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Ophthalomology > Red Eye > Flashcards

Red Eye Flashcards

0
Q

Bacterial conjunctivitis - symptoms

A 
Irritation & tearing, Discharge
Red eye
Eyelids stuck together in the morning
Will start in one eye and spreads to another
Intermittent blurred vision
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1
Q

Bacterial conjunctivitis - causative organisms

A

Staphylococcus aureus

Streptococcus pneumoniae

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2
Q

Bacterial conjunctivitis - signs

A

Mucopurulent discharge
Lid erythema/oedema
Tear film debris
Diffuse conjunctival injection with/without papillae (raised areas of inflammation with a central blood vessel, if >1mm giant papillary conjunctivitis

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3
Q

Bacterial conjunctivitis - diagnosis

A

Diagnosis is based on clinical signs - conjunctival swab and culture is possible but not usually needed
Differential diagnosis - viral conjunctivitis, allergic conjunctivitis, blepharitis

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4
Q

Bacterial conjunctivitis - Management

A

Clean discharge
Wash hands/use separate towels from family
Broad spectrum antibiotics -> chloramphenicol QDS for 7 days

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5
Q

Viral conjunctivitis - aetiology

A

Often adenovirus type 3 - 8 days incubation period
Common in autumn and winter
Wash hands and clean equipment between pt due to high contagiousness

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6
Q

Viral conjunctivitis - symptoms

A

Acute red eye - watering
Soreness & irritation
May have systemic viral symptoms - bilateral in 40%
Intermittent blurred vision

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7
Q

Viral conjunctivitis - signs

A

Diffuse conjunctival injection (superficial inflamed vessels)
Chemosis (oedema of the conjunctiva)
Watery or mucoid discharge - mild/moderate eyelid swelling
Follicles -> inflamed collections of WBCs without a central vessels
Punctuate keratitis or corneal opacifications
Pre-auricular adenopathy

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8
Q

Viral conjunctivitis - Treatment

A

Self limiting
Warm compress
Artificial tears
Highly contagious for 2 weeks, so avoid work and close contact with family members -> separate towels

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9
Q

Allergic conjunctivitis - history

A

History of atopic disease
Contact with allergen
Seasonal

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10
Q

Allergic conjunctivitis - symptoms

A

Itching
Tearing
Intermittent blurry vision

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11
Q

Allergic conjunctivitis - signs

A 
Bilateral
Eyelid oedema - normal cornea
Diffuse conjunctival injection with papillae
Watery to stringy mucoid discharge
No pre-auricular lymph nodes
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12
Q

Allergic conjunctivitis - Management

A

Cold compress
Artificial tears
Topical mast cell stabilisers –> sodium chromoly ate QDS 1/12

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13
Q

Chlamydial conjunctivitis - causes

A

Direct contact with infected genital secretions, or eye to eye contact
Assess risk of transmitted infection
In men –> urethritis, proctitis, epididymis is, prostatitis
In women –> cystitis, cervicitis, pelvic inflammatory disease

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14
Q

Chlamydial conjunctivitis - symptoms

A

Acute/sub-acute onset of red eye
Consider if viral/bacterial conjunctival lasts over 3 weeks
Irritation and Mucopurulent discharge
Typically unilateral then bilateral

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15
Q

Chlamydial conjunctivitis - signs

A

Normal eyelids -> conjunctival injection - well developed follicles
Palpable pre auricular lymph nodes
Chemosis and peripheral corneal infiltrates

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16
Q

Chlamydial conjunctivitis - diagnosis

A

Fluorescent antibody stain
Enzyme immunoassay tests
Giemsa stain - intracytoplasmic inclusion bodies in epithelial cells, polymorphonuclear leukocyte and lymphocytes

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17
Q

Chlamydial conjunctivitis - management

A

Refer to genito-urinary medicine/identify source
Antibiotics -
Oral - azithromycin
Topical - erythromycin

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18
Q

Bacterial keratitis

A

A serious unilateral corneal infection requiring prompt treatment
Due to trauma, FB, corneal exposure and contact lens wear

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19
Q

Bacterial keratitis symptoms

A

Unilateral acute pain, red eye, FB sensation, photophobia, watering and decreased vision

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20
Q

Bacterial keratitis signs

A

white corneal infiltrate with epithelial defect, diffuse conjunctival injection, Mucopurulent discharge.
Poss anterior chamber cells with hypopyon (fluid level)
May lead to ulceration, perforation or endopthalmitis

21
Q

Bacterial keratitis - management

A

Refer to ophthalmology as emergency
Corneal scrap for gram stain and cultures
Stop wearing contact lens
Hourly topical antibiotics –> eg ofloxacin

22
Q

Herpes simplex conjunctivitis

A

Caused by direct transmission of virus via infected secretions
Ask about previous herpetic eye/mouth/genital disease
Examine cornea with fluorescein
Any recent topical/systemic steroids or immune suppressed state

23
Q

Herpes simplex conjunctivitis - signs

A

Vesicular blepharitis
Follicular conjunctivitis
Preauricular adenopathy
Staining epithelial dendrites - single or multiple branching ulcerated epithelial lesions which stain with fluorescein

24
Q

Herpes simplex conjunctivitis - symptoms

A 
Severe monocular pain & red eye
Photophobia
Tearing
Blurred vision
Hx of previous episodes
25
Q

Herpes simplex conjunctivitis - management

A

Refer to ophthalmology for topical aciclovir

26
Q

Herpes zoster - aetiology

A

Also known as shingles
A common, unilateral infection usually in the elderly
15% of the time affects the ophthalmic division of the trigeminal
(Herpes zoster ophthalmicus)

27
Q

Herpes zoster - symptoms

A

Skin rash and discomfort
Headache, fever, malaise
Blurred vision, eye pain and red eye

28
Q

Herpes zoster - signs

A

May not involve the eye - ocular involvement more likely if side of nose involved - hutchinson’s sign
Conjunctivitis and episcleritis that usually resolve in a week
Can cause - keratitis/corneal lesions, uveitis or scleritis, optic neuritis and extra ocular muscle palsies

29
Q

Herpes zoster - treatment

A

Initial skin rash is maculopapular -> vesicular –> burst to form ulcers –> treat with oral aciclovir 800mg 5x daily for 5days
Eye symptoms should also resolve with oral aciclovir but uveitis and acute corneal lesions may require topical steroids (only to be prescribed by an ophthalmologist)

30
Q

Anterior uveitis - causes

A

Most commonly idiopathic, but may - traumatic/post-op, infection (syphillis, TB, herpes), systemic disease (sarcoid, MS, behcets, MS), inflammatory bowel diseases, juvenile chronic arthritis, autoimmune (HLA B27, ankylosing spondylitis, reiter syndrome, psoriatic arthritis)

31
Q

Anterior uveitis

A

Inflammation of the uvea - middle, pigmented, vascular structures of the eye including iris, cillary body and choroid

32
Q

Anterior uveitis - symptoms

A

Unilateral/bilateral painful red eye with - photophobia and tearing with zero to mild decreases in vision

33
Q

Anterior uveitis - signs

A

Circum-corneal injection
Keratic precipitates - cellular aggregates that form on the inferior corneal endothelium - possible hypopyon
Watery discharge
Distorted or constricted pupil

34
Q

Anterior uveitis - complications

A

Secondary glaucoma or cataract

Posterior synechiae - adhesion between the iris and the anterior lens capsule, usually at the pupillary border

35
Q

Anterior uveitis - investigations

A

Complete ocular/systemic Hx and exam - check for any underlying conditions
Attacks usually last from several days up to 6 weeks –> the majority of patient are managed with topical steroids and cycloplegia eye drops –> dilate the pupil to avoid post synechiae and relieve cillary spasm to reduce pain

36
Q

Sub-conjunctival haemorrhage

A

Generally idiopathic or trauma - can be coughing, sneezing, hypertension or surgery
Diffuse or localised blood - if there is no posterior margin visible consider intracranial bleed
Reassure pt, will resolve & if recurrent consider systemic disease

37
Q

Episcleritis

A

Recurrent idiopathic condition with acute grittiness & blurring
O/E - localised redness without discharge or corneal involvement - examine to exclude conjunctival/subtarsal FB or other ocular disease - refer to ophthalmologist if unsure or not self-limiting
May require oral/topical NSAIDs or topical steroids

38
Q

Scleritis - cause

A

50% idiopathic
50% associated with systemic disease - herpes zoster, SLE, RA, relapsing polychondritis, wegener granulomatosis, polyarteritis nodosa

39
Q

Scleritis - symptoms

A

Gradual onset of severe pain, tearing and photophobia
Vision may be normal or mildly blurred
Pain is deep and dull -> may wake patient at night

40
Q

Scleritis - signs

A

Scleral hyperaemia –> tender to touch
Any pale areas may indicate necrotising scleritis
Possible corneal +- intraocular inflammation

41
Q

Scleritis - management

A

Refer to ophthalmologist
Treat with oral NSAIDs/corticosteroid
Systemic evaluation by rheumatologist
Possible cytotoxic agents

42
Q

Acute angle closure glaucoma (AACG)

A

Acute increase in the IOP due to occlusion of the trabecular meshwork at the angle of the anterior chamber - this occurs when the iris is pushed forward to block the meshwork
‘Pupil block’ can also occur where aqueous humour fails to pass through the pupil so IOP rises

43
Q

Acute angle closure glaucoma (AACG) - symptoms

A

Presents as an acute, painful, unilateral red eye with loss of vision (can be 6/36 or worse)
Halos around lights, nausea and vomiting
May have had previous symptoms or may be asymptomatic

44
Q

Acute angle closure glaucoma (AACG) - signs

A

Reduced visual acuity
Corneal oedema causing clouding
Raised IOP
Oval, unreactive pupil (due to iris ischaemia)

45
Q

Acute angle closure glaucoma (AACG) - risk factors

A

Hypermetropia - shorter eye so shallower anterior chamber
Family history - Asians have shallower anterior chambers
Age > 30, with age the lens thickens and pushes the iris forwards increasing the risk of AACG
Female

46
Q

Acute angle closure glaucoma (AACG) - management

A

Refer to ophthalmology immediately
IOP lowing treatments
Surgery to overcome pupil block - laser iridotomy

47
Q

Chalazion

A

A common, chronic condition of inflamed meibonium glands causing secondary lipogranulomatous inflammation -more common in pts with seborrhoeic dermatitis or acne rosacea
A chronic, painless but mildly tender, round swelling of the eyelid
Treat with hot compress BD, incision and curettage if persists - antibiotics don’t help

48
Q

Pre-septal cellulitis

A

A medical emergency - an infection of the subcutaneous tissue anterior to the orbital septum - refer, oral antibiotics
Exclude orbital cellulitis
Causing fever, pain and swelling - ocular motility/acuity normal
O/E - ptosis, unilateral tender/inflamed periorbital oedema

49
Q

Orbital cellulitis

A

A medical emergency - infection of the soft tissue posterior to the orbital septum –> life threatening if it spreads to the intracranial space
Refer to ophthalmology for emergency treatment with systemic antibiotics
Caused by staph aureus or strep pneumoniae

50
Q

Orbital cellulitis - signs

A 
Systemically unwell, lid & conjunctival oedema, proptosis
Reduced eye movements 
and if severe optic nerve dysfunction
- vision loss
- RAPD

Ophthalomology (11 decks)

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