The Red Eye

Question 1

common causes of a red eye

Answer 1

Conjunctivitis 
Keratitis 
Anterior uveitis 
Scleritis/epscleritis 
Acute angle closure glaucoma 
Subconjunctival haemorrhage 
Orbital disease

Question 2

what is a subconjunctival haemorrhage

Answer 2

look v dramatic but just a blood blister

blood vessel bleeds under conjunctiva - has little or no consequence

Question 3

what is orbital cellulitis

Answer 3

inflammation of the tissues behind the orbital septum

most commonly caused by infection from the sinuses

causes permanent vision loss and can spread to the brain

Question 4

what immune defences does the eye have

Answer 4

eye lids
tears
conjunctivae (mucous)
epithelium (conjunctiva/corneal)

Question 5

where are tears produced

Answer 5

lacrimal glands

Question 6

what does an ache in the eye usually suggest

Answer 6

an intraocular problem

Question 7

what does an itch in the eye usually suggest

Answer 7

allergy

Question 8

what does dryness/grittiness/foreign body sensation suggest

Answer 8

problem with the surface of the eye

Question 9

what examination can you do to quickly determine if there is raised IOP

Answer 9

Bllotting- eye feels ‘stony hard’

Question 10

what is blepharitis

Answer 10

inflamed eyelids

Question 11

what are the two types of anterior blepharitis

Answer 11

seborrhoeic (oily skin flakes causing irritation)

staphylococcal (infection involving lash follicle)

both give a v red lid margin

Question 12

what is anterior blepharitis

Answer 12

Meibomian gland dysfunction

the redness is in the deeper part of the lid and the lid margin looks normal

Question 13

symptoms of blepharitis

Answer 13

gritty eyes
foreign body sensation
mild discharge

Question 14

signs of seborrhoeic blepharitis

Answer 14

red lid margin
scales ++
Dandruff +
(no ulceration, lashes unaffected)

Question 15

signs of staphylococcal blepharitis

Answer 15

lid margin red
lashes distorted, loss of lashes, ingrowing lashes
styes, ulcers of lid margin
corneal staining, marginal ulcers

Question 16

signs of posterior blepharitis

Answer 16

lid margin skin and lashes unaffected

meibomian glad openings pouting and swollen

dried secretion at gland

meibomian cysts

associated with acne rosacea

Question 17

treatment for blepharitis

Answer 17

lid hygiene - daily bathing/warm compress
Supplementary tear drops
Oral doxycycline for 2-3 months

v difficult to irradiate

Question 18

what are the types of infective conjunctivitis

Answer 18

viral
bacterial
chlamydial

Question 19

what are the non-infective types of conjunctivitis

Answer 19

allergic
chemical/drugs
skin diseases - eczema

Question 20

symptoms of conjunctivitis

Answer 20

red eye
foreign body sensation - gritty eye
discharge- sticky eye
itch (allergy)

Question 21

signs of conjunctivitis

Answer 21

red eye (redness is diffuse more towards fornices (top and bottom))
discharge 
papillae or follicles 
sub conjunctival haemorrhage 
chemises (oedema) 
pre-auricular glands (if viral)

Question 22

how long does it take for acute bacterial conjunctivitis to clear on its own

Answer 22

14 days

Question 23

what are the most common causative organisms for bacterial conjunctivitis

Answer 23

staph azures
strep pneumoniae
h.influenza

Question 24

what causes follicular conjunctivitis

Answer 24

chlamydia

Question 25

what viruses can cause conjunctivitis

Answer 25

adenovirus herpes simplex herpes zoster

Question 26

what is chemosis

Answer 26

conjunctival oedema

Question 27

what are the layers of the cornea

Answer 27

epithelium stroma endothelium

Question 28

where on the cornea do infective ulcers lie

Answer 28

centrally

Question 29

what causes infective corneal ulcers

Answer 29

viral fungal bacterial ancanthamoeba

Question 30

where on the cornea do autoimmune ulcers lie

Answer 30

peripherally

Question 31

causes of autoimmune corneal ulcers

Answer 31

rheumatoid arthritis | hypersensitivity eg. marginal ulcers

Question 32

symptoms of corneal ulcers

Answer 32

``` pain (needle like and severe) photophobia produce lacrimation reduced vision circumcorneal redness ```

Question 33

when might not you feel the pain of a corneal ulcer

Answer 33

if it is the herpes virus (this affects the corneal nerves)

Question 34

signs of a corneal ulcer

Answer 34

``` Circumcorneal redness Abnormal corneal reflex Corneal opacity Staining with fluorescein Hypopyon ```

Question 35

what can cause exposure keratitis

Answer 35

thyroid eye disease VII palsy (can't close lid, this can lead to a corneal ulcer)

Question 36

what can cause keratoconjunctivitis sicc

Answer 36

sjogrens can lead to a corneal ulcer

Question 37

what causes neurotrophic keratitis

Answer 37

Herpes zoster

Question 38

what vitamin deficiency can cause a corneal ulcer

Answer 38

vitamin A

Question 39

how do you treat a corneal ulcer

Answer 39

Corneal scrape for gram stain and culture to determine cause antimicrobial if antibiotic (eg, hourly ofloxacin) antiviral if herpetic (aciclovir ointment 5x day) anti-inflammatory if autoimmune (oral/topical steroids)

Question 40

what can cause anterior uveitis

Answer 40

autoimmune disease infections malignancy (leukaemia) other (idiopathic, trauma act)

Question 41

what are some autoimmune causes of anterior uveitis

Answer 41

Reiter's Ulcerative Colitis Ankylosing spondylitis Sarcoidosis

Question 42

what are some infective causes of anterior uveitis

Answer 42

TB Syphylis Herpes simplex Herpes zoster

Question 43

symptoms of anterior uveitis

Answer 43

pain reduced vision photophobia red eye (circumcorneal)

Question 44

signs of anterior uveitis

Answer 44

``` ciliary injection cells and flared in anterior chamber keratin precipitates hypopyon small or irregular pupil (synechiae) ```

Question 45

treatment for anterior uveitis

Answer 45

topical steroids mydriatics investigate for systemic associations

Question 46

what is episcleritis

Answer 46

superficial inflammation of the sclera - self limiting but recurrent

Question 47

what is episcleritis commonly associated with

Answer 47

gout

Question 48

what is scleritis

Answer 48

serious disease deeper in the sclera

Question 49

symptoms/signs of scleritis

Answer 49

v painful association with vasculitis (Rh arthritis, Wegners) Injected deep vascular vessels associated with uveitis

Question 50

what is the phenylephrine test used for

Answer 50

to differentiate between episcleritis and scleritis

Question 51

how do you treat episcleritis

Answer 51

it is self limiting lubricant topical NSAIDS mild steroids

Question 52

How do you treat scleritis

Answer 52

oral NSAIDS oral steroids Steroid sparing agents

Question 53

signs/symptoms of acute closed angle glaucoma

Answer 53

``` severe pain acute onset nausea and vomiting Circumcorneal injection Cornea cloudy Pupil mid dilated Eye stony hard ```