4- Ophthalmology (Red eye: painless) Flashcards
summary of common causes of red eye
pink eye = conjunctivitis
how to think about differentiating red eye
Differentiating red eye
- Painful or painless?
- Normal Vision or changed vision
- Normal intraocular pressure or raised? (normal 10-21mmHg)
painful vs painless causes of red eye
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
Painful and reduced vision : normal or raised intraocular pressure
Ophthalmic history
- 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
differentials for painless red eye
- Conjunctivitis
- Blepharitis
- Episcleritis
- Subconjunctival haemorrhage
connjunctivitis background
- Inflammation of the conjunctiva
- Layer that covers the inside of the eyelids and sclera of the eye
Causes:
- Viral
- Bacterial
- Allergic
general presentation of conjunctivits
- 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
presentation of the different causes of conjunctivitis
Viral conjunctivitis
- 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
bacterial conjunctivitis
- 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
Chlamydial conjunctivitis
- 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
allergic conjunctivis
Allergic
- Caused by contact with allergens
- Causes swelling of the conjunctival sac and eyelid with a significant watery discharge and itch
- bilateral
- seasonal
general management of viral conjunctivitis
- 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
general management of bacterial conjunctivitis
- 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
management of children <1 month with conjunctivitis
- Patients under 1 month need urgent ophthalmology review
- Can be associated gonococcal infection -> sight loss and pneumonia
management of allergic conjunctivitis
- 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
Dry eye and blepharitis
Background
- Inflammation of the eyelid margins
- Associated with dysfunction of meibomian glands -> styes and chalazions
Cause of blepharitis
- Bacteria (staphylococcal blepharitis)
- Skin conditions such as dandruff
Presentation blephritis
- Gritty, itchy dry sensation
- Flakes or crusts around roots of eyelashes
Subconjunctival haemorrhage
Background
- 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
Risk factor/causes of subconjunctival haemorrhage
- 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
Presentation of subconjunctival haemorrhage
- Bright red patch anywhere in the conjunctiva with sharply defined edges and relatively normal conjunctiva surrounding it -> SEGMENTAL
- Painless
- Does not affect vision
Management of subconjunctival haemorrhage
- 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
Episcleritis
Background
- 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
Risk factor/causes of episcleritis
- Associated with inflammatory disorders such as rheumatoid arthritis and IBD
Presentation of episcleritis
- 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
management of episcleritis
- 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
