past sinus infection
Lacking Hibs vaccination
5Ps
Pain - throbbing, deep
-worsens on eye movement
-radiates to forehead, cheek, teeth
Proptosis
Periocular swelling
-chemosis
-erythema
Pupil involvement, visual changes
-blurred vision, diplopia
-decreased visual acuity
-RAPD if optic nerve involved
Palsy - restriction/paralysis of extraocular muscles
Systemic unwellness
Symptoms of primary sinus infection
Orbital cellulitis
-investigations
-most common causative organisms
-management
Opthalmology assessment
-decreased vision
-RAPD
-proptosis
-dysmotility
-edema
-erythema
FBC - WCC, CRP high
Blood cultures and microbiology swab
CT contrast - inflammation of orbital tissue deep to septum, sinusitis
Strep
Staph aureus
Hibs
IV ABx IP
Preseptal cellulitis
-risk factors
-presentation
Breaks in skin
Local infections - sinusitis, URTI
Red, edema of eyelids, spread to surrounding skin
Ptosis from swelling
Fever
Preseptal cellulitis
-investigations
-causative organisms
-management
Bloods - high CRP
Swab discharge
Contrast CT orbit - differentiate between preseptal and orbital
Staph aureus, staph epidermidis, strep, anaerobes
Secondary care assessment
PO coamox
Admit children for admission if needed
Anterior uveitis
-pathophysiology
-associations
-presentation
-management
Iritis - inflammation of iris and ciliary body
HLA B27
-AS, reactive arthritis
-IBDs
-Behcet’s
-Sarcoidosis
Acute eye pain
Small, irregular pupil
Intense photophobia
Ciliary flush
Hypopyon
Visual acuity normal => impaired
URGENT OPTHAL REFERRAL
Cycloplegic - dilate pupil to relieve pain and photophobia
-atropine, cyclopentane
Steroid eye drops
Blepharitis
-pathophysiology
-association
-presentation
-management
Inflammation of eyelid margins
COMMON - Posterior blepharitis - meibomian gland dysfunction => dry eyes leading to irritation
LESS COMMON - Anterior - seborrhoeic dermatitis, staph
Bilateral grittiness, discomfort along margins
Sticky eyes
Styes, chalazions, 2ndary conjunctivitis more common
Hot compress TDS
Lid hygiene
-cotton wool in cooled boiled water and baby shampoo/Na2HCO3
Artificial tears
Episcleritis
-pathophysiology
-associations
-presentation
-differentiating between episcleritis and scleritis
-management
Acute inflammation of episclera
MAJORITY IDIOPATHIC
Linked to IBD, RA
Red eye
Bilateral
Mild pain, photophobia
Gentle pressure => injected vessels move
Phenylephrine => vessels blanche
Conservative
Artificial tears
Scleritis
-pathophysiology
-associations
-presentation
-differentiating between episcleritis and scleritis
-management
Full thickness sclera inflammation
MAJORITY NON INFECTIVE
-RA, SLE
-sarcoidosis, GPA
Red painful eye
Watery, photophobia
Gradual decreased vision
Gentle pressure => vessels do NOT move
Phenylephrine => vessels don’t blanche
SAME DAY OPTHAL ASSESSMENT
PO NSAIDs => PO CS if severe => immunosuppressants
Treat underlying condition
Keratitis
-pathophysiology
-causes to know about
-presentation
-management
-complications
Corneal inflammation
Bacteria - S Aureus
-Pseudomonas in contact lens wearers
Amoebic - acanthamoebic keratitis in contaminated soil/water contact
Viral - HSV
Red painful eye
Photophobia
Gritty
SAME DAY OPTHAL ASSESSMENT => slit lamp
Stop using contacts
TOP quinolones
Cycloplegic pain relief
Corneal scarring
Perforation
Endophthalmitis
Visual loss
Herpes simplex keratitis
-presentation
-management
Red, painful eye
Photophobia
Teary
Reduced visual acuity
Fluorescein stain => epithelial ulcer
Dendritic corneal ulcer
IMMEDIATE OPTHAL REFERRAL
TOP aciclovir
Conjunctivitis
-pathophysiology
-core presentation
-types and how to differentiate between the 2
Inflammation of conjunctiva
Sore red unilateral
Bacterial
-purulent discharge, sticky eyes
Viral
-serous discharge
-recent URTI
-preauricular LN
Conservative - 1-2wks
TOP chloramphenicol
-fusidic acid if pregnant
Avoid contact lenses
-fluorescein used to find corneal scarring
Don’t share towels
School exclusion not needed
Allergic conjunctivitis
-presentation
Red, swollen eyes
-ITCHY
Background of atopy, seasonal, allergens
1st line - TOP/systemic antihistamines
2nd line - TOP mast cell stabiliser (sodium cromoglicate and nedocromil
