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

presentation of acute angle glaucoma

Answer 3

severe pain vomiting needing opoiods
associated headache
reduced vision
more common in south East Asians
more common in hyperopia

Question 4

problems affecting lids and lashes

Answer 4

blepharitis, chalazion, stye, cellulitis

Question 5

why does blephoritis happen during reading/working/driving

Answer 5

you blink less often when your concentration

Question 6

recent surgery is a red flag for

Answer 6

endopthalmitis

Question 7

uveal prolapse looks like

Answer 7

Question 8

very high intraoccular pressur is a red flag for

Answer 8

acute angle glaucoma

Question 9

previous episodes makes these conditions more likely

Answer 9

uveitis, keratitis, foreign body, seasonality, chalazion/stye

Question 10

rheumatological disease makes thse conditions more likely

Answer 10

uveitis, episclertis, scleritis, dry eyes (Sjogren’s)

Question 11

problems affecting the cornea

Answer 11

abrasion, FB, keratitis, chemical injury

Question 12

recent dental work is a red flag for

Answer 12

orbital cellulitis

Question 13

is stye is

Answer 13

an infected eyelash follicle

Question 14

a chalazion is

Answer 14

non infective inflammation
collection of lipid secretion blocks a duct

Question 15

a fixed mid-dilated pupil with high pressure and pain

Answer 15

angle closure glaucoma

Question 16

white blood cells in the anterior chamber

Answer 16

uveitis

Question 17

when to use topical anaesthetics

Answer 17

topical aneasthetic drops: minums oxybupricaine drops
dont put in if there is a globe rupture or penetrating foreign body

Question 18

infective conjunctivitis aetiology

Answer 18

70% viral
30% bacterial
minority are chlamydia

Question 19

treatment of chlamydial conjunctivitis

Answer 19

history of unprotected sex
will need swab and azithromycin

Question 20

blood fluid level in the eye

Answer 20

hyphaema

Question 21

corneal involvement of conjunctivitis

Answer 21

punctate epithelial erosions

Question 22

management of conjunctivitis

Answer 22

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

Question 23

do you need antibiotics for normal bacterial conjunctivitis

Answer 23

dont need chlorsig unless severe
leading to antibiotic resistance

Question 24

do you need topical decongestant

Answer 24

eye can get addicted to it
maybe usee for a patient who has an important event

Question 25

if you suspect chlamydial conjunctivitis

Answer 25

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

Question 26

microbial keratitis Hx

Answer 26

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

Question 27

aetiology of microbial keratitis

Answer 27

mainly gram positive staph, pseudomonas, acanthomoeba

Question 28

hypopion

Answer 28

Question 29

management of microbial keratitis

Answer 29

oral analgesia urgent ophthalmology referral remove both contact lenses (save them for culturing) corneal scrape (with anaesthesia), admission, intensive fortified broad spectrum topical antibiotics

Question 30

herpetic keratitis Hx

Answer 30

unilateral associated rash, recurrence

Question 31

aetiology of herpetic keratitis

Answer 31

HSV1, VZV UV exposure, concurrent illness, immunosuppression

Question 32

examination of herpetic keratitis

Answer 32

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

Question 33

hutchinson's sign

Answer 33

lesions on the tip of the nose

Question 34

management of herpes simplex keratitis

Answer 34

topical antiviral acyclovir ointment 5x per day +/- oral acyclovir or valacyclovir have to catch it within 72 hours for this to be effective needs to be seen by opthalmology oral analgesia

Question 35

management of herpes zoster opthalmicus

Answer 35

oral valacyclovirr for VZV within 72 hours of onset +/- topical antibiotic skin cream referral to ophthalmology oral analgesia no steroids

Question 36

epiphora

Answer 36

watering

Question 37

corneal abrasion management

Answer 37

urgent referral to opthalmology if infection suspected topical ABx oral analgesia +/- patching follow up within a week no steroids

Question 38

removing a foreign body

Answer 38

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

Question 40

episcleritis history

Answer 40

red eye +/- discomfort, lacrimation, no discharge mild to moderate pain recurrent may have had a preceding illness

Question 41

aetiology of episcleritis

Answer 41

idiopathic metabolic eg. gout infectious collagen-vascular / rheumatological condition usually unilateral main differential is scleritis

Question 42

management of epislceritis

Answer 42

topical steroids oral NSAIDs referral to ophthalmology review more urgently is you're worried it's scleritis

Question 43

photophobia, cells in the anterior chamber, unusual eye shape

Answer 43

acute anterior uveitis

Question 44

history of acute anterior uveitis

Answer 44

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

Question 45

aetiology of acute anterior uveitis

Answer 45

ankylosing spondylitis (HLAB27) idiopathic inflammatory, infective, malignancy

Question 46

examination of acute anterior uveitis

Answer 46

limbal injections, AC cells, hypopyan (if it's really bad) keratin precipitates, posterior synechiae pain on examining the unaffected eye (shine a torch into the good eye, pupil constricts on the bad eye causing pain)

Question 47

management of uveitis

Answer 47

refer to ophthalmology +/- rheumatology (to investigate for underlying rheumatological disease) sunglasses investigate for underlying disease topical steroids (sometimes injected steroids or systemic immunosuppression)

Question 48

things that are threats to sigh or life

Answer 48

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