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red eye Flashcards

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1
Q

itching symptom?

A

allergy

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2
Q

srcatchiness/burning

A

assess lid, cornea
foreign body
dry eye
inward eyelash

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3
Q

localised lid tenderness

A

hordeolum

chalazion

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4
Q

deep intense pain

A

corneal abrasions

scleritis, ant uveitis, acute glaucoma, sinusitis

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5
Q

photphobia

A

corneal abrasions, iritis, acute glaucoma

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6
Q

halo vision

A

corneal oedema (acute glaucoma, contact lens overwear)

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7
Q

ciliary flush

A

injection of deep conjunctival vessels and episcleral vessels
surrounding the cornea.

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8
Q

ciliary flush sign seen in what conditions

A

iritis, scleritis or acute glaucoma

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9
Q

what is conjunctival heamorrhage

A

engorgement of more superficial vessels.

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10
Q

diseases of the lids

A

Blepharitis

  1. Marginal keratitis
  2. Trichiasis
  3. Chalazion/ Stye
  4. Sub-tarsal foreign body
  5. Dacrocystitis
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11
Q

disease of the conjunctiva

A

Bacterial conjunctivitis

  1. Gonococcal conjunctivitis
  2. Chlamydial conjunctivitis
  3. Viral conjunctivitis
  4. Allergic conjunctivitis
  5. Subconjunctival haemorrhage
  6. Episcleritis vs Scleritis
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12
Q

diseases of the cornea

A

Bacterial keratitis

  1. Herpetic keratitis
  2. Foreign body
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13
Q

symptoms of blepharitis

A

worse in the morning

Foreign body sensation/ gritty

sticky in the morning

eyelid margins red

Itching

  1. Redness
  2. Mild pain
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14
Q

what is blepharitis

A

inflammation of lid margin

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15
Q

characteristics of belpharitis

A
  • lid crusting
  • redness
  • telangectasia
  • misdirected lashes
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16
Q

whats ass with blepharitis

A

styes

conjuctivitis

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17
Q

treatment for blepharitis

A

hot water compression with massage of eyelids

topical ABx chloramphenicol -ANTERIOR BELPHARITIS
oral tetracycline - POSTERIOR blepharitis

lubricants

BAD
doxycycline - no pregnant lady or childre

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18
Q

complication of blepharitis

A

marginal keratitis

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19
Q

what is marginal keratitis

A 
Associated with chronic
staphylococcal blepharitis
► Hypersensitivity to
staphylococcal exotoxins
► Subepithelial marginal
infiltrate separated from
the limbus by a clear zone
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20
Q

signs of marginal keratitis

A

Foreign body sensation
pain

white ulcers in cornea
lacrimation
red eye

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21
Q

treatment for marginal keratitis

A

Short course of topical low
dose steroids
► Treat associated
blepharitis

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22
Q

what is trichiasis

A

Inward turning lashes

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23
Q

aetiology of trichiasis

A

Aetiology: Idiopathic/ Secondary to chronic
blepharitis, herpes zoster
ophthalmicus

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24
Q

symptoms of trichiasis

A

foreign body

sensation, tearing

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25
Tx for trichiasis
``` Lubricants 2. Epilation 3. Electrolysis- few lashes 4. Cryotherapy- many lashes ``` whole eyelid - eyelash reposition
26
what is internal hordeolum
acute chalazion infection to the meiobian gland
27
signs of internal hordeolum
Tender nodule within the tarsal plate ► May be associated cellulitis
28
Tx for internal hordeolum
Hot compresses 2. Topical antibiotic ointment 3. Incision and drainage once the infection subsided
29
what is external hordeolum
stye Staphylococcal abscess of lash follicle and it’s associated gland of Zeiss or Moll
30
signs of external hordeolum
Tender nodule in the lid margin pointing through the skin
31
Tx for stye or external hordeolum
Hot compresses 2. Epilation of lash associated with the infected follicle 3. Topical antibiotic ointment
32
causes of bacterial conjunctivitis
- Staph aureus - Staph epidermidis - Strep pneumoniae - Haemophilus influenzae
33
symptoms of bacterial conjunctivits
1. Subacute onset 2. Redness 3. Grittiness 4. Burning 5. Mucopurulent discharge 6. Often bilateral 7. No photophobia
34
signs of bacterial conjunctivits
Crusty lids 2. Conjunctival hyperaemia 3. Mild papillary reaction 4. Lids and conjunctiva may be oedematous
35
Tx for bacterial conjunctivitis
Topical antibiotics effective in 2 to 7 days (except in very severe infections) Chloramphenicol or fusidic acid use if pregnant appropriate first-line treatment
36
causes chalmydial conjunctivitis
``` Veneral infection- Chlamydia trachomatis serotypes D to K ► sexually active adolescents/ adults (+/- genital infection) ► chronic with a mild keratitis ```
37
symptoms/signs of chlamydial conjunctivitis
- Usually unilateral - FB sensation - Lid crusting with sticky discharge - follicles - No response with topical antibiotics
38
Ix for chlamydial conjunctivitis
1. Direct monoclonal fluorescent antibody microscopy 2. PCR
39
treatment for chlamydial conjunctivitis
topical tetracycline/ oral doxycycline/ azithromycin
40
aetiology of viral conjunctivitis
- adenoviral - Adenovirus types 3, 4 and 7 -pharyngoconjunctival fever (PCF) Adenovirus types 8 and 9 - epidemic keratoconjunctivitis
41
symptoms of viral conjunctivitis
- Acute onset - serous discharge - Bilateral - Watery discharge - Soreness, FB sensation - Often no photophobia - History of URTI - periauricular lymph nodes
42
associations of viral conjunctivitis
``` ►Follicles ►Haemorrhages ►Inflammatory membranes ►Lymphadenopathy (esp preauricular node) ►Keratitis occurs on 80% with EKC and 30% PCF ```
43
treatment for viral conjunctivitis
- No specific therapy, self resolving, up to two weeks - Advice (very contagious) - Topical steroids for keratitis if risk of scarring
44
symptoms/signs of allergic conjunctivits
- Itch++ - Bilateral - Watery discharge - Chemosis (oedema) - Papillae (can be giant `cobblestone’ in chronic cases
45
Ix for allergic conjucntivitis
``` Exclude infection (generally viral is NOT itchy) IgE levels ? Patch testing ```
46
treatment for allerfic conjunctivitis
- cold compresses - remove (reduce) allergen - NSAIDS - antihistamines oral/ topical (olapatanol) - mast cell stabilizers (sodium cromoglycate) - topical corticosteroids Immunosuppressants (cyclosporin) for steroid resistant cases
47
what is spontaneous subconjunctival heamorrhage
Painless red eye without | discharge
48
what is epsicleritis
episcleral inflammation - more superficial
49
how to differentiate between episcleritis v scleritis
phenylepihrine drops | - constrict blood vessels as episcleral is superficial one drop would make the eye white unlike scleritis
50
symptoms/signs episcleritis
``` Often asymptomatic Mild tearing/ irritation Tender to touch Vessels blanch with phenylephrine - no visual distubance ```
51
Tx for episcleritis
- Lubricants - NSAIDS (Froben po 100mg tds) Rarely low dose steroids (predsol)
52
define scleritis
Scleral inflammation with maximal | congestion in the deep vascular plexus
53
symptoms/signs of scleritis
``` Pain (often severe boring) Significant ocular tenderness to movement and palpation Watering and photophobia Appearance bluish-red ► Localized ► Diffuse ► Nodular ``` pallor within the area of redness -> ischaemia
54
aetiology of scleritis Ix
- usually immune rather than infectious - 30-60% associated systemic disease- connective tissue disease - Most commonly with rheumatoid arthritis SLE, HZO ``` Ix - RF ANA ANCA ESR CRP Plasma Viscosity ```
55
Tx for scleritis
- underlying condition - NSAIDs - topical corticosteroids + lubricants - oral steroids - immunosuppresive therapy
56
what is pterygium
Fibrovascular growth from the conjunctiva onto the cornea
57
Tx for
1) Excision of pterygiumcovering of defect with a conjunctival autograft or amniotic membrane 2. Adjuvant mitomycinreduce recurrence
58
corneal abrasion/foreign body
Severe pain esp with blinking | ► Watering ++
59
causes of bacterial keratitis
- Staph aureus - Strep pyogenes - Strep pneumonia - Pseudomonas aeruginosa
60
risk factors for bacterial keratitis
1. Contact lens wear- extended wear soft lenses ``` 2. Pre-existing chronic corneal disease e.g. neurotrophic keratopathy ► NB small 2 mm ulcer can rapidly spread ► Rare with hard lenses ```
61
symptoms of bacterial keratitis
- Ocular pain - Watering & discharge - Foreign body sensation - Decreased vision - Photophobia
62
signs of bacterial keratitis
- Corneal lesion (ulcer) may be visable - Corneal oedema - hypopyon
63
Ix for bacterial keratitis
URGENT Ix 1. Blood agar (for most fungi and bacteria except Neisseria) 2. Chocolate agar (for Neisseria and Moraxella) 3. Sabourand agar (for fungi)
64
treatment for bacterial keratitis
Ofloxacin Regime 1. Initially hrly 2. Subsequently 2 hourly (waking hours) ``` 3. Tapered ► Cyclopentolate tds ► Steroids when cultures become sterile and evidence of improvement (7-10 days after initiation of treatment) ```
65
what is herpes simplex keratitis
► Reactivation of latent herpes simples virus type 1 ► Migrates down branch of the trigeminal nerve to cornea
66
history of HS keratitis patient
Hx Cold sores Run down, stress
67
symptoms of HS keratitis
``` red, painful eye photophobia epiphora visual acuity may be decreased fluorescein staining may show an epithelial ulcer - Tearing - Light sensitivity - epithelial layer damaged - Pain, hyperaemia ```
68
signs of HS keratitis
- Corneal sensation reduced - Dendritic ulcer - Geographic amoeboid ulcer esp if incorrect use of steroid
69
treatment for HS keratitis
- Topical aciclovir ointment 5X/day 10-14 days - Cyclopentolate ``` - (1st episode aciclovir 400mg po tds 10-21 days, 400mg bd prophylaxis for up to 1 year) (topical steroids- to minimize scarring) ```
70
signs of herpes zoster patient
``` Crusting and ulceration of skin innervated by 1st division of trigeminal nerve ► Lesions to tip of noseHutchinson’s sign, increased chance ocular involvement ```
71
treatment for herpes zoster
immediate referral to an ophthalmologist Oral aciclovir within 48hrs of onset of vesicles 800mg 5x day for 7 days (No effect if later) 2. Aciclovir ointment within 5/7
72
differentiate between preseptal cellulitis and orbital cellulitis
``` the orbital septum - fibrous membrane that originates from the orbital periosteum and inserts into the anterior surface of the tarsal plate of the eyelid ``` not well developed in children
73
preseptal cellulitis
- Infection of the subcutaneous tissues anterior to the orbital septum
74
postseptal cellulitis
Infection and inflammation within the orbital cavity producing orbital signs and symptoms
75
causes of eye cellulitis
- Bacterial infection usually results from local spread of adjacent URTI ► Preseptal usually follows periorbital trauma or dermal infection ► orbital most commonly secondary to ethmoidal sinusitis
76
causative organisms for preseptal cellulitis
Staphylococcus aureus and Staphylococcus epidermidis
77
causative organisms for postseptal cellulitis
``` Strep pneumoniae and pyogenes, Staph aureus Haemophilus influenzae, anaerobes ```
78
predisposing factors of cellulitis
``` Recent upper respiratory tract infections ► Trauma ► Sinus disease ► Recent dental work or infections ► Systemic symptoms- fever ► CNS symptoms- headache, neck stiffness ```
79
signs of preseptal cellulitis
- Preseptal infection causes erythema, induration, and tenderness of the eyelid ► Amount of swelling may be so severe that patients cannot open the eye ► Patients rarely show signs of systemic illness
80
signs of orbital cellulitis
- Redness and swelling around the eye - Severe ocular pain - Visual disturbance - Proptosis - Ophthalmoplegia/pain with eye movements - Eyelid oedema and ptosis - Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare) - proptosis ► chemosis ► ophthalmoplegia - pain when moving the eye ► decreased visual acuity
81
Tx for pre-septal
Mild preseptal cellulitis: COAMOXICLAV SEVERE OR ORBITAL CEFTRIAXONE augmentin or first generation cephalosporin, warm compresses, topical antibiotics for concurrent conjunctivitis 1. Failure to respond within 48- 72 hours consider iv antibiotics
82
Tx for orbital cellulitis
1. Immediate referral 2. Needs admission for iv antibiotics 3. +/- imaging blood culture, CRP, WBC
83
complications of eye cellulitis
``` Raised Intraocular pressure ► Endophthalmitis ► Optic neuropathy ► Meningitis ► Cavernous Sinus Thrombosis ► Subperiosteal/ orbital infections ```
84
risk factor of steroid eye drops
lead to fungal infections to corneal ulcers
85
features of a corneal ulcer
- eye pain - photophobia watering of eye - focal fluorescein - staining of the cornea
86
signs of blunt trauma
►Mild – moderate “bruise” ocular tissues Eye wall intact ►Moderate – severe Rupture eye wall Very severe consequences
87
signs of lacerating trauma
►“cut” eye wall | ►Outcome depends on extent and location
88
causes of ocular trauma
``` Foreign bodies Corneal abrasions Disruption of globe Intraocular foreign bodies Hyphemas Orbital wall fractures Chemical injury ```
89
acid injuries of eye
Acid burns produce denaturation and coagulation of protein. Acid damage often limited by nuetralization of the buffering action of the tissues ►Damage limited to area of contamination ►Sulfuric and Nitric acids most common ►Usually industrial, but may result from automobile battery explosions
90
alkaline injuries of eye
►Penetrate ocular tissues rapidly and produce intense ocular reactions - lipophilic breaks fatty acids and penetrates and damages tissues - Coagulates proteins -> creates a barrier ►Damage widespread, uncontrolled, and progressive ►Often results in epithelial loss, corneal opacification, scarring, severe dry eye, cataract, glaucoma and blindness conjunctival injection -> ischaemia blanching of vessels
91
treatment for chemical injury
►Instill a drop of topical anesthetic if available (proparicaine) ►Use eye irrigation solutions and normal saline IV drip 1L ►Squeeze copious amounts of solution into the eye and direct towards the temple, away from the unaffected eye 4. Re-check pH, and continue irrigation until pH of 7.0 achieved 5. Evert the upper lids, with double eversion using forceps if possible 6. Sweep deep into upper and lower fornices with cotton bud to remove particles 7. Re-check pH every 15 mins for >1 hour (including under the lids) and irrigate again if not pH 7. Further Mx 1. ABx - topical erythromycin ointment 4x -> provide ocular lubrication and prevent infection 2. atropine/cyclopentolate -> pain relief 3. steroids -> reduce inflammation/prevent corneal breakdown
92
what is hyphema
►Blood in the anterior chamber ►Usually associated with trauma ►Requires emergent referral to an ophthalmologist for treatment
93
treatment for hyphema
``` ► Strict bedrest ► Topical steroids ► Topical cycloplegic agents ► Admit to hospital if young or concerned about follow-up or compliance ► Need daily exams for 5 days including measurement of intraocular pressure ► Sickle-cell prep (patients with sickle cell trait need more aggressive management of elevated intraocular pressures) ```
94
purulent eye discharge in babies what do u do
swabs first
95
aeitiology of blepharitis
eibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis). Blepharitis is also more common in patients with rosacea
96
blunt trauma complication
glaucoma
97
hyphema?
blood in the anterior chamber of the eye
98
what is orbital cellulitis
infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe. It is usually caused by a spreading upper respiratory tract infection from the sinuses and carries a high mortality rate.
99
risk factors for orbital cellulitis
- Childhood - Previous sinus infection - Lack of Haemophilus influenzae type b (Hib) vaccination - Recent eyelid infection/ insect bite on eyelid (Peri-orbital cellulitis) - Ear or facial infection
100
how to differentiate between preseptal and orbital cellulitis
reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
101
Ix for orbital cellulitis
Full blood count – WBC elevated, raised inflammatory markers. Clinical examination involving complete ophthalmological assessment – Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema. CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis. Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.
102
what is keratitis
inflammation of the cornea.
103
causes of keratitis
bacterial typically Staphylococcus aureus Pseudomonas aeruginosa is seen in contact lens wearers fungal amoebic acanthamoebic keratitis accounts for around 5% of cases increased incidence if eye exposure to soil or contaminated water parasitic: onchocercal keratitis ('river blindness') viral: herpes simplex keratitis environmental photokeratitis: e.g. welder's arc eye exposure keratitis contact lens acute red eye (CLARE)
104
features of keratitis
red eye: pain and erythema photophobia foreign body, gritty sensation hypopyon may be seen
105
Mx for Keratitis
``` stop using contact lens until the symptoms have fully resolved topical antibiotics typically quinolones are used first-line cycloplegic for pain relief e.g. cyclopentolate ```
106
complications of keratits
corneal scarring perforation endophthalmitis visual loss
107
referral regarding keratitis
contact lens wearers assessing contact lens wearers who present with a painful red eye is difficult an accurate diagnosis can only usually be made with a slit-lamp, meaning same-day referral to an eye specialist is usually required to rule out microbial keratitis
108
bartolnella henselae
Cat scratch disease - usually causes a neuroretinitis with a classical macular star. May have systemic symptoms and lymphadenopathy.
109
borrelia burgdorferi
Lyme disease - More usually causes a follicular conjunctivitis but may result in a panuveitis. May expect a mention of a target rash (erythema migrans) and systemic symptoms.
110
long term complications of chemical injury
Glaucoma - damage to the trabecular meshwork dry eye - reduce/absent mucus in teat film damage to the eyelids or palpebral conjunctiva

opthamology (16 decks)

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