Red Eye

Question 1

What are the differentials of a painless red eye?

Answer 1

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

Question 2

What are the differentials of a painful red eye?

Answer 2

Glaucoma
Anterior uveitis
Scleritis
Keratitis
Foreign body

Question 3

What are the three types of conjunctivitis and how do they present?

Answer 3

Bacterial: purulent discharge, worse in morning
Viral: raised pre auricular lymph nodes, clear discharge
Allergic: watery discharge and itch

Unilateral or bilateral
Red eye
Gritty sensation
Discharge

Question 4

What is the management of conjunctivitis?

Answer 4

Usually gets better without any treatment in 2-3 weeks.

If bacterial, can give chloramphenicol eye drops.

Question 5

How does a subconjunctival haemorrhage present and what are the causes?

Answer 5

Painless, bright red blood patch (burst blood vessel) between sclera and conjunctiva. Usually idiopathic or due to coughing, sneezing or heavy lifting.

Can cause it:
Hypertension
Bleeding disorders
Whooping cough
Blood thinners
NAI

Question 6

What occurs in anterior uveitis?

Answer 6

Inflammation in the anterior part of the uvea

Neutrophils, lymphocytes and macrophages invade the anterior chamber = floaters

Question 7

What is anterior uveitis associated with?

Answer 7

HLA B27 conditions:
Ankylosing spondylitis
IBD
Reactive arthritis

Question 8

How does anterior uveitis present?

Answer 8

Unilateral symptoms that start spontaneously 
Dull, aching, pain
Ciliary flush
Photophobia (ciliary muscle spasm)
Excessive lacrimation 
Abnormally shaped pupil

Question 9

What can be used to treat anterior uveitis?

Answer 9

Steroids
Cycloplegic-mydriatic medications (e.g. atropine, these dilate and fix the pupil)
Immunosuppresants (DMARDs, TNFi)

Question 10

What is blepharitis?

Answer 10

Inflammation of the lid margins causing chronically irritable red eyes
Red margins or scales will be seen

Use hot compresses, lubricating eye drops and treat with fucithalmic ointment

Question 11

What are complications of contact lens wear?

Answer 11

Corneal abrasion
Allergic reaction
Neovascularisation
Corneal ulcer

Question 12

What are the symptoms of corneal abrasion?

Answer 12

A feeling like there is something in your eye
Pain
Tearing
Redness

Question 13

What is a Stye?

Answer 13

Infection of the glands of Moll (sweat glands at base of eyelashes), glands of Zeis (sebaceous glands at base of eyelashes), infection of the Meibomian glands

Question 14

What is a Chalazion?

Answer 14

When a Meibomian cyst becomes blocked up

Swelling in the eye that is typically not tender

Question 15

What is preorbital cellulitis and how does this present?

Answer 15

Eyelid and skin infection in front of orbital septum (around the eye)
CT scan differentiates between this and orbital cellulitis

Systemic antibiotics

Question 16

What is orbital cellulitis and how does this present?

Answer 16

Infection that involves tissues behind the septum

Differential features: pain on eye movement, reduced eye movements, changes is vision, abnormal pupil reactions

Requires admission and IV antibiotics urgently

Question 17

Describe the pathophysiology of acute angle closure glaucoma

Answer 17

Ciliary epithelium secretes aqueous humor in the posterior chamber
Humor travels to the anterior chamber
Fluid flows out through the trabecular meshwork and into the canal of Schlemm and then into aqueous veins

In acute glaucoma this becomes fully blocked

Increased intraocular pressure causes atrophy of the outer rim of the optic nerve = peripheral vision loss

Question 18

What are the clinical signs of acute angle closure glaucoma?

Answer 18

Optic nerve damage (disc cupping)
Visual field loss (peripheral, and sausage shaped blind spots)
High disc to cup ratio
Abrupt onset of eye pain, redness, blurry vision, headache, halos around yees

Question 19

What is the initial management of acute angle closure glaucoma?

Answer 19

While waiting for an ambulance:
Lie patient on back,
Pilocarpine eye drops (pilocarpine acts on muscarinic receptors and causes pupil to constrict and the pathway to open up)
Acetazolamide 500mg (reduces production of aqueous humor)

Question 20

What are the long term management options that can be used for glaucoma?

Answer 20

Topical prostaglandin (latanoprost): increases outflow of aqueous secretion

Topical B Blockers (timolol), and topical carbonic anhydrase inhibitors (dorzolamide): decrease aqueous humor production

Topical a agonists (brimonidine): decreases aqueous secretion and increases outflow