The Acute Red Eye Flashcards
What are the five most common causes of red eye?
What are two less common but important ones to remember?
Most common causes of red eye - Conjunctivitis* (blepharo-conjunctivitis *) - Keratitis - Anterior uveitis - Scleritis / Episcleritis - Acute Angle Closure Glaucoma Less common but ones to remember - Subconjunctival haemorrhage - Orbital disease e.g. cellulitis
Subconjunctival haemorrhage
- Who tends to get it?
- When is it significant?
- Natural history?
- Commonly seen in older age groups – blood vessels tend to leak
- Only significant if recurrent – can be sign of hypertension or clotting abnormality
- Unlike a bruise elsewhere is stays red the whole time and lasts 7-10 days
Where does the infection in orbital cellulitis tend to come from?
Infection passed from adjacent ethmoidal or frontal sinus
What can lower lid disease do to the cornea?
Corneal ulcer
Blinking protects the cornea – lower lid defect looks dramatic but actually not very serious and won’t damage the eye although it can cause tears to roll down cheek -> dermatitis.
Which questions should you ask in an ocular history?
Presenting complaint - Pain - Foreign body sensation, grittiness, dryness - Ache - Itch - Discharge / Tearing / epiphora - Photophobia - Visual loss? - Past ocular disorders - ? Contact lenses General - Past medical history - Drug history (topical and systemic) - Family history - Social history
How can pain give you a clue as to where pathology lies?
- Ocular surface – foreign body sensation
- Dull ache to brow – inflammation within the eye itself e.g. uveitis, scleritis
What is itch a classic symptom of?
Allergy
Visual loss + red eye
Which three things should you think of?
Acute glaucoma
Scleritis
Severe keratitis
Describe the elements of eye examination
- Facial appearance
- Lids (lid margins, lashes)
- Conjunctivae – (tarsal and bulbar)
- Cornea
- Anterior chamber
- Iris / pupil
- Intra-ocular pressure
How can intraocular pressure be assess digitally?
Intraocular pressure can be assessed digitally – compare one eye against the other – look down to the floor and ballot the eye just under superior orbital rim – comparing difference in hardness between one eye and the other.
What are the two types of blepharitis?
How are they split?
Where is the redness in each type?
Anterior
Posterior
This split between anterior and posterior is anatomical
- Anterior = anterior lid margin
-> lid margin redder than deeper part of lid
- Posterior = posterior lid margin, where the Meibomian glands are
-> redness is in deeper part of lid, lid margin often quite normal looking
Which condition is posterior blepharitis most likely to have?
Skin problems e.g. acne rosacea
What are some symptoms of blepharitis?
Similar to conjunctivitis
Gritty eyes
Foreign body sensation
Mild discharge
What are the two causes of anterior blepharitis?
Seborrhoeic (squamous) scales on the lashes
Staphylococcal – infection involving the lash follicle
What cause posteior blepharitis?
Meibomian gland dysfunction (M.G.D.)
Describe the signs seen in Seborrhoeic vs staphylococcal blepharitis
Seborrhoeic - Lid margin red - Scales ++ - Dandruff+ - (No ulceration, lashes unaffected) Staphylococcal - Lid margin red - Lashes distorted, loss of lashes, ingrowing lashes – trichiasis, tepee sign shown above - Styes, ulcers of lid margin - Corneal staining, marginal ulcers (due to exotoxin)
Describe the signs of posterior blepharitis i.e. “Meibomian Gland Disease”
- Lid margin skin and lashes unaffected
- M.G. openings pouting & swollen
- Inspissated (dried) secretion at gland openings
- If completely blocked get back pressure - get granulomatous inflammation which can cause Meibomian Cysts (chalazia)
Don’t confuse a Meibomian cyst with a stye – this is acute abscess of eyelash follicle which is on anterior lamella. Meibomian cyst sits on the posterior lamella
