26. Red eye Flashcards

Question

features that are seen particualrly in corneal ulcer

Answer 1

eye pain photophobia watering of the eye

Answer 2

focal fluorescein staining of the cornea can show corneal ulceration with corneal haze Refer urgently to ophthalmologist to consider infective, autoimmune causes dn for definitive care

Answer 3

PC: Sudden onset discomfort/FB sensation, watering eye May occur whilst hammering or chiselling without eye protection or following minor trauma to the eye. A contact lens may have been ‘lost’ and cause FB sensation

Answer 4

Fluorescein with blue light may show corneal ulceration/abrasion

Answer 5

Refer to opthalmology urgently, make nil by mouth, tetanus, CT scan - Anaesthetise eye with topical local anaesthetic (proxymetacaine, tetracaine or oxybuprocaine) to allow examination and treatment - Gently pick up foreign body with cotton bud/irrigate lavishly with sterile saline. Recheck for FB. the bevel of a needle may also be used. - Protect eye with an eye shield until local anaesthetic has worn off and give topical chloramphenicol for 3 days. - If unable to remove FB or evidence of corneal abrasion, speak to senior or on-call opthalmologist

Answer 6

PC: red eye, irritation/grittiness, discharge (watery, mucoid, sticky or purulent), morning stickiness, transient blurring of vision related to discharge Bacterial: purulent discharge, Eyes may be 'stuck together' in the morning. One then both eyes Viral: clear discharge, Recent URTI, Preauricular lymph nodes. One then both eyes Allergic: prominent itch, eyelids swollen, history of atopy

Answer 7

should be no significant pain, should be no photophobia, should be normal visual acuity

Answer 8

normally a self-limiting condition that usually settles without treatment within 1-2 weeks if purulent - swab to rule out gonococcal infection 1. Chloramphenicol drops or ointment 0. Topical fusidic acid is an alternative and should be used for pregnant women. contact lens users: topical fluoresceins should be used to identify any corneal staining treatment as above contact lens should not be worn during an episode of conjunctivitis

Answer 9

Chloramphenicol drops are given 2-3 hourly (while awake) initially for 2 days then 6 hourly for a week. Chloramphenicol ointment is given qds initially

Answer 10

advice should be given not to share towels school exclusion is not necessary

Answer 11

first-line: topical or systemic antihistamines second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

Answer 12

scleritis is classically painful wheras episcleritis is not in episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera phenylephrine drops may be used to differentiate between episcleritis and scleritis phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made

Answer 13

The majority of cases are idiopathic, associated conditions include: - inflammatory bowel disease - rheumatoid arthritis

Answer 14

The majority of cases are idiopathic, associated conditions include: inflammatory bowel disease rheumatoid arthritis

Answer 15

- red eye - classically not painful (in comparison to scleritis) - watering and mild photophobia may be present

Answer 16

conservative artificial tears may sometimes be used

Answer 17

rheumatoid arthritis: the most commonly associated condition systemic lupus erythematosus sarcoidosis granulomatosis with polyangiitis

Answer 18

red eye classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present watering and photophobia are common gradual decrease in vision

Answer 19

same-day assessment by an ophthalmologist oral NSAIDs are typically used first-line oral glucocorticoids may be used for more severe presentations immunosuppressive drugs for resistant cases (and also to treat any underlying associated diseases)

Answer 20

PC: diffuse area of bright red blood under the conjunctiva May have FB sensation, no other symptoms (no photophobia, no pain, no altered vision)

Answer 21

Check BP for malignant haemorrhage If recurrent check FBC and clotting, may need eye protection eg tape at night if swollen and unable to close Speak to ophthalmologist only if recurrent or severe

Answer 22

Blepharitis is inflammation of the eyelid margins. It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis).

Answer 23

meibomian gland dysfunction (common, posterior blepharitis) The meibomian glands secrete oil on to the eye surface to prevent rapid evaporation of the tear film. Any problem affecting the meibomian glands (as in blepharitis) can hence cause drying of the eyes which in turns leads to irritation

Answer 24

symptoms are usually bilateral grittiness and discomfort, particularly around the eyelid margins eyes may be sticky in the morning eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis styes and chalazions are more common in patients with blepharitis secondary conjunctivitis may occur

Answer 25

- hot compress 2x per day - 'lid hygeine' mechanical removal of the debris from lid margins using cotton wool buds, boiled water and baby shampoo - artificial tears may be given for symptom relief

Answer 26

infection in sebacous glands/sweat glands management: hot compresses and analgesia Topical antibiotics (e.g., chloramphenicol) may be considered if it is associated with conjunctivitis or if symptoms are persistent.

Answer 27

A chalazion occurs when a Meibomian gland becomes blocked and swells. It is often called a Meibomian cyst. It presents with a swelling in the eyelid that is typically not tender (however, it can be tender and red). Treatment is with warm compresses and gentle massage towards the eyelashes (to encourage drainage). Rarely, surgical drainage may be required.

Answer 28

dry eyes chronic bilateral desiccaion of the conjunctiva and cornea due to inadequate tear film

Answer 29

an autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces. It may be primary (PSS) or secondary to rheumatoid arthritis or other connective tissue disorders, where it usually develops around 10 years after the initial onset. Sjogren's syndrome is much more common in females (ratio 9:1).

Answer 30

dry eyes: keratoconjunctivitis sicca dry mouth vaginal dryness arthralgia Raynaud's, myalgia sensory polyneuropathy recurrent episodes of parotitis renal tubular acidosis (usually subclinical)

Answer 31

rheumatoid factor (RF) positive in nearly 50% of patients ANA positive in 70% anti-Ro (SSA) antibodies in 70% of patients with PSS anti-La (SSB) antibodies in 30% of patients with PSS

Answer 32

Schirmer's test: filter paper near conjunctival sac to measure tear formation

Answer 33

Artificial tears (e.g., polyvinyl alcohol eye drops during the day and carbomer gel at night) Artificial saliva Vaginal lubricants Pilocarpine (oral) can be used to stimulate tear and saliva production Hydroxychloroquine may be considered, mainly in patients with associated joint pain

Answer 34

Eye problems, such as keratoconjunctivitis sicca and corneal ulcers Oral problems, such as dental cavities and candida infections Vaginal problems, such as candida infection and sexual dysfunction

Answer 35

Pneumonia Bronchiectasis Non-Hodgkins lymphoma Peripheral neuropathy Vasculitis Renal impairment

Answer 36

Preseptal cellulitis is sometimes also referred to as periorbital cellulitis. It is an infection of the soft tissues anterior to the orbital septum - this includes the eyelids, skin and subcutaneous tissue of the face, but not the contents of the orbit. This is in contrast to orbital cellulitis, which is an infection of the soft tissues behind the orbital septum, and is a much more serious infection. Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) must be absent in preseptal cellulitis - their presence would indicate orbital cellulitis

Answer 37

- Preseptal cellulitis occurs most commonly in children - 80% of patients are under 10 and the median age of presentation is 21 months - It is more common in the winter due to the increased prevalence of respiratory tract infections. orbital cellulitis - Mean age of hospitalisation 7-12 years

Answer 38

1. Refer to secondary care, orbital is much more time critical 1. CT with contrast to differentiate between + FBC, blood culture, swab of any discharge Periorbital: often oral co-amoxiclav and observation Orbital: IV abx

Answer 39

sinus infection, facial infection, insect bite

Answer 40

Staph. aureus, Staph. epidermidis, streptococci and anaerobic bacteria

Answer 41

History - detail of injury (specifics) Exam - vision - fluirescin dye, slit lamp ?puncture ?foreign body ?laceration Plan - refer to opthalmology urgent on-call - NBM - CT - eye shield

Answer 42

purulent discharge - suspect gonococcal/STI