Ophthalmology - Acute Red Eye

Question 1

What can be involved in presenting complaint?

Answer 1

Change in vision, redness, pain, discharge, double vision and change in appearance of eye

Question 2

What can be included in past ocular history?

Answer 2

Previous similar episode
Previous surgery
Contact lens wear
Amblyopia - lazy eye

Question 3

What can be included in past medical history?

Answer 3

CV risks - ischaemic optic neuropathies, retinal vein occlusion and CN palsies
Eczema/asthma/hay fever
Joints - uveitis, scleritis and episcleritis
Bowels - IBS - uveitis
Infection - uveitis

Question 4

What is included in drug history?

Answer 4

Ethambutol and chloroquine
Tamsulosin - intraoperative floppy iris syndrome
Anticoagulants

Question 5

What can be included in the social history?

Answer 5

Driver
Smoking - CV risk, age related macular degeneration , thyroid eye disease
Alcohol - nutritional optic neuropathies
Drug abuse

Question 6

How is vision assessed in adults?

Answer 6

Snellen chard - best corrected acuity measured at 6m
Recorded as 6/60 - 6/6
Numerator is distance form chart and denominator is distance that is normal

Question 7

What is used to assess vision in babies and toddlers?

Answer 7

Babies - preferential looking
Toddlers - matching Kay pictures
Older children - naming Kay pictures or Snellen chart

Question 8

What is included in inspection of eye?

Answer 8

Facial asymmetry, rashes, lip position (ptosis, entropion, ectropion)
Globe position - proptosis and enophthalmos
Pupil symmetry
Lumps, bumps, redness and discharge

Question 9

What is used for examination?

Answer 9

Slit lamp
Fundoscopy
Visual field exam
Eye movement and pupil exam

Question 10

What are commonly encountered ophthalmic conditions?

Answer 10

Acute red eye - anterior segment
Loss of vision - posterior segment
Trauma

Question 11

How is acute red eye examined?

Answer 11

Staining with fluorescein - outlines epithelial defects

Question 12

What is the symptoms of infective conjunctivitis?

Answer 12

Gritty, red and discharge (purulent and watery)

Question 13

What is the treatment for infective conjunctivitis?

Answer 13

Topical antibiotics - chloramphenicol/ fucidic acid

Question 14

What are the symptoms of subconjunctival haemorrhage?

Answer 14

Red and painless
Treatment is reassurance - if BP high then do again after presentation

Question 15

What are the symptoms and signs of allergic conjunctivitis?

Answer 15

Itchy, red, discharge, acute, lid swelling and conjunctival swelling (chemosis)

Question 16

What is the treatment of allergic conjunctivitis?

Answer 16

Topical antihistamine
Avoid allergen
Mast cell stabilisers - sodium chromoglycate

Question 17

What are the signs of symptoms of corneal ulcer?

Answer 17

Pain, red, photophobia, discharge, history of contacts, corneal defects with surrounding infiltrate and pus or cells in anterior chamber

Question 18

What is the treatment of corneal ulcer?

Answer 18

Corneal scrape - MCS culture
Topical antibiotics

Question 19

What are the symptoms and signs of corneal abrasion?

Answer 19

History of trauma, pain, red, watering, blurred vision and epithelial defect

Question 20

What is the treatment for corneal abrasion?

Answer 20

Topical antibiotics
Analgesia

Question 21

What are the symptoms and signs of acute anterior uveitis?

Answer 21

Pain, watering, photophobia, blurred vision/ floaters, red, keratic precipitates, cells in AC, hypopyon (white fluid in AC) and small irregular pupil

Question 22

What is the treatment of acute anterior uveitis?

Answer 22

Topical steroids - prednisolone
Dilating drops - cyclopentolate

Question 23

What are the signs and symptoms of scleritis?

Answer 23

Intense pain, redness, nodule which does not move over sclera and very tender

Question 24

What is the treatment for scleritis?

Answer 24

Systemic steroids

Question 25

What is the signs and symptoms of acute angle closure glaucoma?

Answer 25

Very painful, redness, blurred vision, nausea and vomiting, hazy cornea, fixed mid dilated pupil and hard eyeball

Question 26

What is the treatment for acute angle closure glaucoma?

Answer 26

Lower IOP - carbonic anhydrase inhibitors, BB and prostaglandins Constrict pupil - pilocarpine Laser iridotomy

Question 27

Describe orbital cellulitis

Answer 27

Infection of orbital tissues Symptoms - very painful, red, blurred vision, diplopia, generally unwell, pyrexia proptosis and reduced eye movements

Question 28

What is the treatment for orbital cellulitis?

Answer 28

Admit and IV antibiotics CT scan Drainage of pus

Question 29

What are the signs and symptoms of endophthalmitis?

Answer 29

Is inflammation of internal eye tissues Redness, blurred vision, pain and history or recent surgery

Question 30

What is the treatment for endophthalmitis?

Answer 30

Admit and topical antibiotics Vitreous tap Intravitreal antibiotics

Question 31

What is thyroid eye disease?

Answer 31

Inflammation of orbital fat and muscles Can compress nerve

Question 32

What are the signs and symptoms of thyroid eye disease?

Answer 32

Red, blurred vision, pain, diplopia, history of thyroid dysfunction, proptosis, lid retraction and reduced eye movement

Question 33

What is the treatment for thyroid eye disease?

Answer 33

Topical lubrication Systemic steroids Orbital radiotherapy Orbital decompression