Infections of the eye

Question 1

What is scleritis

Answer 1

Inflammation of the full thickness of the sclera

Question 2

Associated systemic conditions with scleritis

Answer 2

RA, SLE, IBD, sarcoidosis and granulomatosis with polyangitis

Question 3

What % of scleritis affects both eyes

Answer 3

50% of cases of bilateral

Question 4

Presentation of scleritis

Answer 4

Severe pain, pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation to the eye

Question 5

Management of scleritis

Answer 5

Look for underlying condition, NSAIDs, steroids and immunosuppression

Question 6

What is episcleritis

Answer 6

Benign and self-limiting inflammation of the sclera

Question 7

Where is the episclera located

Answer 7

Situated just underneath the conjunctiva, outmost layer of sclera

Question 8

What is episcleritis associated with

Answer 8

Not infection usually, mainly RA and IBD

Question 9

Presentation of episcleritis

Answer 9

Acute onset of unilateral symptoms
Mild pain
Segmental redness
Foreign body sensation
Dilated episcleral vessels,
Watering of eye, no discharge

Question 10

Management of episcleritis

Answer 10

Self limiting and will recover in 1-4 weeks, in mild cases no treatment is necessary. Lubricating eye can help, cold compresses, analgesia

Question 11

What parts of the eye does anterior uveitis involve

Answer 11

Iris and anterior chamber

Question 12

What parts of the eye does intermediate uveitis involve

Answer 12

Peripheral retina and vitreous

Question 13

What parts of eye does posterior uveitis involve

Answer 13

Choroid and retina

Question 14

Associations with acute anterior uveitis

Answer 14

HLA B27 related conditions such as ankylosing spondylitis, IBD, reactive arthritis

Question 15

Associations with chronic anterior uveitis

Answer 15

Sarcoidosis, syphilis, Lyme disease, TB, herpes, JIA

Question 16

Presentation of anterior uveitis

Answer 16

Unilateral symptoms that start spontaneously without a history of trauma or precipitating events. May occur with flare of an associated disease such as reactive arthritis

Question 17

Symptoms of anterior uveitis

Answer 17

Dull, aching, painful
Red, ciliary flush
Reduced visual acuity
Floaters and flashes
Miosis
Photophobia
Excessive tear production
Posterior synechiae
Hypopyon

Question 18

Management of anterior uveitis

Answer 18

Steroids, cycloplegic-mydriatic medications such as cyclopentolate or atropine eye drops, DMARDS and TNF inhibitors.

Question 19

Treatment options of severe cases of anterior uveitis

Answer 19

laser therapy, cryotherapy or surgery

Question 20

What does cyclopegic mean

Answer 20

Paralysing the ciliary muscles

Question 21

What does mydriatic mean

Answer 21

Dilating the pupils

Question 22

What types of medications are cyclopentolate and atropine

Answer 22

Antimuscarinic

Question 23

What is the role of antimuscarinic

Answer 23

Medications that blocks to the action of the iris sphincter muscles and ciliary body. These dilate the pupil and reduce pain associated with ciliary spasm by stopping the action of the ciliary body.

Question 24

Types of posterior uveitis

Answer 24

Retinitis, vasculitis and neuroretinitis

Question 25

What is ciliary flush

Answer 25

Ring of red spreading from the cornea outwards

Question 26

What causes an abnormally shaped pupil

Answer 26

Posterior synechiae (adhesions) which pull the iris

Question 27

What is a hypopyon

Answer 27

Collection of white blood cells in the anterior chamber seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level

Question 28

Where is the conjunctival layer

Answer 28

Thin layer of tissue that covers to inside of the eyelids and the sclera of the eye

Question 29

Three main types of conjunctivitis

Answer 29

Bacterial, viral, allergic

Question 30

Presentation of conjunctivitis

Answer 30

Unilateral or bilateral, red eyes, bloodshot, itchy or gritty sensation, discharge from eye

Question 31

Bacterial conjunctivitis symptoms

Answer 31

Purulent discharge and inflamed conjunctiva, typically worse in morning.

Question 32

Symptoms of viral conjunctivitis

Answer 32

Clear discharge, associated with other symptoms of viral infection, tender preauricular lymph nodes

Question 33

Management of bacterial conjunctivitis

Answer 33

Usually gets better on its own, but hloramphenicol and fuscific acid can be used for eye drops

Question 34

What can neonatal conjunctivitis infection be related to

Answer 34

Gonococcal infection

Question 35

Symptoms of allergic conjunctivitis

Answer 35

Swelling of conjunctival sac and eyelid with watery discharge and itch. After contact with allergens

Question 36

Management of allergic conjunctivitis

Answer 36

Oral or topical antihistamines. Topical mast-cell stabilisers can be used in patients with chronic seasonal symptoms

Question 37

What is keratitis

Answer 37

Inflammation of the cornea

Question 38

Causes of keratitis

Answer 38

Viral - herpes simplex. Bacterial - pseudomonas or staphylococcus. Fungal - candida or aspergillus. Contact lens acute red eye (CLARE). Exposure to keratitis

Question 39

What is the most common cause of keratitis

Answer 39

Herpes simplex keratitis

Question 40

What is stromal keratitis

Answer 40

When the inflammation reaches the layer between the epithelium and endothelium (stroma).

Question 41

Complications of stromal keratitis

Answer 41

Stromal necrosis, vascularisation, scarring, corneal blindness

Question 42

Which layer does herpes keratitis usually affect

Answer 42

Any part of the eye but mostly epithelial layer of cornea

Question 43

Presentation of keratitis

Answer 43

Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced visual acuity

Question 44

Diagnosis of keratitis

Answer 44

Fluorescein staining will show a dendritic corneal ulcer. Slit-lamp exam is required for diagnosis. Corneal swabs or scrapings to isolate the virus

Question 45

Management of keratitis

Answer 45

Aciclovir topical or oral, ganciclovir eye gel, topical steroids may be used alongside. Corneal transplant