Opthalmology - Red Eye and Eye Trauma Flashcards
(85 cards)
1
Q
What are the causes of painful red eye?
A
- eye trauma
- corneal ulcers
- anterior uveitis
- scleritis
- acute angle-closure glaucoma
- endopthalmitis
2
Q
What is microbial keratitis?
A
The sight-threatening infection and inflammation of the cornea.
NB: bacterial and viral keratitis are most common.
3
Q
Risk factors for microbial keratitis.
A
- contact lens wearer*
- ocular trauma
- dry eye
- immunosuppression
*any red eye in a contact lens wearer is keratitis unless proven otherwise.
4
Q
Symptoms of microbial keratitis.
A
- pain
- photophobia
- reduced visual acuity
- discharge
5
Q
Signs of microbial keratitis.
A
- conjunctival injection
- focal corneal haziness
- hypopynon (see image)
6
Q
Discharge characteristics of
a) bacterial keratitis
b) viral keratitis
A
a) mucopurulent discharge
b) clear, watery discharge
7
Q
Complications of microbial keratitis.
A
- rapid, permanent sight loss
8
Q
Management of microbial keratitis.
A
Topical:
- antibiotics
- antivirals
- antifungals
Topical cycloplegics, oral analgesics and antiemetics should be prescribed to improve patient comfort.
9
Q
What is uveitis?
A
Inflammation of the uveal tract:
- anterior (iris)
- intermediate (ciliary body and vitreous humour)
- posterior (retina, choroid)
10
Q
What is acute anterior uveitis?
A
Acute inflammation of the anterior uveal tract (iris).
11
Q
Symptoms of acute anterior uveitis.
A
- red, watery eye
- photophobia
- dull ache
- mildly affected visual acuity
12
Q
Signs of acute anterior uveitis.
A
- ciliary injection
- irregular pupil
- cloudy cornea
- hazy iris
- hypopynon
13
Q
Investigating acute anterior uveitis.
A
Slit lamp examination:
- keratic precipitates
- cells
- flares (clouding)
14
Q
Causes of acute anterior uveitis.
A
- HLA-B27 autoimmune conditions (e.g. psoriatic arthritis, ankylosing spondylitis)
- inflammatory bowel disease
- sarcoidosis
- infection
15
Q
Infective causes of acute anterior uveitis.
A
- HSV
- HZV
- tuberculosis
- syphilis
16
Q
Treatment aims in acute anterior uveitis.
A
- control inflammation
- prevent visual loss
- minimise long term complications
17
Q
Treatment of acute anterior uveitis.
A
Urgent referral to opthalmology:
Slow tapering regime of topical steroids.
Cycloplegics - paralyse the ciliary muscle and cause relaxation of accommodation.
18
Q
Risk factors for anterior scleritis.
A
- rheumatoid arthritis
- infection
- trauma
NB: No HLA association
19
Q
Symptoms of anterior scleritis.
A
- painful eye movements
- diplopia
- myositis
- red eye
20
Q
Management of anterior scleritis.
A
Investigate to exclude underlying autoimmune and infectious aetiology.
Management involves treating the underlying cause:
- high dose steroids in rheumatological disease
- antibiotics in infection
Urgent referral to ophthalmologist required.
21
Q
What is acute angle-closure glaucoma (AACG)?
A
Acutely raised intraocular pressure associated with a physically obstructed anterior chamber angle.
22
Q
Symptoms of AACG.
A
- deep ocular ache
- headache
- nausea and vomiting
- reduced visual acuity
- glare / halo around lights
23
Q
Signs of AACG.
A
- conjunctival injection
- hazy cornea limiting view of iris and pupil
- fixed, non-reactive, mid-dilated pupil
- high intraocular pressure (>30mmHg)
24
Q
Normal intraocular pressure.
A
11-21mmHg
25
Conservative management of AACG.
- oral analgesia
- oral antiemetics
- lay flat on back*
*gravity helps to bring the lens away from the iris, opening the anterior chamber angle.
26
Specialist management of AACG.
- systemic pressure-reducing agents
- topical pressure-reducing agents (e.g. beta blockers)
- topical steroids
- peripheral iridotomy
27
What is endophthalmitis/
Overwhelming infection of internal structures of the eye, potentially resulting in permanent blindness and loss of the eye.
28
Causes of endophthalmitis.
Exogenous source:
- cataract surgery
- intravitreal injection
Endogenous source:
- severe infection elsewhere (e.g. endocarditis, candida sepsis)
29
Symptoms of endophthalmitis.
- severe pain
- rapidly progressive visual loss
- photophobia
- floaters
- recent intraocular surgery or injection (<6 weeks)
Patients with endogenous endophthalmitis may be too unwell to report symptoms.
30
Signs of endophthalmitis.
- diffuse conjunctival injection
- corneal haze
- hypopyon
- relative afferent pupillary defect
31
Management of endophthalmitis.
True ophthalmic emergency.
Surgical intervention with sampling of vitreous fluid, followed by injection of intravitreal antibiotics.
Patients are admitted for topical and systemic therapy with close monitoring.
32
Types of eyelid trauma.
- periocular haematoma
- lacerations
33
History of periocular haematoma.
Blunt force to the eyelid or forehead - it appears more severe than the actual injury.
34
Management of periocular haematoma.
Self-limiting condition - conservative management including cold compresses and oral analgesia.
35
Management of eyelid laceration.
- irrigation
- tetanus jab
- abx for surrounding cellulitis
- glue / specialist repair
36
Pathophysiology of a blowout fracture.
Blunt force trauma to the eye causes a sudden increase in intraorbital pressure, creating a fracture of the orbital floor and medial wall.
37
Symptoms of blowout fracture.
- history of trauma to eye
- diplopia*
- blurring of vision
*improves following resolution of soft tissue swelling
38
Signs of blowout fracture.
- periorbital ecchymosis
- oedema
- enophthalmos
- loss of sensation in infraorbital nerve
39
Imaging of blowout fracture.
CT for visualisation of:
- extent of bony fracture
- prolapse of soft tissue
- extraocular muscle entrapment
40
Management of orbital blowout fracture.
Conservative management:
- ice packs
- nasal decongestants
- don't blow nose
Medical management:
- oral steroids (sight threatening swelling)
Surgical repair:
- non-resolving diplopia
- cosmetic reasons
41
Symptoms of corneal abrasion / superficial foreign body.
Ocular surface symptoms:
- pain
- discomfort
- grittiness
- epiphora
- photophobia
Visual acuity is unaffected unless the injury involves the visual axis (front of the pupil).
42
Signs of corneal abrasion.
- conjunctival hyperaemia
- clear corner with no areas of whitening
- visible foreign body embedded in the conjunctiva
Important to evert the lower and upper eyelid as foreign bodies may be embedded underneath.
43
Management of simple corneal abrasion (no foreign body).
Will health within 48-72 hours spontaneously.
Topical prophylactic antibiotics and analegsia can be given.
44
Management of corneal abrasion with superficial foreign body.
Removal of foreign body to prevent secondary microbial keratitis.
Topical anaesthetic drops used to aid examination and removal; irrigation with normal saline; cotton bud can be gentle rolled to remove.
45
What is hyphaema?
Blunt trauma that compresses the globe can have a shearing effect on blood vessels within the eye, leading to a haemorrhage in the anterior chamber.
46
Complications of hyphaema.
Haemorrhage into the anterior chamber causes uncontrolled elevation of intraocular pressure.
This can lead to iscaemic optic neuropathy and visual loss.
47
Management of hyphaema.
Conservative:
- keep upright with head elevated (blood settles)
- rigid eye shield
- avoid strenuous physical activity
Medical (comfort):
- oral analgesics
- oral antiemetics
- topical cycloplegics
Surgical management may be required in non-resolving cases.
48
Which type of chemical injury to the eye is more severe?
Acid or alkali?
Alkali is more severe as it penetrates more deeply into the ocular tissue.
Acids coagulate proteins, forming a protective barrier.
49
Emergency treatment of chemical burns to the eye.
- initial pH measured
- topical anaesthetic
- crystalloid fluid for irrigation
- upper eyelid everted
50
How long should the eye be irrigated for following chemical injury?
- >15 minutes
- pH neutralises to 7
51
Define penetrating eye injury.
Full-thickness laceration of the globe, with associated retained intraocular foreign body.
52
Presentation of penetrating eye injury.
- severe pain
- blurred / double vision
- photophobia
Any high-velocity injury to the globe is a penetrating eye injury until proven otherwise.
53
Signs of penetrating eye injury.
- severe periocular swelling
- open globe injury
- misshapen pupil
- embedded foreign body
-shallow anterior chamber
54
Investigations of penetrating eye injury.
CT scan of the orbit may reveal retained foreign bodies.
Do not use MRI (?metal foreign body).
55
Management of penetrating eye injury.
Place a rigid eye shield without an eye pad.
Systemic prophylactic antibiotics.
Check tetanus status.
Urgent referral to opthalmology for surgical repair.
56
What is retrobulbar haemorrhage?
Ocular trauma or eyelid surgery causes a haemorrhage, raising intraorbital pressure.
This can cause compressive ischaemia to the optic nerve (orbital compartment syndrome)
57
Symptoms of retrobulbar haemorrhage.
- difficulty opening eye
- diminished visual acuity
- reduced colour vision
- painful eye movements
58
Signs of retrobulbar haemorrhage.
- diminished visual acuity
- relative afferent pupillary defect
- reduced colour vision
- proptosis
59
Investigations of retrobulbar haemorrhage.
CT scan - defer if signs of orbital compartment syndrome (OCS).
60
Management of orbital compartment syndrome.
Immediate decompression via lateral canthotomy and cantholysis.
61
What are the causes of painless red eye?
- dry eye
- acute conjunctivitis
- episcleritis
- subconjunctival haemorrhage
62
What is dry eye?
A syndrome of bilateral ocular surface inflammation, and tear film instability.
63
Causes of dry eye.
Evaporative: meibomian gland dysfunction (blepharitis) leading to unstable tears that evaporate easily. Most common.
Tear deficiency: Sjorgren's syndrome, leading to damage to the aqueous secreting lacrimal glands.
64
Signs of dry eye.
- erythematous, thickened eyelids
- crusting eyelashes
- lumps on eyelid
65
Management of dry eye.
Lifestyle modifcations: reducing contact lens wear, regular breaks when using a screen, increasing level of humidity.
Regular lid hygiene (warm compresses, following by lid massages).
Ocular lubricants (eyedrops).
Symptoms not controlled with these measures should be referred to ophthalmology for specialist management.
66
What is conjunctivitis?
Inflammation of the conjunctiva over the sclera and inner eyelids.
67
Symptoms of conjunctivits.
Usually bilateral:
- general ocular discomfort
- watering eyes
- grittiness
- discharge
- crusted shut in morning
68
Signs of conjunctivitis.
- conjunctival injection
- swollen conjunctiva
- debris
69
Commonest cause of conjunctivitis.
Viral conjunctivitis - adenovirus.
Bacterial conjunctivitis is less common - Pneumococcas, Staphylococcus, Haemophilus.
70
How can viral and bacterial conjunctivitis be differentiated?
Viral conjunctivitis: clear, watery discharge with associated coryzal symptoms.
Bacterial conjunctivitis: mucopurulent discharge and extensive conjunctival injection.
71
Management of
a) viral conjunctivitis
b) bacterial conjunctivitis
a) lubricants and cold compress for symptomatic relief; contagious so regularly wash hands and don't share towels.
b) lubricants and cold compresses for symptomatic relief; topical antibiotic drops; contagious so regularly wash hands and don't share towels.
72
Which STIs are associated with bacterial conjunctivitis.
- Chlamydia trachomatis
- Neisseria gonorrhoea
73
Presentation of STI conjunctivitis.
- unilateral, non-resolving conjunctivitis
- severe discharge
74
Management of STI conjunctivitis.
Systemic antibiotic treatment.
Referral to GUM.
75
Symptoms of allergic conjunctivitis.
Usually bilateral:
- general ocular discomfort
- watering eyes
- grittiness
- discharge
- crusted shut in morning
ITCHING IS HALLMARK FEATURE.
76
What is episcleritis?
Inflammation of the episclera; the thin vascular layer between the superficial conjunctiva and sclera.
77
Causes of episcleritis.
- no obvious precipitants
- associated with systemic autoimmune conditions (e.g. UC)
78
Presentation of episcleritis.
Sectoral area of hyperaemia.
Subconjunctival injection is superficial, so is moveable with a swab.
79
How is episcleritis and scleritis differentiated?
Scleritis: painful; doesn't move with swab.
Episcleritis: painless; moves with swab.
80
Management of episcleritis.
No specific treatment and the condition is self-limiting.
Topical lubricants to manage symptoms.
Non-resolution within 2-3 weeks should prompt referral to an ophthalmologist.
81
Causes of subconjunctival haemorrhage.
Precipitated by:
- trauma
- lifting heavy weights
- eye rubbing
82
Risk factors for subconjunctival haemorrhage.
- hypertension
- anticoagulants
- antiplatelets
The development of subconjunctival haemorrhage can, therefore, be an indicator of underlying issues such as uncontrolled hypertension or deranged coagulation (e.g. raised INR).
83
Symptoms of subconjunctival haemorrhage.
Usually asymptomatic.
May produce a gritty feeling.
84
Signs of subconjunctival haemorrhage.
Haemorrhage which stops at the junction between the cornea and conjunctiva.
85
Management of subconjunctival haemorrhage.
Exclude risk factors:
- INR
- blood pressure
Lubricants for symptomatic relief.
Advise the haemorrhage will resolve over a few weeks.
