Red eye Flashcards
Conjunctivitis
caused by virus / bacteria / trauma / fungus
symptoms:
(viral) transmits from coldsore to eye. red, itchy, unilateral
(bacterial) pink eye, sticks together on waking, thick discharge, foreign body sensation. associated with otitis media
(fungal) immunosuppressed patients, organic material in eye
(allergic) stringy discharge, papillae inflamed, history of atopy, bilateral*
conjunctivitis investigations
virus: HSV dendritic ulcer
trauma: lights up with fluroescein stain (welder) from orange to green
flurosecein
rapid adenovirus immunoassays
cultlure
occular PH if chemical splash injury?
conjunctivitis treatment
viral: aciclovir drops / self resolve / cool compress with articifical tears. but usually self limitting 10-14 days
bacterial: chloramphenicol
allergy:
1st line: topical or systemic anti histamine. cobblestoning
2nd line: topical mast cell stabilisers, sodium cormoglicate
pregnant- topical fusidic acid x2 daily
do not share towels- school exclusion not necessary
peri orbital cellulitis
affects the skin and soft tissue in front of the septum.
symptoms- swelling, redness, fever, pain
*no pain with eye movements
vision is normal
orbital cellulitis
- causes
- symptoms
- investigations
- treatment
cause: frequently extends from adjacent sinus infections / peri ocular trauma
affects deeper tissue behind the septum
symptoms: purulent inflammation of the cellular tissue of the orbit.
swelling, redness, fever, pain, >37.9’C
pain WITH movement of eye, double vision, blurring, ptosis
diagnosis: CT scan
treat- antibiotics (broad spect) ivitaxim, co amoxiclav
(can spread from chronic sinusitis)
scleritis
- symptoms
- diagnosis
- treatment
entire sclera is red
often bilateral
systemic disease
pain with eye movement
infiltration of lymphocytes, plasma cells, macrophages
diagnose with phenylephrine drops:
episcleritis: blanches
scleritis: remains non blanching
IX: visual acuity testing, slit lamp exam, phenylephrine, CT, MRI, US?
tx: NSAIDs, abx, diclofenac, prednisolone, topical steroid, rheumatology, methotrexate.
episcleritis
common and benign inflammation of the episcleral vessels. patch of the sclera is red
associated with IBS/RA
systemically well
mild pain / discomfort
tx: topical lubricant, NSAIDS, referral if recurrent
Iritis clinical features and management
iritis / anterior uveitis
inflammation of the uveal tract. associate with HLAB27 (RA, AS, IBD)
uveal tract= choroid, iris, ciliary body
common with autoimmunity pain over hours/days progressive red-eye unilateral reduction in visual acuity photophobia blurred vision *black star*
management: refer to ophthalmology, corticosteroids
chalazion (stye)
warm cloth compress and massage
keratitis
cornea
inflammation of the cornea
causes:
1. bacterial ulcer- staph/strep
contact lenses (pseudmonas)
- viral hepes HSV
- autoimmune- syphilis, fungal, ameobic.
children- h.influenza
neonatal - nisseria
fungal - aspergillus, candida
protozoa- acantheometa
pain and red eye
gritty, foreign body
ix: stain with fluroscein
mx: corneal scraping, antimicrobial, avoid steroids?
acute angle glaucoma
blockadge of aqeous outflow causing a right in IOP
open angle= progressive and isidious
closed angle= iris and conea angle
symptoms:
acute onset, unilateral, severe pain, boring pain, blurred vision, halos around light, hazy cornea (water build up in cornea), non reactive mid dilated pupil.
papilloedema
swollen optic disc raised pressure (e.g. congestion, veins can't drains)
pale optic disc
vascularity has been lost - atrophy
what are the most common orbit tumours?
children- rhabdomyosarcoma (most common 1’ malignancy of the orbit)
adults- neuroblastoma most common metastatic tumour
orbit tumour
blow out fractures from blunt trauma to the eye, causes orbit to rupture.
orbital floor fractures can cause restricted up gaze if muscle entrapment
