Ophthalmology - the red eye Flashcards
(63 cards)
1
Q
causes of painful red eye
- normal vision
A
- episcleritis
- corneal foreign body
2
Q
causes of painful red eye
- abnormal vision
A
- glaucoma
- corneal abrasions
- uveitis
- scleritis
- endophthalmitis
- corneal foreign body
- keratitis
- traumatic or chemical injury
3
Q
causes of painless red eye
A
- dry eye
- conjunctivitis
- episcleritis
- subconjunctival haemorrhage
4
Q
definition
acute angle-closure glaucoma
A
optic nerve damage caused by significant rise in intraoccular pressure
caused by blockage in aqueous humour trying to escape from the eyes
5
Q
pathophysiology
acute angle-closure glaucoma
A
- iris bulges forwards and seals off trabecular meshwork
- . stops aqueous humour draining away
- aqueous humour builds up in the eye causing increased pressure
6
Q
risk factors
acute angle-closure glaucoma
A
- increasing age
- female
- family history
- chinese /east asian
- shallow anterior chamber
- medications can precipitate:
- adrenergics e.g. noradrenaline
- anticholinergics e.g. oxybutynin
- tricylic antidepressants e.g. amitriptyline
7
Q
presentation
acute angle-closure glaucoma
A
- systemically unwell
- short history of:
- severely painful red eye
- blurred vision
- halos around lights
- associated headache, nausea and vomiting
8
Q
examination findings
acute angle-closure glaucoma
A
- red eye
- teary eye
- hazy cornea
- decreased visual acuity
- pupil dilated and fixed
- firm and hard on palpation
9
Q
MX
acute angle-closure glaucoma
A
- urgent opthalmology assessment
- pilocarpine eye drops -> acts on muscarinic receptors in the sphincter of iris
- acetazolamide -> carbonic anhydrase inhibitor -> reduce production of aqueous humour
- timolol -> B-blocker -> reduces production of aqueous humour
- difinitive: laser iridotomy
10
Q
definition, cause
infective endophthalmitis
A
- Inflammation of aqueous and/or vitreous humour
- most commonly seen after trauma or intraocular surgery
11
Q
Signs and symptoms
infective endophthalmitis
A
- symptoms:
- painful eye
- loss of vision
- signs:
- lid swelling
- discharge
- red eye
- hypopyon (pus in the anterior chamber)
- reduced vision
12
Q
Mx
infective endophthalmitis
A
urgent referral to ophthalmologist for
- vitreous sampling
- intravitreal antibiotics
- vitrectomy -> remove vitreous humour and replace wth saline
13
Q
definition, epidaemiology
orbital cellulitis
A
- life threatening infection of the soft tissues behind the orbital septum
- more common in children
14
Q
causes
orbital cellulitis
A
usually spreading upper respiratory tract infection from sinuses
- Haemophilus influinzae
- Staph aureus
- Strep
15
Q
risk factors
orbital cellulitis
A
- childhood (mean age 7-12)
- previous sinus infection
- lack of Haemophilus influenzae type b vaccination
- recent eyelid infection/ insect bite on eyelid
- ear or facial infection
16
Q
signs and symptoms
orbital cellulitis
A
symptoms:
- fever, pain and visual impairment
signs:
- unilateral
- tender
- warm and red periorbital lid oedema
- ptosis
- proptosis
- painful ophthalmoplegia
- optic nerve dysfunction
- visual disturbance
17
Q
investigations
orbital cellulitis
A
- FBC
- clinical exam - complete ophthalmological assessment
- CT scan with contrast → thickened periocular tissues
- blood culture and swab
18
Q
Mx
orbital cellulitis
A
admission and IV antibiotics
19
Q
periorbital cellulitis
A
- less serious, superficial infection anterior to the orbital septum
- from superficial tissue injury
- can progress to orbital cellulitis
- NO reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements
20
Q
definition
corneal abrasion
A
scratches or damage to the cornea causing a red, painful eye and photophobia
corneal epithelium is scraped and lost after eye trauma
21
Q
causes
corneal abrasion
A
- damaged contact lenses
- may be associated with psudomonas infection
- fingernails
- foreign bodies
- tree branches
- makeup brushes
- entropion - inward turning eyelid
22
Q
presentation
corneal abrasion
A
often history of trauma, followed by:
- painful red eye
- photophobia
- foreign body sensation
- epiphoria - excessive tear production
- blurred vision
fluroscein stain - yellow-orange stain and collects in abrasions or ulcers when viewed under cobalt blue light
23
Q
MX
corneal abrasion
A
- uncomplicated corneal abrasions usually heal over 2-3 days
- more complicated cases need assessment and management by ophthalmology. options include:
- removing foreign bodies
- simple analgesia
- lubricating eye drops
- hypromellose - least viscous (lasts 10 mins)
- polyvinyl alcohol - middle viscous
- carbomer - most viscous (lasts 30-60 mins)
- antibiotic eye drops
- close follow-up
24
Q
features
corneal/subtarsal foregin body
A
- eye pain
- foreign body sensation
- photophobia
- watering eye
- red eye
25
# red flags
corneal/subtarsal foregin body
- severe pain
- irregular, dilated or non-reactive pupils
- significant reduction in visual acuity
26
# Mx and advice to Pt
corneal/subtarsal foregin body
management:
- removal
- topical antibiotics following removal
advice to the patient:
- wear sunglasses or stay out of bright light to help with light sensitivity
- advise on eye protection to prevent future injury
- don’t touch or rub the eye abd avoid contact lenses while the eye recovers
27
# definition
hyphaemia
blood in the anterior chamber following blunt trauma to the eye
28
# signs and symptoms
hyphaemia
- symptoms:
- red eye
- severe loss of vision following trauma
- signs:
- visible blood in anterior chamber
- cornea may also be stained
- eye may be very sore in intraocular pressure is raised
- haematocornea causes cloudy vision
29
# management
hyphaemia
- bed rest
- eye pad
- topical atropine to reduce risk of rebleeding
- urgent assessment by ophthalmologist
- treatment of raised intraocular pressure or anterior chamber irrigation may be needed
consider non accidental injury or blood disorder in children
30
# signs
chemical injury
- corneal haze
- limbal ischaemia
- loss of epithelium
can cause severe damage and vision loss
31
# management
chemical injury
- ocular emergency
- initial management:
- extensive irrigation of the eyes under topical anaesthetic with normal saline until the ph remains normal
- intensive topical steroids, antibiotics and lubricants given
later management:
- limbal stem cell grafting
- keratoplasty or keratoprosthesis
32
# signs
penetrating eye injury
- soft eye
- protruding iris
- irregular pupil
33
# complications
penetrating eye injury
perforated eye is prone to infection (endophthalmitis)
late complication → sympathetic ophthalmia - inflammation of the uvea of the normal eye
34
# Mx
penetrating eye injury
- surgical primary repair
35
# definition
conjunctivitis
inflammation of the conjunctiva
- thin layer of tissue that covers the inside of the eyelids and the sclera
36
# classification
conjunctivitis
- bacterial
- viral
- allergic
unilateral or bilateral
37
# general presentation
conjunctivitis
- red, bloodshot eye
- itchy or gritty sensation
- discharge
does not cause pain, photophobia or reduced vision
38
# presentation
bacterial conjunctivitis
- purulent discharge
- worse in the morning when the eyes may be stuck together
- usually starts in one eye and can spread to the other
- highly contagious
39
# presentation
viral conjunctivitis
- common
- clear discharge
- often associated with symptoms of viral infection
- may be tender pre-auricular nodes
- also contagious
40
# presentation
allergic conjunctivitis
- caused by contact with allergens
- causes swelling of the conjunctival sac and eyelid
- itching and watery discharge
41
# Mx
conjunctivitis
- usually resolves in 1-2 weeks without treatment
- hygeine measures: don't share towels, hand washing
- clean with cotton wool and cooled boiled water
- bacterial -> chloramphenicol or fusific acid eye drops
- allergic -> antihitamines, oral or topical. mast-cell stabilisers for chronic Sx
42
# definition
uveitis
inflammation of the uvea
- uvea is in between the retina and the sclera
- composed of choroid (most vascular layer in the body), ciliary body and iris
43
# classification
uveitis
- anterior: iris
- intermediate: ciliary body
- posterior: choroid
44
# causes
uveitis
- autoimmune
- infectious
- drug induced
- traumatic
40-50% no cause
45
# associations
uveitis
may be associated with underlying autoimmune conditions:
- seronegative spondyloarthropathies e.g. ank spond
- inflammatory bowel disease
- sarcoidosis
- Behcet’s disease
46
# symptoms, anterior, intermediate
uveitis
anterior
- painful red eye (dull aching pain)
- reduced visual acuity
- photophobia (due to ciliary muscle spasm)
- excessive lacrimation
intermediate
- blurring
- floaters
47
# exam findings
uveitis
- ciliary flush
- miosis
- abnormally shaped pupil due to posterior synechiae (adhesions)
- hypopyon - inflammatory cells collected as a white fluid in the anterior chamber
48
# Mx
uveitis
- urgent referral to opthal
- steroid eye drops
- cycloplegics - dilate pupil and reduce pain
- intermediate/posterio -> steroid injections or implant
- recurrent cases: DMARDs or anti-TNF
49
# definitino
keratitis
inflammation of the cornea
50
# causes
keratitis
- viral: HSV most common
- bacterial - staph aureus, pseudomonas in contact lense
- fungal
- amoebic - exposure to soil
- exposure keratitis - inadequate eyelid coverage
51
# presentation
keratitis
- primary infection often involves mild symptoms of blepharoconjunctivitis
- recurrent infection may present with:
- painful red eye
- photophobia
- vesicles
- foreign body sensation
- watery discharge
- reduced visual acuity
- signs:
- white area on cornea, peripheral or central
52
# investigations
keratitis
- slit lamp -> fluorescein staining shows dendritis corneal ulcer
- corneal scrapings for viral testing
53
# Mx
keratitis
urgent assessment and management by an ophthalmologisy
- topical or oral antivirals
- corneal transplant is an option to treat permanent scarring and vision loss
54
# definition and serious complication
scleritis
inflammation of the sclera
most severe form - scleral necrosis can occur - can lead to perforation of the sclera
55
# causes
scleritis
- most are idiopathic
- associated with systemic inflammatory condition
- rheumatoid arthritis
- SLE
- sarcoidosis
- less commonly, infection (pseudomonas or staphylococcus aureus)
- more common in women
56
# symptoms
scleritis
* Red, inflamed sclera (localised or diffuse)
* Congested vessels
* Severe pain (typically a boring pain)
* Pain with eye movement
* Photophobia
* Epiphora (excessive tear production)
57
# signs
scleritis
- eye is red and may have visible sclera nodules or a necrotic match
- congested vessels
- sclera may be discoloured and is tender to palpation
- reduced visual acuity
58
# Mx
Scleritis
- urgent referral to ophthalmology
- assessment for underlying systemic condition
- topical and/or systemic corticotherapy may be required
59
# definition
episcleritis
benign and self-limiting inflammation of the episclera, the outmost layer of the sclera, just below the conjunctiva
60
# cause
episcleritis
- not usually infectino
- common in young/middle aged
- often associated with RA, IBD
61
# Symptoms and signs
episcleritis
- symptoms
- mild discomfort, tenderness and watering
- usually** not painful**
- **NO photophobia** or discharge and normal visual acuity → otherwise suggests scleritis
- signs:
- sectoral or diffuse redness
- dilated episcleral vessals
- **vessels are mobile** when gentle pressure applied
62
# Mx
episcleritis
- self limiting
- may be relieved with analgesia and lubricating eye drops
- topical steroid if severe
63
how to differentiate between scleritis and episcleritis
- phenylephrine eye drops → causes blanching of the episcleral vessels, causing the redness to disappear
- will not affect the scleral vessels and will not impact the redness in scleritis
