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Opthalmology > 4- Ophthalmology (Red eye: painless) > Flashcards

4- Ophthalmology (Red eye: painless) Flashcards

1
Q

summary of common causes of red eye

A

pink eye = conjunctivitis

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2
Q

how to think about differentiating red eye

A

Differentiating red eye

  • Painful or painless?
  • Normal Vision or changed vision
  • Normal intraocular pressure or raised? (normal 10-21mmHg)
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3
Q

painful vs painless causes of red eye

A

look at which ones affect vision

normal vision
- conjunctivitis
- episcleritis
- subconjunctival haemorrhage

reduced vision
- Scleritis (can be normal)
- Keratitis
- Corneal foreign body (can be noral)
- Uveitis
- Endopthalmitis

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4
Q

Painful and reduced vision : normal or raised intraocular pressure

A
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5
Q

Ophthalmic history

A
  • Affected eye(s)
  • Onset
  • Continuous or intermittent,
  • Severity
  • Exacerbating factors and relieving factors
  • Distance and/or near vision affected
  • Central or peripheral visual field affected
  • Double vision
  • Positive visual symptoms
  • Visual distortions

Positive visual symptoms
- visual disturbance
- red eye
- discharge/watering
- grittiness/dryness
- itching
- photophobia,
- swelling/tenderness

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6
Q

differentials for painless red eye

A
  • Conjunctivitis
  • Blepharitis
  • Episcleritis
  • Subconjunctival haemorrhage
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7
Q

connjunctivitis background

A
  • Inflammation of the conjunctiva
  • Layer that covers the inside of the eyelids and sclera of the eye

Causes:
- Viral
- Bacterial
- Allergic

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8
Q

general presentation of conjunctivits

A
  • Unilateral or bilateral
  • Red eye
  • Bloodshot
  • Itchy or gritty sensation
  • Uncomfortable
  • Discharge from the eye
    DOES NOT CAUSE PAIN, PHOTOPHOBIA OR REDUCED VISUAL ACUITY
  • Vision may be blurry due to discharge of the eye
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9
Q

presentation of the different causes of conjunctivitis

A
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10
Q

Viral conjunctivitis

A
  • Common and usually presents with a clear discharge
  • May be associated with coryzal symptoms such as a dry cough, sore throat and blocked nose
  • May find tender preauricular lymph nodes
  • Contagious
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11
Q

bacterial conjunctivitis

A
  • Purulent discharge
  • Inflamed conjunctiva
  • Worse in morning when the eye may be stuck together
  • Usually starts in one eye and can spread to the other
  • Highly contagious
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12
Q

Chlamydial conjunctivitis

A
  • Mucopurulent discharge
  • More chronic
  • Associate symptoms of venereal disease
  • Conjunctival injection, follicles (conjunctiva has lump appearance like in photo)
  • Swab chlamydial
  • Refer to GUM
  • Topical antibiotics and systemic azithromycin or tetracycline
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13
Q

allergic conjunctivis

A

Allergic
- Caused by contact with allergens
- Causes swelling of the conjunctival sac and eyelid with a significant watery discharge and itch
- bilateral
- seasonal

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14
Q

general management of viral conjunctivitis

A
  • Resolves without treatment after 1-2 weeks
  • Good hygiene
    o Avoid sharing towels or rubbing eyes and regularly washing hands
    o Avoid use of contacts
    o Cleaning eye with cooled boiled water and cotton wool to remove discharge
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15
Q

general management of bacterial conjunctivitis

A
  • Antibiotic drops – although will often get better with treatment
  • Chloramphenicol or fusidic acid eye drops
  • If less than one month
    o We worry about gonorrhea or chlamydia
    o Topical antibiotic drops
    o Admit under paeds
    o Systemic treatment depending on cause
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16
Q

management of children <1 month with conjunctivitis

A
  • Patients under 1 month need urgent ophthalmology review
  • Can be associated gonococcal infection -> sight loss and pneumonia
17
Q

management of allergic conjunctivitis

A
  • Antihistamines (oral or topical)
  • Topical mast-cell stabilisers can be used in patients with chronic seasonal symptoms ->: prevent mast cells releasing histamine -> make take several weeks before showing benefit
18
Q

Dry eye and blepharitis
Background

A
  • Inflammation of the eyelid margins
  • Associated with dysfunction of meibomian glands -> styes and chalazions
19
Q

Cause of blepharitis

A
  • Bacteria (staphylococcal blepharitis)
  • Skin conditions such as dandruff
20
Q

Presentation blephritis

A
  • Gritty, itchy dry sensation
  • Flakes or crusts around roots of eyelashes
21
Q

Subconjunctival haemorrhage
Background

A
  • Common condition where one of the small blood vessels within the conjunctiva ruptures and releases blood into the space between he sclera and the conjunctiva
22
Q

Risk factor/causes of subconjunctival haemorrhage

A
  • Often appear after episodes of strenuous activity such as heavy coughing, weight lifting or straining when constipated
  • Can also be caused by trauma
  • people on blood thinners
  • Idiopathic and otherwise healthy
23
Q

Presentation of subconjunctival haemorrhage

A
  • Bright red patch anywhere in the conjunctiva with sharply defined edges and relatively normal conjunctiva surrounding it -> SEGMENTAL
  • Painless
  • Does not affect vision
24
Q

Management of subconjunctival haemorrhage

A
  • Will resolve spontaneously without treatment
  • Takes around 2 weeks
  • Think about possible causes such as hypertension and bleeding disorders or blood thinners
  • If foreign body sensation -> lubricating eye drops
25
Q

Episcleritis
Background

A
  • Benign and self-limiting inflammation of the episcleral (vascular connective tissue that lies between the sclera and conjunctiva- outermost layer of the sclera) -> situated underneath the conjunctiva
  • Common in young and middle aged adults
  • Not usually caused by infection
26
Q

Risk factor/causes of episcleritis

A
  • Associated with inflammatory disorders such as rheumatoid arthritis and IBD
27
Q

Presentation of episcleritis

A
  • Typically not painful but there can be mild pain/ache
  • Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera.
  • Foreign body sensation
  • Dilated episcleral vessels
  • Watering of eye
  • No discharge
28
Q

management of episcleritis

A
  • Usually self-limiting and will recover in 1-4 weeks
  • Mild cases: no treatment necessary
    o Lubricating eye drops can help symptoms
    o Simple analgesia, cold compresses and safety net advice
  • More severe
    o NSAIDs e.g. naproxen
    o Topical steroid eye drops

Opthalmology (16 decks)

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