Red eyes and red flags part 2

Question 1

allergic conjunctivitis Hx

Answer 1

intermittent/seasonal, itchiness, redness and watering
rhinitis, atopy
chemosis/conjunctival swelling

Question 2

management of allergic conjunctivitis

Answer 2

lubricating eye drops
oral antihistamines
ophthalmology
PRN (for use my ophthalmologists): topical antihistamines, mast cell stabilisers, steroids

Question 3

blephoritis

Answer 3

common
middle aged to elderly patients
oil glands on the eyelid margins
chronic, bilateral, grittiness, burning, watering, intermittant blurring

Question 4

glands that make eye oil

Answer 4

meibomian glands

Question 5

examination of blephoritis

Answer 5

lid erythema, conjunctival injection, punctate staining
dandruff like flakes on eyelashes, blocked meibomian glands

Question 6

management of blephorits

Answer 6

lid hygiene, warm compress, lubricating eye drops
oral omega-3 fatty acids
ophthalmology PRN: topical antibiotic/steroid, oral doxy/minocycline, thermal pulsation

Question 7

lid hygiene

Answer 7

uses a cotton tip dipped in boiled water to scrub eye lashes every day
either bicarb sod or johnson johnson baby shampoo
use a flannel in a warm shower to massage the eye lid to mechanically push out the blockages
lubricating eye drops

Question 8

chalazion

Answer 8

trapped meibomian gland secretion that has enlarged over time
inflammatory condition

Question 9

stye

Answer 9

staph infection of eyelash follicle

Question 10

management of chalazion

Answer 10

warm compress, fish oil supplements

Question 11

management of stye

Answer 11

remove infected lash
warm compress
topical antibiotic ointment eg. clorsig

Question 12

what is the difference between scleritis and episcleritis

Answer 12

both sectoral redness but scleritis is more painful

Question 13

scleritis Hx

Answer 13

sub acute
sectoral reddness
severe pain boring into their head
among most painful eye conditions
visual disturbance
wakes patient at night

Question 14

scleritis aetiology

Answer 14

idiopathic, collagen vascular / rheumatological conditions
gout
infection (HZO, syphilis)

Question 15

management of scleritis

Answer 15

oral NSAIDs
urgent referral to ophthalmology
may need systemic immunosupression, manage with opthal and rheum

Question 16

diagnostic test for scleritis

Answer 16

drop of phenylephirine
conjunctival vessels constrict causing conjunctival redness to go away
if the eye becomes completely white, it must be either episcleritis or conjunctivitis
if the redness remains, it must be scleritis

Question 17

pre-septal cellulitis

Answer 17

also called periorbital cellulitis
infection or inflammation of contents in front of the orbital septum
can become post-septal
subacute (hours to days)
unilateral
young

Question 18

examination of pre septal cellulitis

Answer 18

white eye
peri orbital erythema
normal eye movements
eye isnt proptosed
systemically well

Question 19

management of pre septal cellulitits

Answer 19

opthalmology consult
oral ABs
daily follow up
CT head and orbits if unable to examine eye,

Question 20

red tender swelling near the nose
acute in onset

Answer 20

dacrocystitis

Question 21

dacrocystitis Hx

Answer 21

acute onset
painful red swelling at medial canthus
patient unwell
blocked nasolacrimal sac causing infection
may be discharging - you can swab this
common in kids and >40yo

Question 22

management of dacrocystitis

Answer 22

ophthalmology consult
swab for culture
FBC and CT if febrile or severe
start ABs
can become orbital cellulitis
definitive management is often surgury
beware extension to orbital cellulitis
admission

Question 23

red flags for orbital cellulitis

Answer 23

displaced eyeball
extra occular muscle involvement
red eye
reduced VA

Question 24

management for orbital cellulitis

Answer 24

urgent CT head and orbits
IVABx
opthalmology and ENT consults, admission +/- theatre
FBC, blood cultures, wound swab

Question 25

risks in orbital cellulitis

Answer 25

risk of subperiosteal/orbital/intracranial abscess, meningitis

Question 26

hypopion

Answer 26

pus fluid level in the anterior chamber either infective or inflammatory

Question 27

endophthalmitis Hx

Answer 27

sub acute severe pain recent injection, surgery, contact lens wearer hypopion same day opthalmology referral

Question 28

most common cause of endopthalmitis

Answer 28

injections into the eyes

Question 28

where to the antibiotics need to go for endopthalmitis

Answer 28

injected into the eye

Question 29

endophthalmitis examination

Answer 29

reduced VA, severe injection, peri-orbital erythema, hypopyan cloudy cornea and anterior chamber

Question 30

management of endophthalmitis

Answer 30

urgent ophthalmology consult fast +/- systemic antibiotics vitrous tap and injection of ABs +/- vitrectomy surgery (remove vitreous gel, to remove bacterial load)

Question 31

pterygium

Answer 31

chronic growth over years red eye discomfort

Question 32

management of pterygiums

Answer 32

lubricating eye drops beware rapid growths (may be SCC) referral to ophthalmology for surgery

Question 33

when to refer for surgery for pterigiums

Answer 33

rapid growth threatening vision astigmatism (by exterting traction of the cornea) discomfort cosmesis

Question 34

shallow anterior chamber indicates, dated non reactive pupil, elevated IOP

Answer 34

acute angle glaucoma

Question 35

normal pressure

Answer 35

10-21

Question 36

checking pressure

Answer 36

anesthetise the eye measure intraoccular pressure

Question 37

pressure in acute angle glaucoma

Answer 37

50+ or not recordaable

Question 38

management of acute angle closure

Answer 38

urgent opthal consult topical pressure lowering drops, use at least 3 classes systemic acetazolamide definitive management = laser peripheral iridotomy (makes a hole through the iris

Question 39

definitive treatment for acute angle closure glaucoma

Answer 39

laser peripheral iridotomy makes a hole in the iris using the laser creates a bypass, gives immediate relief have to wait until corneal swelling is reduced sometimes they do one prophylactically in the other eye

Question 40

classes of pressure lowering drops

Answer 40

beta blockers eg. timolol carbonic anhydrase inhibitors alpha-2 agonists prostaglandins