Red Eye Flashcards
Scleritis, Episcleritis, Keratitis, Endophthalmitis, Blepharitis, Styes and chalazions (75 cards)
1
Q
What is scleritis?
A
Full thickness inflammation of the sclera; more serious than episcleritis
2
Q
Besides systemic conditions, what other causes can lead to scleritis?
A
Surgery and infections
3
Q
Does scleritis cause pain or not? How does this help differentiate it from episcleritis?
A
Scleritis causes severe, disruptive pain (often waking the patient at night), whereas episcleritis usually does not cause pain
4
Q
What type of vision changes are typical in scleritis?
A
Reduced visual acuity can occur
5
Q
What are key features of scleritis pain?
A
- Severe pain that worsens over days
- Pain worsened by eye movement
- Tenderness on palpation of the eye
6
Q
What symptom related to pupil response is seen in scleritis?
A
Abnormal pupil reaction to light
7
Q
Why is scleritis considered more serious than episcleritis?
A
Because it involves full thickness inflammation of the sclera and can threaten vision
8
Q
Which sign differentiates scleritis from episcleritis on clinical examination?
A
Pain in scleritis
9
Q
What treatment is used for scleritis management?
A
Oral NSAIDS
10
Q
Scleritis is associated with what systemic diseases?
A
(1) RA
(2) Granulomatosis with polyangiitis
(3) Infections such as Herpes zoster and syphilis
11
Q
What is episcleritis?
A
Inflammation of the episclera, the thin vascular sheet which lies between the conjunctiva and sclera; more superficial and less severe than scleritis
= Usually idiopathic, if no clear cause will be self-limiting
12
Q
If the redness blanches with 10% phenylephrine, what does this mean?
A
The inflammation is episcleritis (superficial vessels constrict)
If it does not blanch, it suggests scleritis (deeper, non-constricting vessels)
= more serious
13
Q
What is episcleritis symptoms?
A
(1) Typically not painful, but there can be mild pain
(2) Segmental redness
= rather than diffuse
(3) There is usually a patch of redness in the lateral sclera
(4) Foreign body sensation
(5) Dilated episcleral vessels
(6) Watering of the eye
(7) No discharge
14
Q
Ulcerative colitis is associated with what eye disease?
A
Episcleritis
15
Q
What is Keratitis?
A
Inflammation of the cornea
16
Q
What are the common clinical features of keratitis?
A
- Photophobia
- Severe ocular pain
- Foreign body sensation
- hypopyon
17
Q
What is hypopyon?
A
Aggregation of inflammatory cells in the anterior chamber of the eye, seen as sediment inferiorly
18
Q
What additional test is needed in suspected Acanthamoeba keratitis?
A
Culture of the contact lens
19
Q
What organisms commonly cause bacterial keratitis?
A
Both Gram-positive and Gram-negative bacteria
20
Q
What is a major risk factor for bacterial keratitis?
A
Contact lens wear or existing corneal pathology
21
Q
How is bacterial keratitis managed?
A
- Hospital admission for hourly antibiotic eye drops and daily review
- Common antibiotics include Ofloxacin (for gram-negatives), Gentamicin and Cefuroxime (for gram-positive and gram-negative bacteria)
22
Q
What causes herpetic keratitis?
A
HSV
23
Q
What are the clinical features of herpetic keratitis?
A
- Very painful
- Often recurrent
- With ragged dendritic ulcers on the cornea
- Reduced corneal sensation over time
24
Q
How is herpetic keratitis treated?
A
Topical antiviral drops (ganciclovir).
= Steroids are contraindicated as they can cause corneal melt and perforation
25
What virus causes adenoviral keratitis?
Adenovirus
26
How does adenoviral keratitis typically present?
1. Bilateral eye involvement
2. Often, after upper respiratory infection or conjunctivitis, it may affect vision
27
How is adenoviral keratitis managed?
Usually supportive; steroids may be used if keratitis becomes chronic to speed recovery
28
What are the key features of fungal keratitis?
1. Chronic symptoms
2. Often in outdoor workers or those with ocular surface disease
3. with more defined corneal lesions and often diagnosed late
29
How is fungal keratitis treated?
With topical antifungal agents
30
What organism causes Acanthamoeba keratitis?
Acanthamoeba
31
Who is most at risk for Acanthamoeba keratitis?
Contact lens wearers
32
How does Acanthamoeba keratitis present?
Extremely painful, often diagnosed late
33
What is the management of Acanthamoeba keratitis?
Anti-amoebic eye drops
34
What is Endophthalmitis?
Devastating infection inside the eye that threatens sight (entire globe) - infection of the entire eye
35
What is the cause of endophthalmitis?
Post-surgical or endogenous or by Staph. epidermidis
36
Describe the clinical presentation of endophthalmitis
1. Very painful
2. Decreasing vision
3. Very red eye
37
What is the management for endophthalmitis?
Intravitreal
1. Amikacin
2. Eftazidime
3. vancomycin
+ topical antibiotics
38
What is blepharitis?
A common chronic inflammatory condition affecting the margin of the eyelids
39
Which age group most commonly develops blepharitis?
Usually middle-aged adults, but it can occur at any age
40
What distinguishes anterior blepharitis?
Inflammation of the base of the eyelashes on the anterior eyelid margin
41
What are the two main causes of anterior blepharitis?
Staphylococcal bacterial infection and seborrhoeic dermatitis
42
How does seborrhoeic blepharitis differ from staphylococcal blepharitis?
Seborrhoeic causes less inflammation but is more oily + greasy scaling
43
What are the common symptoms of blepharitis?
1. Burning
2. Itching
3. Crusting of eyelids
4. Worse in the mornings
5. Both eyes are affected
6. Recurrent styes -hordeola
7. Contact lens intolerance
44
What is posterior blepharitis?
Inflammation of the meibomian glands on the posterior eyelid margin, also known as meibomian gland dysfunction
45
What is the function of the meibomian glands?
To produce the lipid layer of the tear film
46
What is the clinical sign of anterior blepharitis?
Redness at the lid margin (anterior part) more than deeper eyelid tissue
47
What is the clinical sign of posterior blepharitis?
Redness in the deeper part of the lid with often normal lid margin
48
What complications can arise from blepharitis?
1. Stye - hordeolum
2. Chalazion - painless lump on the eyelid from a blocked oil gland
49
What is the first-line management for blepharitis?
Warm compresses and eyelid hygiene
50
How is anterior blepharitis treated if hygiene and compresses fail?
Topical chloramphenicol
51
How is posterior blepharitis treated if first-line measures fail?
Oral doxycycline
52
Why might patients with blepharitis experience contact lens intolerance?
Due to eyelid inflammation and altered tear film quality
53
What is a stye?
Acute localised infection or inflammation of the eyelid margin, usually caused by staphylococcal infection
= They are typically described as a ‘red hot lump’ that points outwards, they cause pain and local inflammation
54
A 35-year-old male presents to the clinic with a painful swelling on his right upper eyelid that developed over the past three days. He describes it as a small, tender lump near the edge of the eyelid.
On examination, you note a 4 mm in diameter lesion located at the eyelid margin. It is slightly red, swollen and tender to touch. There is no significant discharge from the lesion, but mild crusting is noted on the eyelashes. There is no significant warmth or spreading redness around the eye.
His vision is unaffected, and there is no history of similar lesions or trauma to the eye. Given the above, what is the likely diagnosis?
Stye
55
An 18-year-old female presents to the GP Practice with a swelling in her left eyelid. She has noticed the swelling has grown over the week and has become worried about the cosmetic appearance
What clinical feature suggests the swelling is a stye as opposed to a chalazion?
Lash follicle swelling
56
What is the main difference between a chalazion and a stye
Chalazion are non tender
57
'Palpation of the nodule leads to the production of an oily discharge'
This suggests what?
Chalazion
58
A 33-year-old woman presents to her GP with a solitary, non-tender nodule located within the tarsal plate of her right upper eyelid. It has been steadily increasing in size over the last 2 weeks. She has not experienced any changes in her vision
Given the likely diagnosis, what is the most appropriate management?
Warm compress
= A chalazion forms due to blockage of the oil producing Meibomian glands located in the tarsal plate
59
A 40-year-old female presents to Eye Casualty complaining of a painful red eye. She noticed the symptoms on waking this morning and throughout the day has had difficulty looking at bright lights.
Her vision is unaffected, but she reports the pain is worsened by eye movement. She has no medical history and wears no visual aids.
On examination, you note hyperaemia and normal pupillary reflexes.
What is the most likely diagnosis?
Scleritis
60
'Topical 10% phenylephrine is applied to the eye, which transiently resolves the redness'
This suggests what?
Episcleritis
61
A 32-year-old contact lens wearer presented with a painful red eye and photophobia. Examination revealed a corneal ulcer with a hypopyon.
What is the most likely causative organism?
Pseudomonas aeruginosa
62
A 30-year-old Afro-Caribbean female presents to the GP practice complaining of a unilateral red, painful right eye.
On examination, she is non-compliant with eye movements, reporting they are too painful to perform; however, visual acuity is normal. The GP incidentally notes a symmetrical erythematous rash across both cheeks
Given the most likely diagnosis, what is the most appropriate management option?
Scleritis
= Oral NSAID - ibuprofen
63
A 41-year-old male presents to A&E with excruciating pain in his left eye. He says that the pain started when he woke up, and he is having trouble looking at bright lights
Fluorescein staining of his eye reveals multiple small branching epithelial dendrites on the surface of the cornea.
Which is the best management option for this patient?
Herpes Simplex Keratitis
= Topical aciclovir
64
A 21-year-old male comes to the eye casualty with a red, painful eye. He has a past medical history of Crohn's disease. On slit lamp examination with fluorescein dye, dendritic corneal lesions are seen
Given the likely diagnosis, what is the most appropriate management?
Topical aciclovir eye drops
65
A 24-year-old male presents to the GP Practice complaining of a painful left eye. He reports that the pain started last night when he accidentally scratched his eye while taking his contact lens out
He has since found it difficult to look at bright lights and has noticed his vision is ‘blurry’. He has no medical history and is a contact lens wearer. The patient reports good contact lens hygiene and never uses tap water to clean his lenses
On examination, you note hyperaemia and a white deposit on the cornea.
Which is the single most appropriate initial management?
Urgent specialist referral
= This person has Bacterial keratitis
66
What is the hallmark feature of Bacterial keratitis?
hyperaemia and a white corneal infiltrate or opacity
67
A 24-year-old woman presents to the Emergency Department with a painful, red left eye over the past few hours. She also complains of photophobia and a foreign body sensation. She admits to wearing contact lenses in the shower and when swimming. Examination on the slit-lamp with fluorescein staining shows a dendritic corneal ulcer
What is the most likely causative agent contributing to this patient's symptoms?
Herpes Simplex Virus type 1 (HSV-1)
68
What is the hallmark feature of herpes simplex virus (HSV) keratitis?
Dendritic corneal ulcer
69
A 25-year-old man presents to A&E with a 1-day history of a painful red eye, photophobia, and excessive tearing. He reports that it feels as though there is something in his eye. Slit lamp investigation with fluorescein staining reveals a branching, linear pattern, which fluoresces bright green under the dye
Given the likely diagnosis, what is the most appropriate initial management?
Topical acyclovir
70
What is the hallmark feature of Acanthamoeba keratitis?
Severe pain that is disproportionate to clinical signs
71
A 28-year-old myopic man attends the eye casualty with an acutely painful red right eye. His corrected visual acuity is 6/6 on the left and 6/60 on the right.
On examination, the left eye is normal, but on the right eye, there is evidence of a central corneal ulcer with associated ciliary injection and a small hypopyon in the anterior chamber. He normally wears soft contact lenses and admits to washing them in the sink between uses
What is the most likely diagnosis?
Acanthamoeba keratitis
= most associated with washing contacts in water/ sink
72
A 76-year-old woman who is two days post op following a cataract operation presents to the emergency department with severe eye pain and visual loss in her right eye
On examination, the eye is red with ciliary injection, corneal oedema, and an absent red reflex
What is the most likely diagnosis?
Bacterial endophthalmitis
73
A 37-year-old male attends their GP complaining of swollen and itchy eyes. On examination, there is no conjunctival injection, but you note a crusty appearance at the base of the eyelashes
Given the most likely diagnosis, what is the best management for this patient?
Conservative management
= Patients are advices to apply warm compressed twice daily to clean debris from their eyelids
74
A 76-year-old man presents 4 days after cataract surgery to his right eye with a painful red right eye
On examination, he has a severely injected conjunctiva and a white fluid level in the anterior chamber. What is the most likely diagnosis?
Endophthalmitis
75
A 70-year-old male presents to the Accident & Emergency with an acutely painful red eye with blurred vision that began the same morning. He has a history of bilateral cataracts for which he underwent surgery 4 weeks ago.
On examination, there is conjunctival injection in the right eye. Slit lamp examination reveals a hypopyon. Visual acuity is reduced to counting fingers in the right eye
Which of the following is the most likely diagnosis?
Endophthalmitis
