The Acute Red Eye

Question 1

what is a subconjunctival haemorrhage?

Answer 1

bleeding between conjunctiva and sclera
can be seen in clotting disorders or severe hypertension
usually disappears after 1-2 weeks

Question 2

what is orbital cellulitis?

Answer 2

infection of the soft tissues around the orbit and globe of the eye
can track back to the brain
life threatening

Question 3

name 4 defensive structures in the eye

Answer 3

lids (structure, function, blink, secretion of Meibomian)
tears
conjunctivae
epithelium-conjunctival/corneal

Question 4

5 important features of tears

Answer 4

tear flow/blinking
mucous trapping
lysozyme
immunoglobulin - IgA and IgG
Complement

Question 5

gritty, stingy pain vs achy pain in the eye?

Answer 5

gritty = ocular surface
ache = inside

Question 6

what does itch indicate?

Answer 6

allergy

Question 7

what are contact lens wearers susceptible to?

Answer 7

acanthamoeba

Question 8

what are the 2 locations in the conjunctiva?

Answer 8

tarsal = inside of eyelid which faces the eyeball/bulbar conjunctiva which cover upper portion of eyeball
bulbar = sits overlying the upper eyeball, faces tarsal conjunctiva

Question 9

what is blepharitis?

Answer 9

inflamed eyelids

Question 10

causes of blepharitis in anterior lamella?

Answer 10

seborrheic (squamous) = scales on the lashes
staph = infection involving lash follicle (stye)
lid margin redder than deeper part of lid

Question 11

causes of blepharitis in posterior lamella?

Answer 11

Meibomian gland dysfunction (MGD)
redness is in deeper part of lid
lid margin often quite normal looking

Question 12

give 4 symptoms of blepharitis

Answer 12

similar to conjunctivitis
gritty eyes
foreign body sensation
mild discharge

Question 13

blepharitis is associated with what 3 other eye conditions?

Answer 13

conjunctivitis
keratitis
episcleritis

Question 14

signs of seborrheic anterior blepharitis?

Answer 14

lid margin red
scales
dandruff
no ulceration, lashes unaffected

Question 15

signs of staphylococcal blepharitis?

Answer 15

lid margin red
lashes distorted, loss of lashes, ingrowing lashes - trichiasis
sytes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)

Question 16

5 features of posterior blepharitis?

Answer 16

lid margin skin and lashes unaffected 
MG openings pouting and swollen
inspissated (dried) secretion at gland openings
Meibomian cysts (chalazia)
associated with acne rosacea

Question 17

how is blepharitis managed?

Answer 17

lid hygiene - daily bathing, warm compresses
supplementary eye drops
oral doxycycline for 2-3 months

Question 18

2 groups of causes of conjunctivitis?

Answer 18

infective
- bacterial
- viral
- chlamydial 
other
- allergic
- chemical/drugs
- skin diseases (e.g eczema)

Question 19

5 symptoms of conjunctivitis?

Answer 19

red eye
foreign body sensation - gritty eye
discharge - sticky eye
itch (if allergic)
normal vision

Question 20

6 signs of conjunctivitis?

Answer 20

red eye
discharge
papillae or follicles
sub-conjunctival haemorrhage
chemosis (oedema)
pre-auricular glands (if viral)

Question 21

what usually causes bacterial conjunctivitis and how is it managed?

Answer 21

staph aureus, strep pneumoniae, haemophilus influenzae

usually self limiting within 14 days but topical antibiotics can clear faster

Question 22

3 causes of follicular conjunctivitis?

Answer 22

viral (adenovirus, Herpes)
chalmydia
drugs (propine, trusopt)

Question 23

what is chemosis?

Answer 23

conjunctival oedema

Question 24

name 6 causes of chronic conjunctivitis

Answer 24

blepharitis
chlamydial infection
keratoconjunctivitis sicca
lacrimal disease
sensitivity to topical glaucoma medication
sub-tarsal foreign body

Question 25

what are the 3 layers of the cornea?

Answer 25

epithelium stroma endothelium

Question 26

what usually causes a central corneal ulcer?

Answer 26

infection - viral - fungal - bacterial - acanthamoeba

Question 27

what usually causes peripheral corneal ulcer?

Answer 27

autoimmune - rheumatoid arthritis hypersensitivity (e.g marginal ulcers)

Question 28

5 symptoms of corneal ulcer?

Answer 28

``` severe pain (not as much if viral) photophobia profuse lacrimation may have reduced vision red eye - circumcorneal ```

Question 29

5 signs of corneal ulcers?

Answer 29

``` redness corneal reflex (reflection abnormal) corneal opacity staining with fluorescein hypopyon ```

Question 30

dendritic ulcers?

Answer 30

caused by herpes | stains with fluorescein

Question 31

autoimmune vs infective corneal ulcer?

Answer 31

``` autoimmune = peripheral (immune destruction at the limbus) infective = central ```

Question 32

name 4 special groups of corneal ulcers

Answer 32

``` exposure keratitis (thyroid, VII palsy) keratoconjunctivitis sicca (sjogrens) neurotrophic keratitis (H. zoster or V1 palsy) vitamin deficiency (Vit A) ```

Question 33

how are corneal ulcers managed?

Answer 33

identify cause (corneal scrape for gram stain and culture) antimicrobial if bacterial (ofloxacin) antiviral if herpetic (acyclovir) anti-inflammatory if autoimmune (steroids)

Question 34

4 general causes of anterior uveitis?

Answer 34

autoimmune (reiters, UC, Ank Spondylitis, sarcoidosis) infective (TB, syphilis, herpes) malignancy (leukaemia) other (idiopathic, trauma, secondary to eye disease)

Question 35

4 symptoms of anterior uveitis?

Answer 35

dull achy pain (+ referred pain to brow) may have reduced vision photophobia red eye (circumcorneal)

Question 36

5 signs of anterior uveitis?

Answer 36

``` ciliary injection cells and flare in anterior chamber keratic precipitates (cells floating around get deposited behind cornea) hypopyon synechiae (small or irregular pupil) ```

Question 37

how is anterior uveitis managed?

Answer 37

topical steroids (pred forte hourly for 4-8 weeks) mydriatics (cyclopentolate) investigate for systemic associations if chronic/recurrent

Question 38

5 features of episcleritis?

Answer 38

``` associated with gout minor eye iritation recurrent nodules may occur self limiting ```

Question 39

5 features of scleritis?

Answer 39

association with serious systemic vasculitides (RA, wegners granulomatosis) extremely painful injection of deep vascular plexus (violaceous hue) associated uveitis is common no blanching on phenylephrine test

Question 40

how are scleritis and episcleritis differentiated?

Answer 40

phenylephrine causes blanching in episcleritis | scleritis = more painful

Question 41

how is episcleritis managed?

Answer 41

self limiting | lubricants/topical NSAIDs/mild steroids

Question 42

how is scleritis managed?

Answer 42

oral NSAIDs oral steroids steroid sparing agents

Question 43

features of acute closed angle glaucoma?

Answer 43

``` severe pain nausea circumcorneal injection cloudy cornea pupil mid-dilated eye is stony hard ```

Question 44

who is acute closed angle glaucoma most common in?

Answer 44

elderly | hypermetropic (can tell if they have thick/magnified glasses)