The Red Eye and Adnexal Oncology

Question 1

Presentation of acute closed angle glaucoma

Answer 1

Extreme, deep, dull pain 
Red eye
Sudden onset 
Visual loss - visual field changes 
Fixed dilated pupil 
Systemically very unwell and vomiting
Hard eye 
Cloudy / steamy cornea

Question 2

Possible symptoms along with a red eye

Answer 2

Blurred vision / affected vision 
Pain 
Itching
Discharge
Watery / excess tear production

Question 3

Who is at a higher risk of closed angle glaucoma?

Answer 3

Inuits

Older age

Question 4

Which of a constricted or dilated pupil would result in a smaller angle and therefore lead to CAG?

Answer 4

A dilated pupil

Question 5

What should be done if an older patient presents with vomiting?

Answer 5

Check the eyes

Question 6

Who is rubiotic glaucoma seen in?

Answer 6

DM

Question 7

What is glaucoma?

Answer 7

Damage to the optic nerve due to with or without raised IOP

Question 8

What does IOP stand for?

Answer 8

Intraocular pressure

Question 9

How is normal IOP maintained? What would increased IOP do to this?

Answer 9

Pump in the cornea is on the endothelium of the eye
Pumps water out and maintains arrangement of collagen / proteins
Raised IOP would displace them and cause hazy vision

Question 10

What prodromal symptoms are seen in someone with threatening glaucoma?

Answer 10

Halos and lights in the evening

Intermittent evening headaches

Question 11

What is the conjunctiva?

Answer 11

A translucent membrane that carries blood vessels

Question 12

How can conjunctivitis be passed onto a baby from mum?

Answer 12

Vaginally

Question 13

Why is it important to diagnose congenital conjunctivis?

Answer 13

Can penetrate through the cornea and can result in bilateral blindness

Question 14

Types of conjunctivis

Answer 14

Viral
Bacterial
Allergic

Question 15

How can someone get conjunctivitis?

Answer 15

Direct contact
Newborns; vaginally
Chlamydia infection
Flies

Question 16

What causative organism causes newborn conjunctivis?

Answer 16

Gonococcus bacteria

Question 17

What presentation would indicate conjunctivitis caused by chlamydia?

Answer 17

UNILATERAL conjunctivitis > 2 weeks

Question 18

What virus usually causes conjunctivitis?

Answer 18

Adenovirus

Question 19

How long does a corneal abrasion take to heal?

Answer 19

48 hours

Question 20

Pathology of a corneal abrasion

Answer 20

Removal of corneal epithelium
Has not gone through to stroma
NO infiltrates

Question 21

Presentation of corneal abrasion

Answer 21

Very painful - stingy pain

Feeling of something in eye

Question 22

What should always be checked for in a corneal abrasion?

Answer 22

Under the eyelid for a foreign body

Question 23

Causes of corneal ulcer / keratitis

Answer 23

Autoimmune
Bacterial 
Viral 
Fungal 
Amoeba 
Irritant

Question 24

Pathology of keratitis / corneal ulcer

Answer 24

Penetration of stroma

White infiltrates

Question 25

Causative organisms of viral corneal ulcers

Answer 25

HSV | HZV

Question 26

Who gets fungal corneal ulcers?

Answer 26

Immunosuppressed | Hot tropical countries

Question 27

Pathology of irritant corneal ulcers

Answer 27

Oil not being produced so bacteria build up and production of by products by them causing the irritation

Question 28

Is there infiltrates in corneal ulcers?

Answer 28

Yes, white infiltrates

Question 29

What is a lesion near the outside of the cornea called?

Answer 29

Near the limbus

Question 30

What is the lesion near the middle of the cornea called?

Answer 30

Visual access

Question 31

In shingles what comes first, the pain or the rash?

Answer 31

Pain

Question 32

What happens if have shingles in V1?

Answer 32

Usually starts on the scalp then moves to the eye, so check them then look at the cornea for microdendrites

Question 33

What is a feature of a viral corneal ulcer?

Answer 33

Dendrites

Question 34

Where is the blood supply to the deeper part of the eye found?

Answer 34

Limbus

Question 35

What do floaters indicate?

Answer 35

The back of the eye

Question 36

Are all blephritis red eyes?

Answer 36

No, it is a spectrum

Question 37

What is blephritis?

Answer 37

Inflammation of the ridges of the eyelids

Question 38

What does the uvea consist of?

Answer 38

Iris Ciliary body Choroid

Question 39

Presentation of iritis / anterior uveitis

Answer 39

Acute Red eye ; centrally around cornea at limbus Deeper pain Small and irregular pupil; lens and iris getting stuck as iris gets stuck when inflamed Hazy vision / floaters Photosensitivity / photophobia Accommodative pain e.g. looking up close, at light etc

Question 40

What may patients get with a corneal problem?

Answer 40

Light sensitivities

Question 41

Presentation of a subconjunctival haemorrhage

Answer 41

Red eye Stingy A lot of coughing Can look very serious

Question 42

How long does a subconjunctival haemorrhage take to resolve? Does it need treatment?

Answer 42

2 - 3 weeks | Not usually requiring Tx

Question 43

Is a subconjunctival haemorrhage serious?

Answer 43

No it is fine but can look very serious

Question 44

What is a retrobulbar haemorrhage?

Answer 44

Haemorrhage at the back of the eye in the retrobulbar space which tracks forward Can lead to compartment syndrome at back of eye

Question 45

Causes of retrobulbar haemorrhage

Answer 45

Anticoagulation e.g. warfarin Trauma Complication of eye / orbital surgery AV malformations

Question 46

Presentation / pathology of retrobulbar haemorrhage

Answer 46

``` Increased IOP -> damage to optic nerve Diplopia - muscles dying - optic nerve dying - no room for the eyeball to move ```

Question 47

Function of the sclera

Answer 47

Attachment to muscles | Structural

Question 48

Pathology of scleritis

Answer 48

Sclera melts | Loss of structure of the eye

Question 49

Is scleritis serious?

Answer 49

Yes

Question 50

What condition is scleritis associated with?

Answer 50

RA

Question 51

Does scleritis always have a red eye?

Answer 51

Not if happens at the back of the eye

Question 52

Presentation of scleritis

Answer 52

``` Extreme pain, wakes up from sleep Deep pain Pain on movement Redness - purple/funny coloured Vision fine ```

Question 53

What colour would a very bad case of scleritis be at what would this be at risk of?

Answer 53

Black | Perforation

Question 54

Where does episcleritis effect?

Answer 54

Top of sclera

Question 55

Is episcleritis serious?

Answer 55

No

Question 56

Presentation of episcleritis

Answer 56

Sectorial red - bright red Mild pain / no pain Comes and goes

Question 57

What does phenylafferen do?

Answer 57

Constricts blood vessels

Question 58

Treatment of a chemical in the eye

Answer 58

Wash out very quickly

Question 59

If there is dust in the eye, what also needs to be done?

Answer 59

Wash on and under eyelid

Question 60

If an eye is burnt by a chemical, can It heal? Why?

Answer 60

No | As dont have the limbus rehealing pattern

Question 61

What is a hiphemia?

Answer 61

Layers of blood in the anterior chamber

Question 62

Types of trauma to the eye

Answer 62

Blunt force | Penetrating

Question 63

What is endoptholmitis?

Answer 63

An infected eye - inflammation of the intraocular fluids due to infection

Question 64

Causes of endoptholmitis?

Answer 64

Recent operations eg. glaucoma surgery, cataracts

Question 65

Presentation of endoptholmitis

Answer 65

Red eye White pussy layer Hipopiem

Question 66

Pathology of orbital cellulitis

Answer 66

Pus collecting and pushing forward

Question 67

Presentation of orbital cellulitis

Answer 67

Diplopia Red eye Systematically unwell Meningitis

Question 68

What can occur secondary to the pus in orbital cellulitis?

Answer 68

Compartment syndrome

Question 69

What is looked at with optic disc changes?

Answer 69

1. Visual acuity 2. Pupils - RAPD 3. Colour vision 4. Visual fields 5. Look at the disc

Question 70

What should the optic disc look like?

Answer 70

Pink / orange colour | Donut shaped - thick outer layer

Question 71

What does cupping of the optic disc indicate?

Answer 71

Glaucoma

Question 72

Over time what can chronic glaucoma cause damage to?

Answer 72

Optic nerve

Question 73

What visual defect can glaucoma lead to?

Answer 73

Arcing defects in visual fields | - tunnel vision

Question 74

Where is your blind spot?

Answer 74

On the optic nerve

Question 75

What is the normal pressure of the eye?

Answer 75

10 - 21 mmHg

Question 76

Most common cause of conjunctivitis? What does this often have a relevant history of?

Answer 76

Viral | Goes along often with URTI or sore throat

Question 77

Presentation of bacterial conjunctivitis

Answer 77

Thick profuse green discharge | Eye stuck together in morning

Question 78

Causes / associations of uveitis

Answer 78

``` Syphillis Lyme Sarcoidosis HLA - B27 conditions Connective tissue diseases ```

Question 79

What can happen to uveitis in someone with JIA? What is done due to this?

Answer 79

May have a very white eye | Screening is carried out as may have chronic uveitis

Question 80

In uveitis, what is found on the corneal epithelium?

Answer 80

Inflammatory cells

Question 81

Presentation of a dendritic ulcer

Answer 81

Pain Red eye Watery eye Vision may be affected

Question 82

Cause of dendritic ulcer in the eye

Answer 82

HSV

Question 83

What is Hutchisons sign? What does it mean?

Answer 83

The tip of the nose is involved in shingles, then there is an increased chance the cornea is involved as they have a common innervation

Question 84

What is Marcus gunns pupil?

Answer 84

Relative afferent pupillary defect due to lesion before the optic chiasm

Question 85

How is Marcus gunns pupil diagnosed?

Answer 85

Swinging light test

Question 86

Findings of Marcus gunns pupil

Answer 86

Affected and normal eye appears to dilate when the light is shown on the affected eye

Question 87

Causes of Marcus gunns pupil

Answer 87

Retinal detachment | Optic neuritis