Red and tender eye Flashcards
(96 cards)
1
Q
Acute conjunctivitis accounts for over ______ of all eye complaints seen in general practice
A
25%
2
Q
A clear or mucous discharge indicates ______
A
viral or allergic conjunctivitis
3
Q
______(inflammation of the cornea) is
one of the most common causes of an
uncomfortable red eye.
A
Keratitis
4
Q
__________ often
presents painlessly as the neurotrophic effect
grossly diminishes sensation
A
Herpes simplex keratitis (dendritic ulcer)
5
Q
DDx of red eye
A
- trauma
- foreign body, including IOFB
- corneal ulcer
- iritis (uveitis)
- viral conjunctivitis (commonest type)
- acute glaucoma
6
Q
_______ generally has a gradual onset of redness, while a small foreign body will produce a very rapid hyperaemia
A
Conjunctivitis or uveitis
7
Q
Photophobia occurs usually with _____ and _____
A
uveitis
and keratitis.
8
Q
The wearing of contact lenses is very important as these are prone to cause infection or the _________ which resembles an acute ultraviolet (UV) burn.
A
‘overwear syndrome’,
9
Q
Red eye red flags (urgent ophthalmic
referral)
A
- Severe ocular pain
- Severe orbital pain
- Reduction of vision
- Loss of vision
- Diplopia
- Dilated pupil
- Abnormal corneal signs
- Globe displacement
- Endophthalmitis
- Microbial keratitis ± contact lens use
10
Q
The four essentials of the eye examination are:
A
- testing and recording vision
- meticulous inspection under magnification
- testing the pupils
- testing ocular tension
11
Q
This is conjunctivitis in an infant less than 1 month old and is a notifiable disease
A
Neonatal conjunctivitis
ophthalmia neonatorum
12
Q
Etilogy for neonatal conjunctivitis
A
Chlamydia trachomatis accounts for 50% or
more of cases
13
Q
Dx of
A
The diagnosis is
confirmed by PCR tests on the conjunctival secretions
14
Q
Tx of neonatal conjunctivitis
A
Treatment is with oral erythromycin for 21 days and local sulfacetamide eye drops.
15
Q
___________, which
usually occurs within 1–2 days of delivery, requires vigorous treatment with intravenous cephalosporins or penicillin and local sulfacetamide drops
A
Neisseria gonorrhoeae conjunctivitis
16
Q
______ is a chlamydial conjunctivitis that is
prevalent in outback areas and in the Indigenous population.
A
Trachoma
17
Q
Recurrent and untreated Trachoma leads to
\
A
id scarring and inturned lashes (entropion) with
corneal ulceration and visual loss
18
Q
Delayed development of the nasolacrimal duct occurs in about_______ of infants
A
6%
19
Q
DDx for red eye in the elderly
A
In an elderly patient there is an increased possibility of acute glaucoma, uveitis and herpes zoster
20
Q
________ should be considered in any patient over the age of 50 presenting with an acutely painful red eye.
A
Acute angle closure glaucoma
21
Q
_____is defined as an episode of
conjunctival inflammation lasting less than 3 weeks.
A
Acute conjunctivitis
22
Q
Acute conjunctivitis
Diffuse hyperaemia of____ and ______
A
tarsal or bulbar
conjunctivae
23
Q
Typical features of bacterial conjunctivitis
A
Purulent discharge with sticking together of eyelashes in the morning is typical.
24
Q
Organisms causing bact conj
A
- Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus
- Streptococcus pyogenes
- N. gonorrhoeae (a hyperacute onset)
- Pseudomonas aeruginosa
25
Tx of mild bacterial conjunctivitis
Mild cases may resolve with saline irrigation of the eyelids and conjunctiva but may last up to 14 days if untreated
26
Tx of moderate to severe conj
Chloramphenicol 0.5% eye drops, 1–2 hourly for 2 days, 1 decrease to 4 times a day for another 7 days
27
How to Tx Bacterial conj from diff organisms
Pseudomonas and other coliforms:
use topical gentamicin and tobramycin
28
How to Tx Bacterial conj from diff organisms
N. gonorrhoeae: _________
use appropriate systemic
| antibiotics
29
Shows a brick red follicular
| conjunctivitis with a stringy mucus discharge. What etiology of bacterial conjunctivitis?
Chlamydia trachomatis —may be sexually
| transmitted
30
The most common cause of viral conjunctivitis is ________
adenovirus
31
This viral infection produces a follicular conjunctivitis.
Primary herpes simplex infection
32
How to dx Primary herpes simplex infection
Dendritic ulceration highlighted by fluorescein staining is diagnostic
33
Antiinfective for Primary herpes simplex infection
Aciclovir 3% ointment, 5 times a day for 14 days or for at least 3 days after healing
34
What is Atropine for in Mx of primary herpes simplex
prevent reflex spasm of the
| pupil
35
Types of allergic conjunctivitis
• vernal (hay fever) conjunctivitis, and
• contact hypersensitivity reactions, e.g. reaction
to preservatives in drops
36
This is usually seasonal and related to pollen
| exposure. There is usually associated rhinitis
Vernal (hay fever) conjunctivitis
37
Tx of Vernal (hay fever) conjunctivitis
1 Topical antihistamines/vasoconstrictors
2 Mast cell stabilisers, e.g. sodium cromoglycate
2% drops, 1–2 drops per eye 4 times daily or
ketotifen
3 Combination of 1 and 2
4 Topical steroids (severe cases
38
Tx of Contact hypersensitivity
Treat with naphazoline or phenylephrine.
• If not responding, refer for possible
corticosteroid therapy.
39
__________appears spontaneously, is a beefy red localised haemorrhage
with a definite posterior margin
Subconjunctival haemorrhage
40
Cause of Subconjunctival haemorrhage
It is usually caused by a sudden
| increase in intrathoracic pressure such as coughing and sneezing.
41
Cause of Subconjunctival haemorrhage
T or F
It is not related to hypertension
T
42
What is the Tx of Subconjunctival haemorrhage?
No local therapy is necessary
43
The_________ is a vascular layer that lies just beneath the conjunctiva and adjacent to the sclera.
episclera
44
Which is self-limiting, episcleritis or scleritis?
scleritis
45
There are no significant associations with ______, which is usually idiopathic, but __________ may be associated
with connective tissue disease,
episcleritis
scleritis
46
CTDs associated with scleritis?
rheumatoid arthritis and herpes zoster and rarely sarcoidosis and tuberculosis.
47
Clinical features of episcleritis?
```
no discharge
• no watering
• vision normal (usually)
• often sectorial
• usually self-limiting
```
48
Tx of episcleritis?
Treat with topical or oral steroids
49
Clinical features of scleritis?
Scleritis:
• painful loss of vision
• urgent referral
50
The iris, ciliary body and the choroid form the ______ which is the vascular coat of the eyeball
uveal tract,
51
________(acute iritis or iridocyclitis) is
| inflammation of the iris and ciliary body and this is usually referred to as acute iritis
Anterior uveitis
52
Causes of uveitis
Causes include autoimmune-related diseases such as the seronegative arthropathies (e.g. ankylosing spondylitis), SLE, IBD, sarcoidosis and some infections (e.g. toxoplasmosis and syphilis).
53
MX of uveitis
Treatment includes pupil dilatation with
atropine drops and topical steroids to suppress inflammation. Systemic corticosteroids may be
necessary.
54
Prognosis of anterior uveitis
The prognosis of anterior uveitis is good
if treatment and follow-up are maintained, but
recurrence is likely
55
________(choroiditis) may involve the
| retina and vitreous
Posterior uveitis
56
______ should always be considered in a
| patient over 50 years presenting with an acutely painful red eye
Acute glaucoma
57
When does the attack of acute glaucoma happen?
The attack characteristically strikes in the evening when the pupil becomes
semidilated
58
How to Tx acute glaucoma
treatment can be initiated with
| acetazolamide (Diamox) 500 mg IV and pilocarpine 4% drops to constrict the pupil or pressure-lowering drops.
59
_________ an acute abscess of a lash follicle or associated glands of the anterior lid margin, caused usually by S. aureus
Stye (external hordeolum
60
Ddx for stye
A stye may be confused with a
| chalazion, orbital cellulitis or dacryocystitis
61
Tx of stye
* Perform lash epilation to allow drainage of pus (incise with a size 11 blade if epilation does not work).
* Use chloramphenicol ointment if the infection is spreading locally.
62
Also known as internal hordeolum, this granuloma of the meibomian gland in the eyelid may become inflamed and present as a tender irritating lump in the lid.
Chalazion (meibomian cyst)
63
DDx for Chalazion (meibomian cyst)
sebaceous gland carcinoma and
| basal cell carcinoma.
64
_______ is usually a staphylococcal microabscess of the gland and oral antistaphylococcal antibiotics (not topical) are recommended
Meibomianitis
65
This common chronic condition is characterised by inflammation of the lid margins and is commonly associated with secondary ocular effects such as
styes, chalazia and conjunctival or corneal ulceration
Blepharitis
66
Main types of blepharitis
* seborrhoeic blepharitis
* staphylococcal blepharitis
* blepharitis associated with rosacea
67
Mainstay of Tx in blepharitis
Eyelid hygiene is the mainstay of therapy
68
For chronic blepharitis short-term use of a
| _______
```
corticosteroid ointment (e.g. hydrocortisone
0.5%) can be very effective
```
69
________is infection of the lacrimal
sac secondary to obstruction of the nasolacrimal
duct at the junction of the lacrimal sac
Acute dacryocystitis
70
Acute dacryocystitis
Inflammation is localised over the
_____
medial canthus.
71
_______ is infection of the lacrimal gland
| presenting as a tender swelling on the outer upper margin of the eyelid
Dacroadenitis
72
Viral infection asstd withDacroadenitis
mumps
73
Orbital cellulitis includes two basic types—
peri-orbital (or preseptal) and orbital (or postseptal) cellulitis
74
cellulitis which is potentially blinding and life-threatening condition
orbital (or postseptal) cellulitis
75
orbital or preorbital
restricted and painful eye movements
orbital cellulitis
76
When to refer Herpes zoster ophthalmicus
Ocular problems
include conjunctivitis, uveitis, keratitis and
glaucoma
77
Tx of HZO
oral anti-herpes virus agents
| such as oral aciclovir 800 mg, 5 times daily for 10 days
78
If sight at risk in HZO, what is the Tx
aciclovir 10 mg/kg IV slowly 8 hourly for 10 days
79
Ideal time to give Acyclovir
provided this is
| commenced within 3 days of the rash appearing
80
________ is a yellowish elevated nodular growth on either side of the cornea in the area of the palpebral fissure
Pinguecula
81
_______is a fleshy overgrowth of the
conjunctiva onto the nasal side of the cornea and usually occurs in adults living in dry, dusty, windy
areas
Pterygium
82
Dx of corneal DO
Diagnosis is best performed with a slit lamp using a cobalt blue filter and flourescein staining
83
________ presents as scattered small lesions on the cornea which stain with fluorescein if they are deep enough
Punctate keratopathy
84
Think corneal abrasion if the eye is ______
‘watering’ and painful (e.g. caused by a large insect like a grasshopper or other foreign body)
85
This is responsible for at least 1.5 million new cases of blindness every year in the developing world and for
significant morbidity in developed countries
Microbial keratitis
86
Microbial keratitis
______is the most common
causative organism in contact lens wearers
Pseudomonas aeruginosa
87
Microbial keratitis
_______ is associated with bathing or
washing in contaminated water
Acanthamoeba
88
Problems with contact lenses
Infection is more likely to occur with ____
soft rather than hard lenses
89
Problems with contact lenses
They should not be worn for sleeping
since this increases the risk of infection ________
10-fold.
90
Hard lens trauma
This may cause corneal abrasions with irreversible endothelial changes or ptosis, especially with the
_________
older polymethyl-methacrylate-based lenses
91
A common problem, usually presenting at night, is bilateral painful eyes caused by UV ________to both corneas some 5–10 hours previously
‘flash burns’
92
What to do with penetrating eye injuries
* X-ray
* tetanus prophylaxis
* transport by land
* injection of anti-emetic
93
This is an intra-ocular bacterial infection which
| may complicate any penetrating injury including intra-ocular surgery
Endophthalmitis
94
Endophthalmitis assoctated with pus in the anterior chamber
Pus may be seen in the anterior chamber
| (hypopyon
95
Never use corticosteroids in the presence of a_______
dendritic ulcer
96
Beware of the contact lens _________, which is treated in a similar way to flash burns
‘overwear syndrome’
