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Red Eye Flashcards

(50 cards)

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1
Q

What are the key features of a red eye history?

A 
Duration
One eye or both
Photophobia
VISUAL LOSS
DISCHARGE
PAIN
Past medical history
Contact lenses?
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2
Q

How should visual loss be interpreted in the context of a red eye?

A

Mild/moderate loss –> common, especially with watering/discharge
Severe loss –> urgent referral

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3
Q

What would a scratchy/gritty pain suggest in the context of a red eye?

A

External/surface problem –> look at lids, conjunctiva, cornea

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4
Q

What would a deep aching pain suggest in the context of a red eye?

A

Intra-ocular/orbital pathology

e.g. iritis, scleritis, angle closure glaucoma

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5
Q

What should be checked first on examination of a red eye?

A

Visual acuity

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6
Q

What are you looking for on examination of the eyelids?

A

Any lid malposition e.g. entropion or ectropion

Foreign body under lid

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7
Q

What is is the difference between an entropion and an ectropion?

A

Entropion –> lid curled in

Ectropion –> lid curled out

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8
Q

What are you looking for on examination of the conjunctiva?

A

Distribution of redness

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9
Q

What does the distribution of redness tell you?

A

If redness greatest in conjunctival fornices (inside lids) –> likely surface infection or lid disease
If redness greatest around cornea –> likely intra-ocular problem (more severe)

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10
Q

What is another term for redness around the cornea?

A

Circumcorneal injection

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11
Q

How do you examine for corneal abrasions/ulcers?

A

Use fluorescein blue dye + blue light

–> stains any epithelial defect and fluoresces ulcer blue light

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12
Q

What is the name for inflammation of the eyelids?

A

Blepharitis

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13
Q

What are the different types of blepharitis?

A

Anterior:

  • seborrhoeic (squamous)
  • staphylococcal

Posterior:
- meibomian gland disease

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14
Q

How can you tell the difference between anterior and posterior blepharitis?

A

Anterior –> lid margin redder than deeper part of lid, lashes affected
Posterior –> redness in deeper lid, lid margin skin + lashes unaffected

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15
Q

What are the features of seborrhoeic blepharitis?

A

Red lid margin
Scales/dandruff
No ulcers, lashes not affected

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16
Q

What are the features of staphylococcal blepharitis?

A

Infection of lash follicle

  • red lid margin
  • lashes distorted, loss of lashes
  • trichiasis (ingrowing lashes)
  • styes
  • ulcers of lid margin
  • corneal stringing, marginal ulcers
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17
Q

What are the features of Meibomian gland disease?

A

Redness in deeper lid
Gland openings pouting + swollen
Dried secretions at gland openings
Meibomian cysts (chalazia)

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18
Q

Which condition is Meibomian gland disease associated with?

A

Acne rosacea

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19
Q

What is the management of blepharitis?

A

Lid hygiene - daily bathing/warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
(very difficult to eradicate)

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20
Q

What are the different types of conjunctivitis?

A 
Bacterial
Viral 
Follicular (chlamydial)
Allergic
Chemical/drugs
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21
Q

What are the clinical features of bacterial conjunctivitis?

Study These Flashcards
A 
Red sticky eye
Purulent discharge
Gritty discomfort
Mild chemosis (oedema)
Papillae
Usually bilateral but starts in one eye
22
Q

How is bacterial conjunctivitis managed?

Study These Flashcards
A

Topical chloramphenicol

23
Q

What are the features of viral conjunctivitis?

Study These Flashcards
A 
Often bilateral
Watery discharge
Moderate chemosis
Gritty/burning
Pre-auricular lymph nodes
24
Q

What is the management of viral conjunctivitis?

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A

Supportive –> cool compresses/lubricants

25
What are the causes of follicular conjunctivitis?
Chlamydia Viruses e.g. adenovirus, herpes simplex, herpes zoster Drugs e.g. propine, trusopt
26
What are the features of chlamydia conjunctivitis and how should it be managed?
Follicular conjunctivitis in young patient Usually unilateral --> chlamydia PCR swab + GUM referral
27
What is corneal inflammation called?
Keratitis
28
What are the causes of corneal ulcers?
Infective (central): - viral - fungal - bacterial - acanthamoeba Autoimmune (peripheral): - RA - hypersensitivity
29
What are the symptoms of a corneal ulcer?
Pain - severe, needle-like Photophobia Reduced vision Profuse lacrimation
30
What might be seen on examination of a corneal ulcer?
``` Circumcorneal redness Abnormal corneal reflex Corneal opacity Staining with fluorescein Hypopyon ```
31
What is a hypopyon?
Pus in the anterior chamber
32
What are the risk factors for a bacterial corneal ulcer?
Corneal abrasion Contact lenses Dry eye Iatrogenic
33
Which investigation should be done for a suspected bacterial corneal ulcer?
Corneal scrape to determine cause e.g. staph/strep
34
How is bacterial corneal ulcer treated?
Hourly Ofloxacin (topical antibiotic)
35
What is characteristic about a herpetic corneal ulcer?
Dendritic ulcer
36
How is a herpetic ulcer treated?
Topical aciclovir 5x a day for 7-10 days
37
Which treatment should be avoided in herpetic ulcers and why?
DO NOT use topical steroids | --> geographic corneal ulcer
38
What is anterior uveitis?
Inflammation of iris (iritis) and ciliary body
39
What are the symptoms of anterior uveitis?
Ache Photophobia Lacrimation Blurred visual acuity
40
What are the signs of anterior uveitis?
Circumcorneal redness Cells/flare in the anterior chamber Hypopyon if severe Small/irregular pupil (posterior synechiae)
41
Why should anterior uveitis be investigated if chronic or recurrent?
Strong association with HLA-B27 conditions | --> ankylosing spondylitis, IBD, psoriatic arthritis, Reiter's
42
How is anterior uveitis treated?
Topical steroids --> pred forte 1% hourly
43
Which is worse; episcleritis or scleritis?
Scleritis
44
What are the features of episcleritis?
Mild discomfort | Localised, superficial injection on sclera
45
What are the features of scleritis?
Severely painful | Diffuse, deep redness with 'violaceous hue'
46
Which test can be done to tell the difference between scleritis and episcleritis?
Apply topical phenylephrine - redness blanches in episcleritis - does not blanch in scleritis
47
Which conditions is scleritis associated with?
Connective tissue diseases e.g. RA, GPA
48
What is the treatment for episcleritis?
Topical lubricants or NSAIDs
49
What is the treatment for scleritis?
Oral NSAIDs/steroids | Immunosuppression if necrosis
50
Which type of glaucoma presents with a red eye?
Acute angle closure glaucoma | --> ophthalmic emergency

Ophthalmology (12 decks)

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