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opthamology > red eye > Flashcards

red eye Flashcards

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
Q

Tx for trichiasis

A 
Lubricants
2. Epilation
3. Electrolysis- few lashes
4. Cryotherapy- many
lashes

whole eyelid - eyelash reposition

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26
Q

what is internal hordeolum

A

acute chalazion

infection to the meiobian gland

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27
Q

signs of internal hordeolum

A

Tender nodule within the
tarsal plate
► May be associated cellulitis

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28
Q

Tx for internal hordeolum

A

Hot compresses
2. Topical antibiotic ointment
3. Incision and drainage once
the infection subsided

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29
Q

what is external hordeolum

A

stye

Staphylococcal abscess of
lash follicle and it’s
associated gland of Zeiss or
Moll

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30
Q

signs of external hordeolum

A

Tender nodule in the lid
margin pointing through the
skin

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31
Q

Tx for stye or external hordeolum

A

Hot compresses
2. Epilation of lash associated
with the infected follicle
3. Topical antibiotic ointment

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32
Q

causes of bacterial conjunctivitis

A
  • Staph aureus
  • Staph epidermidis
  • Strep pneumoniae
  • Haemophilus influenzae
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33
Q

symptoms of bacterial conjunctivits

A
  1. Subacute onset
  2. Redness
  3. Grittiness
  4. Burning
  5. Mucopurulent discharge
  6. Often bilateral
  7. No photophobia
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34
Q

signs of bacterial conjunctivits

A

Crusty lids

  1. Conjunctival hyperaemia
  2. Mild papillary reaction
  3. Lids and conjunctiva may be oedematous
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35
Q

Tx for bacterial conjunctivitis

A

Topical antibiotics effective in 2 to 7 days (except in very
severe infections)

Chloramphenicol or fusidic acid use if pregnant appropriate first-line
treatment

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36
Q

causes chalmydial conjunctivitis

A 
Veneral infection- Chlamydia
trachomatis serotypes D to K
► sexually active adolescents/
adults
(+/- genital infection)
► chronic with a mild keratitis
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37
Q

symptoms/signs of chlamydial conjunctivitis

A
  • Usually unilateral
  • FB sensation
  • Lid crusting with sticky
    discharge
  • follicles
  • No response with topical
    antibiotics
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38
Q

Ix for chlamydial conjunctivitis

A
  1. Direct monoclonal
    fluorescent antibody
    microscopy
  2. PCR
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39
Q

treatment for chlamydial conjunctivitis

A

topical
tetracycline/ oral
doxycycline/ azithromycin

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40
Q

aetiology of viral conjunctivitis

A
  • adenoviral
  • Adenovirus types 3, 4 and 7
    -pharyngoconjunctival fever
    (PCF)
    Adenovirus types 8 and 9 -
    epidemic keratoconjunctivitis
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41
Q

symptoms of viral conjunctivitis

A
  • Acute onset
  • serous discharge
  • Bilateral
  • Watery discharge
  • Soreness, FB sensation
  • Often no photophobia
  • History of URTI
  • periauricular lymph nodes
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42
Q

associations of viral conjunctivitis

A 
►Follicles
►Haemorrhages
►Inflammatory membranes
►Lymphadenopathy (esp preauricular node)
►Keratitis occurs on 80% with EKC and 30% PCF
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43
Q

treatment for viral conjunctivitis

A
  • No specific therapy, self resolving, up to two weeks
  • Advice (very contagious)
  • Topical steroids for keratitis if risk of scarring
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44
Q

symptoms/signs of allergic conjunctivits

A
  • Itch++
  • Bilateral
  • Watery discharge
  • Chemosis (oedema)
  • Papillae (can be giant
    `cobblestone’ in chronic
    cases
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45
Q

Ix for allergic conjucntivitis

A 
Exclude infection (generally viral is NOT itchy)
 IgE levels ? Patch testing
46
Q

treatment for allerfic conjunctivitis

A
  • cold compresses
  • remove (reduce) allergen
  • NSAIDS
  • antihistamines oral/ topical (olapatanol)
  • mast cell stabilizers (sodium cromoglycate)
  • topical corticosteroids

Immunosuppressants (cyclosporin) for steroid
resistant cases

47
Q

what is spontaneous subconjunctival heamorrhage

A

Painless red eye without

discharge

48
Q

what is epsicleritis

A

episcleral inflammation - more superficial

49
Q

how to differentiate between episcleritis v scleritis

A

phenylepihrine drops

- constrict blood vessels as episcleral is superficial one drop would make the eye white unlike scleritis

50
Q

symptoms/signs episcleritis

A 
Often asymptomatic
 Mild tearing/ irritation
 Tender to touch
 Vessels blanch with phenylephrine
- no visual distubance
51
Q

Tx for episcleritis

A
  • Lubricants
  • NSAIDS (Froben po 100mg tds)
    Rarely low dose steroids (predsol)
52
Q

define scleritis

A

Scleral inflammation with maximal

congestion in the deep vascular plexus

53
Q

symptoms/signs of scleritis

A 
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
Q

aetiology of scleritis

Ix

A
  • 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
Q

Tx for scleritis

A
  • underlying condition
  • NSAIDs
  • topical corticosteroids + lubricants
  • oral steroids
  • immunosuppresive therapy
56
Q

what is pterygium

A

Fibrovascular growth
from the conjunctiva onto
the cornea

57
Q

Tx for

A

1) Excision of pterygiumcovering of defect with a
conjunctival autograft or
amniotic membrane

  1. Adjuvant mitomycinreduce recurrence
58
Q

corneal abrasion/foreign body

A

Severe pain esp with blinking

► Watering ++

59
Q

causes of bacterial keratitis

A
  • Staph aureus
  • Strep pyogenes
  • Strep pneumonia
  • Pseudomonas aeruginosa
60
Q

risk factors for bacterial keratitis

A
  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
Q

symptoms of bacterial keratitis

A
  • Ocular pain
  • Watering & discharge
  • Foreign body sensation
  • Decreased vision
  • Photophobia
62
Q

signs of bacterial keratitis

A
  • Corneal lesion (ulcer)
    may be visable
  • Corneal oedema
  • hypopyon
63
Q

Ix for bacterial keratitis

A

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
Q

treatment for bacterial keratitis

A

Ofloxacin

Regime
1. Initially hrly

  1. 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
Q

what is herpes simplex keratitis

A

► Reactivation of latent herpes
simples virus type 1

► Migrates down branch of the
trigeminal nerve to cornea

66
Q

history of HS keratitis patient

A

Hx
Cold sores
Run down, stress

67
Q

symptoms of HS keratitis

A 
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
Q

signs of HS keratitis

A
  • Corneal sensation reduced
  • Dendritic ulcer
  • Geographic amoeboid ulcer esp
    if incorrect use of steroid
69
Q

treatment for HS keratitis

A
  • 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
Q

signs of herpes zoster patient

A 
Crusting and ulceration of skin
innervated by 1st division of
trigeminal nerve
► Lesions to tip of noseHutchinson’s sign, increased
chance ocular involvement
71
Q

treatment for herpes zoster

A

immediate referral to an ophthalmologist

Oral aciclovir within 48hrs of
onset of vesicles 800mg 5x day
for 7 days (No effect if later)

  1. Aciclovir ointment within 5/7
72
Q

differentiate between preseptal cellulitis and orbital cellulitis

A 
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
Q

preseptal cellulitis

A
  • Infection of the
    subcutaneous tissues anterior to the orbital
    septum
74
Q

postseptal cellulitis

A

Infection and inflammation
within the orbital cavity producing orbital
signs and symptoms

75
Q

causes of eye cellulitis

A
  • 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
Q

causative organisms for preseptal cellulitis

A

Staphylococcus
aureus and
Staphylococcus
epidermidis

77
Q

causative organisms for postseptal cellulitis

A 
Strep
pneumoniae and
pyogenes, Staph
aureus
Haemophilus
influenzae,
anaerobes
78
Q

predisposing factors of cellulitis

A 
Recent upper respiratory
tract infections
► Trauma
► Sinus disease
► Recent dental work or
infections
► Systemic symptoms- fever
► CNS symptoms- headache,
neck stiffness
79
Q

signs of preseptal cellulitis

A
  • 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
Q

signs of orbital cellulitis

A
  • 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
Q

Tx for pre-septal

A

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
Q

Tx for orbital cellulitis

A
  1. Immediate referral
  2. Needs admission for iv antibiotics
  3. +/- imaging
    blood culture, CRP, WBC
83
Q

complications of eye cellulitis

A 
Raised Intraocular pressure
► Endophthalmitis
► Optic neuropathy
► Meningitis
► Cavernous Sinus Thrombosis
► Subperiosteal/ orbital infections
84
Q

risk factor of steroid eye drops

A

lead to fungal infections to corneal ulcers

85
Q

features of a corneal ulcer

A
  • eye pain
  • photophobia
    watering of eye
  • focal fluorescein - staining of the cornea
86
Q

signs of blunt trauma

A

►Mild – moderate
“bruise” ocular tissues
Eye wall intact

►Moderate – severe
Rupture eye wall
Very severe consequences

87
Q

signs of lacerating trauma

A

►“cut” eye wall

►Outcome depends on extent and location

88
Q

causes of ocular trauma

A 
Foreign bodies
 Corneal abrasions
 Disruption of globe
 Intraocular foreign bodies
 Hyphemas
 Orbital wall fractures
 Chemical injury
89
Q

acid injuries of eye

A

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
Q

alkaline injuries of eye

A

►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
Q

treatment for chemical injury

A

►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
Q

what is hyphema

A

►Blood in the anterior chamber
►Usually associated with trauma
►Requires emergent referral to an
ophthalmologist for treatment

93
Q

treatment for hyphema

A 
► 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
Q

purulent eye discharge in babies what do u do

A

swabs first

95
Q

aeitiology of blepharitis

A

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
Q

blunt trauma complication

A

glaucoma

97
Q

hyphema?

A

blood in the anterior chamber of the eye

98
Q

what is orbital cellulitis

A

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
Q

risk factors for orbital cellulitis

A
  • 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
Q

how to differentiate between preseptal and orbital cellulitis

A

reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

101
Q

Ix for orbital cellulitis

A

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
Q

what is keratitis

A

inflammation of the cornea.

103
Q

causes of keratitis

A

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
Q

features of keratitis

A

red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen

105
Q

Mx for Keratitis

A 
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
Q

complications of keratits

A

corneal scarring
perforation
endophthalmitis
visual loss

107
Q

referral regarding keratitis

A

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
Q

bartolnella henselae

A

Cat scratch disease - usually causes a neuroretinitis with a classical macular star. May have systemic symptoms and lymphadenopathy.

109
Q

borrelia burgdorferi

A

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
Q

long term complications of chemical injury

A

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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