Red eyes and red flags part 1

Question 1

red flags

Answer 1

multi trauma
red lids and red glove - could be orbital cellulitis or orbital haemotoma
unable to open eye
uveal prolapse
high intraoccqular pressure

Question 2

what is high intraoocular pressure a red flag for

Answer 2

angle closure glaucoma

Question 3

problems affecting lids and lashes

Answer 3

blepharitis, chalazion, stye, cellulitis

Question 4

problems affecting the cornea

Answer 4

abrasion, FB, keratitis, chemical injury

Question 5

is stye is

Answer 5

an infected eyelash follicle

Question 6

a chalazion is

Answer 6

non infective inflammation
collection of lipid secretion blocks a duct

Question 7

a fixed mid-dilated pupil with high pressure and pain

Answer 7

angle closure glaucoma

Question 8

white blood cells in the anterior chamber

Answer 8

uveitis

Question 9

infective conjunctivitis aetiology

Answer 9

70% viral
30% bacterial
minority are chlamydia

Question 10

management of conjunctivitis

Answer 10

hand hygiene
simple analgesia, ice packs, artificial tears
+/- conjunctival swab
topical decongestants
no antibiotic unless bacterial, no steroid
VA poor, protracted course, recurrent

Question 11

if you suspect chlamydial conjunctivitis

Answer 11

you have to do a swab
cured with a single dose of azithromycin

Question 12

microbial keratitis Hx

Answer 12

severe pain, unilateral
reduced vision
hours to days
contact lens wearer or trauma

Question 13

aetiology of microbial keratitis

Answer 13

mainly gram positive
staph, pseudomonas, acanthomoeba

Question 14

management of microbial keratitis

Answer 14

oral analgesia
urgent ophthalmology referral
remove both contact lenses
corneal scrape, admission, intensive fortified topical antibiotics

Question 15

heretic keratitis Hx

Answer 15

unilateral
associated rash, recurrence

Question 16

aetiology of herpetic keratitis

Answer 16

HSV1, VZV
UV exposure, concurrent illness, immunosuppression

Question 17

examination of herpetic keratitis

Answer 17

skin vessicles, shingles rash
Hutchinson’s sign - the tip of the nose is affected
fundoscopy

Question 18

management of herpes simples keratitis

Answer 18

topical antiviral

Question 19

management of herpes zoster opthalmicus

Answer 19

oral valacyclovirr for VZV

Question 20

removing a foreign body

Answer 20

topical anaesthetic
sterile cotton tip and/or fine gauge needle
ophthalmia burr for rust rings

Question 21

episcleritis history

Answer 21

red eye +/- discomfort, lacrimation, no discharge
recurrent, preceding illness

Question 22

aetiology of episcleritis

Answer 22

idiopathic
metabolic eg. gout
infectious
collagen-vascular

Question 23

management of epislceritis

Answer 23

topical steroids, oral NSAIDs
referral to ophthalmology

Question 24

photophobia, cells in the anterior chamber, unusual eye shape

Answer 24

acute anterior uveitis

Question 25

history of acute anterior uveitis

Answer 25

photophobia, floaters, blurred vision
unilateral, sub-acute
rheumatological disease

Question 26

aetiology of acute anterior uveitis

Answer 26

ankylosing spondylitis
idiopathic
inflammatory, infective, malignancy

Question 27

examination of acute anterior uveitis

Answer 27

limbal injections, AC cells, hypopyan
keratin precipitates, posterior synechiae
pain on examining the unaffected eye

Question 28

management of uveitis

Answer 28

refer to ophthalmology +/- rheumatology
sunglasses
investigate for underlying disease
topical steroids

Question 29

things that are threats to sigh or life

Answer 29

orbital cellulitis
severe trauma
retrobulbar haemorrhage
microbial keratitis
acute angle closure glaucoma