The Red Eye

Question 1

What is the most common cause of a red eye?

Answer 1

Conjunctivitis (blepharo-conjunctivitis)

Question 2

What are some other causes of a red eye?

Answer 2

Keratitis, anterior uveitis, scleritis/episcleritis, acute closed angle glaucoma, subconjunctival haemorrhage, orbital disease (e.g cellulitis)

Question 3

What are some of the defences of the eye?

Answer 3

Lids = blinking, secretions (Meibomian)
Tears = mucous trapping, lysozyme, IgA/G, complement
Conjunctivae = mucous

Question 4

What are some presenting complaints of the eye?

Answer 4

Pain = foreign body sensation, grittiness, dryness, ache

Itch, discharge, tearing, epiphora, photophobia, visual loss

Question 5

What increases the risk of having a red eye?

Answer 5

Previous ocular disorders and contact lenses

Question 6

What should be included in an examination of a patient with red eyes?

Answer 6

Facial appearance, lids (margins, lashes), conjunctivae (tarsal, bulbar), cornea, pupil/iris, anterior chamber, intra-ocular pressure

Question 7

What is blepharitis?

Answer 7

Inflamed eyelid = may be anterior (lid margin) or posterior (Meibomian gland disease)

Question 8

What are the kinds of anterior blepharitis?

Answer 8

Seborrhoeic (squamous) = scales on lashes

Staphylococcal = infection involving lash follicle

Question 9

What part of the eye tends to be red in anterior blepharitis?

Answer 9

The lid margin is redder than the deeper part of the lid

Question 10

What are the signs of seborrheic anterior blepharitis?

Answer 10

Red lid margin, scales, dandruff, no ulceration, lashes unaffected

Question 11

What are the signs of staphylococcal anterior blepharitis?

Answer 11

Red lid margin, distorted lashes, loss of lashes, ingrowing lashes (trichiasis), styes, ulcers of margin, corneal staining

Question 12

What causes ulceration of the lid margin in staphylococcal anterior blepharitis?

Answer 12

Exotoxin produced by the bacteria

Question 13

What part of the eye is red in posterior blepharitis?

Answer 13

Redness is in the deeper part of the eye = lid margin is often normal looking

Question 14

What is posterior blepharitis associated with?

Answer 14

Acne rosacea

Question 15

What are the signs of posterior blepharitis?

Answer 15

Lid margin skin and lashes unaffected, Meibomian gland openings putting/swollen, dried secretion at gland openings, Meibomian cysts

Question 16

What are the symptoms of blepharitis?

Answer 16

Similar to conjunctivitis = gritty eyes, foreign body sensation, mild discharge

Question 17

What other eye diseases is blepharitis associated with?

Answer 17

Conjunctivitis, keratitis, episcleritis

Question 18

How is blepharitis treated?

Answer 18

Lid hygiene = daily bathing, warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months

Question 19

Is blepharitis easy to treat?

Answer 19

No = very difficult to eradicate

Question 20

What are some causes of conjunctivitis?

Answer 20

Infective = viral, bacterial, chlamydial
Non-infective = allergy, chemicals/drugs, skin disease (eczema)

Question 21

What are the symptoms of conjunctivitis?

Answer 21

Red eye, foreign body sensation, gritty eyes, discharge (sticky eye), itch (allergy), vision unaffected

Question 22

What are the signs of conjunctivitis?

Answer 22

Redness diffuse towards fornicles, serous/mucopurulent discharge, papillae or follicles, subconjunctival haemorrhage, chemosis, pre-auricular glands (if viral)

Question 23

What is chemosis?

Answer 23

Oedema of the conjunctivae

Question 24

What are some features of acute bacterial conjunctivitis?

Answer 24

Red sticky eyes and papillae

Question 25

What organisms most commonly cause acute bacterial conjunctivitis?

Answer 25

Staph aureus, strep pneumoniae, haemophilus influenzae

Question 26

How long does acute bacterial conjunctivitis take to clear?

Answer 26

Self limiting = usually clears in about 14 days without treatment (topical antibiotics clear it faster)

Question 27

What are some causes of follicular conjunctivitis?

Answer 27

Adenovirus, herpes simplex/zoster, chlamydia, molluscum contagiosum, drugs (propine, trusopt)

Question 28

What may be some causes of chronic conjunctivitis?

Answer 28

Blepharitis, chlamydial infection, lacrimal disease (chronic dacrocystitis), keratoconjunctivitis sicca, sensitivity to topical glaucoma medication, subtarsal foreign bodies

Question 29

What are the layers of the cornea?

Answer 29

Epithelium, stroma, endothelium

Question 30

What are some features of a corneal examination?

Answer 30

Use of anaesthetics if photophobic, corneal reflex, use of fluorescein, vascularisation, opacity, oedema

Question 31

What are some causes of central (infective) corneal ulcers?

Answer 31

Viral, fungal, bacterial, acanthamoeba

Question 32

What are some peripheral (autoimmune) causes of corneal ulcers?

Answer 32

Rheumatoid arthritis, hypersensitivity (e.g marginal ulcers), rarely polyarteritis etc

Question 33

What are the symptoms of corneal ulcers?

Answer 33

Needle-like severe pain, photophobia, profuse lacrimation, reduced vision, circumcorneal red eye

Question 34

What are some signs of corneal ulcers?

Answer 34

Abnormal corneal reflex, corneal opacity, hypopyon, staining with fluorescein

Question 35

What are some special causes of corneal ulcers?

Answer 35

Exposure keratitis (e.g CN VII palsy), keratoconjunctivitis sicca (e.g Sjogren's), neurotrophic keratitis (e.g herpes zoster), vitamin deficiency (e.g vit A)

Question 36

What is the management for corneal ulcers?

Answer 36

Corneal scrap for gram stain and culture Hourly ofloxacin if bacterial Aciclovir ointment 5x daily if viral Oral or topical steroids if autoimmune

Question 37

What are some autoimmune causes of anterior uveitis?

Answer 37

Reiter's, ulcerative colitis, ankylosing spondylitis, sarcoidosis

Question 38

What are some infective and random causes of anterior uveitis?

Answer 38

``` Infective = TB, syphilis, herpes simplex/zoster Others = malignancy (leukaemia), idiopathic, trauma, secondary to other eye disease ```

Question 39

What are the symptoms of anterior uveitis?

Answer 39

Pain, reduced vision, photophobia, circumcorneal red eye

Question 40

What are the signs of anterior uveitis?

Answer 40

Cells and flares in anterior chamber, keratic precipitates, hypopyon, synechiae (small/irregular pupil)

Question 41

What is the management for anterior uveitis?

Answer 41

1% topical prednisolone hourly tapering over 4-8 weeks | Mydriatics = cyclopentolate 1% twice daily

Question 42

When should anterior uveitis be investigated?

Answer 42

If recurrent or chronic

Question 43

What are some features of episcleritis?

Answer 43

Relatively common, no serious associations, recurrent and self-limiting, nodules may occur

Question 44

What is a condition associated with episcleritis?

Answer 44

Gout

Question 45

What is the treatment for episcleritis?

Answer 45

Lubricants, topical NSAIDs, mild steroids

Question 46

What are some features of scleritis?

Answer 46

Serious = associated with serious systemic vasculitides (e.g rheumatoid arthritis), very painful, associated uveitis common

Question 47

What are some investigations for scleritis?

Answer 47

Injection of deep vascular plexus = shows violaceous hue | Phenylephrine test

Question 48

What is the treatment of scleritis?

Answer 48

Oral steroids and NSAIDs, steroid sparing agent

Question 49

How common is acute closed angle glaucoma?

Answer 49

Rare = except in elderly with hypermetrophic sight

Question 50

What occurs in acute closed angle glaucoma?

Answer 50

Intra-ocular pressure rises acutely due to drainage angle being closed = precipitated by pupil dilation

Question 51

What are some symptoms of acute closed angle glaucoma?

Answer 51

Severe pain and nausea, cloudy cornea (oedematous), pupil mid-dilated, eye stony hard