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Red Eye Flashcards

(37 cards)

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1
Q

Urgent ocular signs (red flags)

A
  • moderate to severe eye pain or photophobia
  • marked redness of one eye
  • reduced visual acuity
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2
Q

Causes of subconjunctival hemorrhage

A
  • increase in intrathoracic pressure
  • trauma (blunt trauma, vigorous rubbing)
  • medication induced (warfarin)
  • systemic disorder (blood dyscrasia)
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3
Q

Management of subconjunctival haemorrhage

A
  • reassurance, conservative, spontanenous resolution 1-2 weeks
  • artificial tears can be given if irritation
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4
Q

Types of hordeolum and organisms involved

A
  • external (stye): acute bacterial infection (lash follicle, gland of zeis or Moll)
  • internal: acute bacterial infection of Meibomian gland

Organisms: staphylococcal

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5
Q

Symptoms and signs of hordeolum

A

Symptoms
- tender lump in eyelid
- epiphora (watery eye)
- local redness of eye and lid

Signs
- external: tender inflamed of lid, multiple abscesses

  • internal: tender inflamed within tarsal plate, painful
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6
Q

Management of hordeolum

A
  • traditional remedies: hot spoon bathing and/or warm compresses may relieve symptoms
  • in presence copious mucopurulent discharge, consider antibiotic drops or ointment (chloramphenicol)
  • severe/recurrent cases: systemic broad spectrum antibiotic
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7
Q

Causes of chalazion

A
  • poor eyelid hygiene
  • acnae rosacae
  • blepharitis
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8
Q

Clinical features of chalazion

A
  • gradual enlarge eyelid nodule
  • eyelid discomfort
  • palpable nodule on eyelid, non erythematous, non fluctuant, non tender
  • eversion of eyelid (if not apparent over skin surface)
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9
Q

Management of chalazion

A
  • conservative tx: lid massage, moist heat, topical mild steroid
  • intralesion steroid injection
  • antibiotic (in cases of infection)
  • incision and drainage
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10
Q

Complication of chalazion

A
  • exert mass on cornea result in astigmatism and blurred vision
  • acute secondary infection predispose to preseptal cellulitis
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11
Q

Causes of blepharitis

A

Anterior
- staphylococcal, dandruff of scalp and eyebrows

Posterior
- glands of eyelids irregularly produce oil

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12
Q

Symptoms of blepharitis

A
  • red, irritated eye that is worse upon waking, itchy, crusted eyelids
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13
Q

Management of blepharitis

A
  • eyelid hygiene: clean with mild soap (eyescrub solution), gentle lid massage, warm compress
  • topical chloramphenicol erythromycin or bacitracin ointment if does not respond to eyelid hygiene
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14
Q

Causes and clinical features of acute viral conjunctivitis

A

Cause: adenovirus

Clinical features:
- conjunctival with/without chemosis and follicles
- mild photophobia
- eyelid edema with/without tender pre auricular lymphadenopathy
- pseudomembrane formation

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15
Q

Complication of acute viral conjunctivitis

A

Keratitis

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16
Q

Management of acute viral conjunctivitis

Study These Flashcards
A
  • spontaneous resolution within 2-3 weeks with supportive topical eye drops (artifical tears)
  • pseudomembrane and keratitis may require topical steroid under supervision of ophthalmologist
17
Q

Signs of acute viral conjunctivitis

Study These Flashcards
A
  • conjunctiva injection
  • pseudomembrane formation
  • follicles at tarsal membrane
18
Q

Acute bacterial conjunctivitis
Causes
Clinic features
Complication

Study These Flashcards
A

Causes
- s pneumonia
- s aureus
- h influenza

Clinical features
- mucopurulent discharge with eye redness
- eyelid edema with/without tender pre auricular lymphadenopathy
- conjunctival injection with/without chemosis

Complication
- corneal ulceration/ perforation

19
Q

Acute bacterial conjunctivitis
- investigation
- management

Study These Flashcards
A

Investigation
- swab c&s, PCR

Management
- none self limiting
- topical antibiotics: CMC, gentamicin
- oral antibiotics; ceftriaxone for gonococcal
- artificial tears

20
Q

Causes of allergic conjunctivitis

Study These Flashcards
A
  • acute allergic
  • seasonal or perennial
  • VKC
  • giant papillary conjunctivitis
21
Q

Clinical features of allergic conjunctivitis

Study These Flashcards
A
  • itchiness, watery or mucus discharge and chemosis
  • papillary hypertrophy
  • limbitis: trantas dots in VKC
  • keratitis: ‘shield ulcer’
22
Q

allergic conjunctivitis
- diagnosis
- management

Study These Flashcards
A

Diagnosis
- clinical
- skin prick test

Management
- avoidance
- topical antihistamines and mast cell stabilizers: olapantadine, sodium cromoglycate
- oral antihistamines
- ophthalmology referral: topical steroids, topical immune modulators

23
Q

Types of dry eye

Study These Flashcards
A

Aqueous deficiency
- sjogren syndrome
- primary: not associated with CTD
- RA, SLE, PAN
- non sjogren syndrome
- primary: age related
- secondary: sarcoidosis, amyloidosis, tb

Evaporative state
- intrinsic causes: meibomian gland ds, low blink rate
- extrinsic causes: keratoconjunctivitis, prolonged contact lens wear -> giant papillary conjuctivitis

24
Q

Dry eye
- Clinical features
- investigation
- management

Study These Flashcards
A

Clinical features
- burning, stinging, tearing
- sandy sensation
- blurring of vision
- light sensitivity

Investigation
- tear osmolarity (raised)
- cornea sensation
- schirmer test
- sjo test

Management
- artificial tears
- warm compression
- eyelash scrubs

25
Corneal abrasion - causes - clinical features - management
Causes Extrinsic: mechanical trauma, foreign bodies, contact lens wear, chemical burns Intrinsic: corneal dystrophy - recurrent corneal erosion Clinical features - eye redness with pain, foreign body sensation - blurring of vision, photophobia, watery discharge - conjunctival injection Mx - eye pad - prophylaxis topical abx - oral vitamin c - pain relief
26
Bacterial keratitis - Causes - Risk factors - Clinical features - Complication
Causes: pseudomonas aeruginosa, staph aureus RF: contact lens user, trauma, ocular surface ds Clinical features: painful red eye with/without mucopurulent discharge, hypopyon, conjunctival injection with/without chemosis Complication: corneal thinning, scar, perforation
27
Bacterial keratitis - Investigation - Management
Ix: corneal scraping for gram stain and C&S Mx: - topical abx: fortified gentamicin - cyclopegic/mydriatic: cyclopentoate In corneal perforation: corneal patch with acrylic glue, therapeutic penetrating keratoplasty
28
Causes of fungal keratitis
Yeast: candida Filamentous: fusarium
29
Fungal keratitis Risk factors Clinical features Investigation Mx
RF - eye contact with vegetative material, immunocompromised, DM Clinical features - eye redness with discharge - conjunctival injection with or without chemosis - corneal infiltrate: feathery and satellite lesion (candida) Complications - corneal ulceration Ix - corneal scraping and mucopurulent discharge for gram and geimsa stains) - sabaroud dextrose agar for C&S Mx - topical antifungal; amphotericin - systemic fungal: fluconazole Surgery: - corneal perforation: surgical corneal patch - progressive infection: therapeutic penetrating keratoplasty
30
Acanthamoeba keratitis RF Clinical features Complication Investigation Management
RF - contact lens use while swimming/bathing - trauma Clinical features - eye redness, blurring of vision - watery discharge - eye pain - ring stromal infiltrate/ulcer Complication - corneal ulcer and perforation Investigation - microbiology: corneal scrapping in E coli enriched non nutrient culture agar - microscopy: corneal confocal miscroscopy Mx - corneal debridement if epithelial defect absent - topical amoebicides: polyhexamethylene biguanide
31
Viral keratitis Cause Clinical features Cx Ix Mx
Cause - herpes simplex type 1/2, herpes zoster Clinical features - eye redness - blurring of vision - conjunctival injection - dendritic corneal ulcer Complication - stromal keratitis - corneal scarring Ix - corneal scrapping in transport media - anterior chamber tap for culture - PCR study Mx - corneal debridement (epithelial defect absent) - antiviral - corneal transplant Supportive - artificial tears - topical steroid
32
Types of scleritis
Non infectious - Malignancy: conjunctival tumours - autoimmune ds: RA, systemic vasculitis - medication s/e: bisphosphonates (osteoporosis) Infectious - virus - bacteria - fungi - parasites
33
Scleritis Clinical features Ix Mx
Clinical features - eye redness with deep eye pain - tender on touch - scleral thinning Ix - uveitic screening; FBP, Rh factor, VDRL, CXR, ESR Mx - immune mediated: systemic NSAIDs, corticosteroids, immunosuppressive therapy - infective: antimicrobial tx
34
Acute ant uveitis Clinical features Ix Mx
Clinical features - keratic precipitates - hypopyon - post synechiae Ix - fbc - esr - crp - vdrl Mx - topical steroid - peri ocular & systemic steroids - mydriatic: tropicamide
35
Acute glaucoma RF Clinical features Ix Mx
Rf - female - fam history - age > 40 y/o - shallow ant chamber Clinical features - sudden painful unilateral blurring of vision - haloes - mid dilated pupil - raised IOP - gaukomflecken Ix - gonioscopy: types of glaucoma - U/s biomicroscopy - ant segment OCT Mx - medical: anti glaucoma eyedrops (b blockers, alpha agonist, carbonic anhydrase inhibitor, prostaglandin analogue) - systemic medication: acetazolamide, mannitol - laser: peripheral iridotomy - surgery: cataract extraction, filtration surgery
36
Preseptal cellulitis vs orbital cellulitis RF Clinical features Ix Mx
Preseptal RF: URTI, Dacrocystitis, hordeolum, impetigo Clinical features preseptal : no proptosis, fever, erythema Orbital cellulitis RF: acute sinusitis, trauma inc orbital fracture, dacrocystitis Orbital cellulitis clinical features: proptosis, diplopia, pain on ocular movement, fever Investigation for both; CT scan orbit & paranasal sinuses, MRI Mx for both; IV antibiotics (ceftriaxone, ceftazidime), surgical drainage
37
Endophthalmitis Types clinical features Ix Mx
Types Exo: post op, traumatic Endo: immunosuppressive, procedures, systemic infection Clinical features: reduce visual acuity, RAPD positive, eyelid swelling, chemosis, hypopyon Ix: B scan us, AC, vitreous tap for C&S Mx: intravitreal abx (ceftazidime, vancomycin), topical and systemic abx, pars plana vitrectomy

Ophthal (9 decks)

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