Red eye Flashcards by Sanjana Shaunak

What are the features of scleritis?

Red eye

Pain ( unlike episcleritis) deep boring pain (wake up at night)

Photophobia

watery eye

gradual decrease in vision

unilateral or bilateral

How well did you know this?

Not at all

Perfectly

Who gets scleritis ?

Common in middle aged women

Immune - Rheumatoid arthritis

Connective tissue diseases e.g. granulomatosis with polyangigit, SLE, relapsing polychondritis

How well did you know this?

Not at all

Perfectly

Is scleritis serious?

Yes !
vision- threatening

emergency

How well did you know this?

Not at all

Perfectly

Management of scleritis?

Urgent opthalmology referral for systemic corticosteroids

Treat:
underlying condition
NSAIDS
corticosteroids
immunosuppression

(certain forms can lead to globe perforation and reduced visual acuity - if suspect shield eye and avoid palpation)

How well did you know this?

Not at all

Perfectly

Investigations for scleritis?

assumed underlying cause until proven otherwise

e.g.
FBC + imflamm markers

RA / syphillis screen

urine dip - blood / protein

B-scan ultrasonography of globe

Xray - chest/ sacroiliac joint

MRI / CT sinuses and orbit

How well did you know this?

Not at all

Perfectly

What investigations for a patient with scleritis with no previously diagnosed systemic disease?

rule out systemic vasculitis

How well did you know this?

Not at all

Perfectly

complications of scleritis?

Scleral thinning
retinal detachment
increased ocular pressure
uveitis
cataract
ischaemia of anterior segment of the globe

How well did you know this?

Not at all

Perfectly

What is cilliary flush? Where is it seen?

injection of deep conjunctival vessels and episcleral vessels surrounding cornea.

seen in:
Iritis (inflammation of anterior chamber aka anterior uveitis)
Acute glaucoma

Don’t get in simple conjunctivitis

How well did you know this?

Not at all

Perfectly

What is conjunctival hyperemia?

engorgement of superior vessels

non specific sign
inflammatory sign

How well did you know this?

Not at all

Perfectly

What are common causes of Bacterial conjunctivitis?

Staph aureus

Staph epidermis

Strep pneumoniae

Haemophilus influenzae

Direct contact with infected secretions (be careful!)

How well did you know this?

Not at all

Perfectly

What are the symptoms of Bacterial Conjunctivitis?

subacute onset

Redness

Grittiness

Burning

mucopurulent discharge

often bilateral

relative NEGATIVE finding: NO photophobia

How well did you know this?

Not at all

Perfectly

What signs do you get in bacterial conjunctivitis?

Crusty lids

conjunctival hyperaemia

mid papillary reaction

oedematous lids and conjunctiva

How well did you know this?

Not at all

Perfectly

What investigations for bacterial conjunctivitis?

If diagnosis uncertain : swab

How well did you know this?

Not at all

Perfectly

What treatment for bacterial conjunctivitis?

Topical antibiotics usually effective in 2-7 days

Chloramphenicol or fusidic acid = 1st line

How well did you know this?

Not at all

Perfectly

What is chlamydial conjunctivitis ?

Chlamydia trachomatis serotypes D to K

see in sexually active adults / adolescents
+/- genital infection

Chronic with a mild keratitis

How well did you know this?

Not at all

Perfectly

What are the symptoms / signs of chlamydial conjunctivitis?

Foreign body sensation / itchy/ irritated

Stuck together in morning

purulent discharge (bacterial)

follicles

How well did you know this?

Not at all

Perfectly

What investigations would you do for chlamydial conjunctivitis?

Swab / smear

Direct monoclonal fluorescent antibody microscopy

PCR

How well did you know this?

Not at all

Perfectly

What is the management for chlamydial conjunctivitis?

Treat:
topical tetracycline / oral doxycycline / azithromycin

Contact tracing

GUM referral

How well did you know this?

Not at all

Perfectly

What is the aetiology of viral conjunctivitis?

Often: adenovirus type 3,4,7

(PCF) pharyncgoconjunctival fever
Adenovirus types 8 +9 - epidemic keratoconjunctivitis

How well did you know this?

Not at all

Perfectly

What are the symptoms of viral conjunctivitis?

Acute onset

bilateral

watery discharge

Foreign body sensation

History of URTI

Relevant negatives: NO photophobi a

How well did you know this?

Not at all

Perfectly

The hyperaemic conjunctiva in viral conjunctivitis can be associated with … ?

i.e. what other signs do you get in viral conjunctivitis

Follices

Haemorrhages

inflammatory membranes

Lymphadenopathy ( esp preauricular)

Keratitis on 80% with EKC and 30% with PCF

How well did you know this?

Not at all

Perfectly

What is treatment of viral conjunctivitis?

self resolving up to 2 weeks

Advice to isolate (v contagious like bacterial)

Topical steroids if keratitis to stop risk of scarring

How well did you know this?

Not at all

Perfectly

What are the RF associated with allergic conjunctivitis?

Study These Flashcards

3/4 have atopy

2/3 FHX of atopy

What are the symptoms + signs of allergic conjunctivitis?

Study These Flashcards

itchy ++
bilateral
Watery discharge

Chemosis (oedema)

Papillae (‘cobblestone’ in chronic cases)

What investigations for allergic conjunctivitis?

Exclude infection (viral NOT itchy) allergy skin patch testing tear IgE levels

What is the treatment for allergic conjunctivitis?

cold compress remove trigger allergen NSAIDs oral antihistamines or topical (olapatanol) Mast cell stabilisers (sodium cromoglycate) topical corticosteroids immunosuppressants (cyclosporin) for steroid resistant cases

Investigations for viral conjunctivitis?

Rapid adenovirus assay PCR

Prostaglandin analogues side effects in opthalmology?

increased eyelash length, iris pigmentation and periocular pigmentation

What are the features of a spontaneous subconjunctival haemorrhage ?

Painless red eye w/o discharge Visual acuity not affected conjunctival vessels masked

What is the treatment for a spontaneous subconjunctival haemorrhage ?

No specific treatment Lubricants self resolves 10 -14 days

If a pt is getting recurrent spontaneous subconjunctival haemorrhages, what investigations should you do?

Do: FBC Clotting studies

What sinister cause could be behind a spontaeneous subconjunctival haemorrhage you must exclude?

Base of skull fracture

What is episcleritis? Common causes?

Episcleritis is describes the acute onset of inflammation in the episclera of one or both eyes. The majority of cases are idiopathic associated conditions include: inflammatory bowel disease rheumatoid arthritis

What are the features of episcleritis?

asymptomatic common mild tearing / irritation tender to touch vessels blanch with phenylephrine

What is the treatment for episcleritis?

Self limiting (months) If doesn't resolve: lubricants NSAIDS (froben po 100 mg tablets) Low dose steroid (predsol)

What is Pterygium?

fibrovascular growth from the conjunctiva over the cornea

What is treatment for Pterygium?

Excision of pterygium Cover defect with a conjunctival autograft or amniotic membrane Adjuvant mitomycin - reduce reoccurence

What are the features of a corneal abrasion / foreign body?

Severe pain (esp when blink) Watering +++

If able what should you do when a pt presents with a FB in cornea and how?

Remove FB with cotton bud under topical anaesthetic

When should you refer a pt with a corneal abrasion

if the abrasion crosses the visual axis

what treatment for a corneal abrasion / FB ?

Chloramphenicol ointment cyclopentolate double pad

When do you need to exclude intraocular FB ?

if the history suggests high impact activity when happened e.g. hammering / grinding without protective eye wear - exclude intraoculaur FB

What are the common causes of bacterial keratitis?

Staph aureus Strep pyogenes Strep pneumoniae Pseudomonas erruginosa

What pt factors / RF for getting bacterial keratitis?

contact lenses- extended wear of soft ones (less likely with hard contact lenses) Corneal disease e.g. neurotrophic keratopathy

What are the symptoms /signs of bacterial keratitis?

Ocular pain watering / discharge FB sensation Decreased vision Photophobia SIGNS: Corneal lesion (ulcer) Corneal oedema hypopyon

What is hypopyon ?

accumulation of leukocytes in the anterior chamber due to severe intraocular inflammation

What investigations for bacterial keratitis ?

Culture : Blood agar: most fungi and bacteria except Neisseria Chocolate agar: Neisseria and Moraxella Sabourand agar: fungi

What is the treatment for bacterial keratitis?

Ofloxacin initially : Hourly Then : 2 hourly (when awake) Cyclopentolate tds Steroids when cultures become sterile / improving (7-10 days after starting treatment)

What is herpes simplex keratitis?

Reactivation of latent herpes simplex virus type 1 Migrates down branch of trigeminal nerve to cornea

What would be in Hx of Herpes simplex keratitis?

Cold sores run down stress

Symptoms / signs of a pt with herpes simplex keratitis?

Tearing light sensitivity pain hyperaemia Corneal sensation reduced dendritic ulcer geographic amoeboid ulcer esp if incorrect use of steroid

Treatment for herpes simplex keratitis

Topical aciclovir ointment - 5 x day for 10-14 days Cyclopentolate topical steroids -minimise scaring

How does herpes zoster in the eyes present ?

Crusting and ulceration of skin innervated by 1st division of trigeminal nerve Hutchinson's sign - lesion to top of nose = increased chance of ocular invovlement

Treatment for herpes zoster in eye?

Oral aciclovir w/in 48 hrs of onset of vesicles 800 mg 5x day for 7 days will have no effect if later Aciclovir ointment within 5/7 days of onset of vesicles

ocular complications of herpes zoster in the eye?

Conjunctivitis uveitis keratitis scleritis optic neuritis

Differentials for conjunctivitis and distinguishing features?

* Dry eyes – presents with dryness, burning, a feeling of something in the eye * Corneal abrasion – severe pain, photophobia, watering of the eye * Uveitis – eye pain, blurred vision, photophobia, floaters, redness * Glaucoma – severe eye pain, nausea, vomiting, blurred vision, halos around lights

Common signs and symptoms of conjunctivitis

* Eye redness * Itching * Irritation * Excessive tearing * Discharge from the eyes, which can vary in consistency based on the cause * Photophobia, which suggests corneal involvement (keratoconjunctivitis) * Notably, visual acuity should not be affected by conjunctivitis.

Red eye Flashcards

(57 cards)