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VISIT TWO > 6.1.7 Manages patients presenting with red eye/s. > Flashcards

6.1.7 Manages patients presenting with red eye/s. Flashcards

1
Q

What is subconjunctival heamorrhage?

A

small localised sleeping under the conjunctiva where posterior borders can be seen –> if there is not white = may be intracranial = emergency

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2
Q

Why do you get sub conj?

A
  1. idiopathic
  2. Tramatic
  3. Recent eye surgery
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3
Q

why can eye surgery casue a sub conj?

A
  1. When adjusting the eye tissue it may rupture a small blood vessel under the conjunctiva
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4
Q

How long does sub conj last?

A

normally around 2 weeks - self resolving

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5
Q

What to do if a px does have a sub conj?

A

measure Blood pressure ,
make sure u can see white
if recurrent refer to gp

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6
Q

What is a ptergium?

A

This is fibrovacular tissue - being wing shaped fold

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7
Q

What casues pyterigium?

A

UV / hot + dusty enviroments

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8
Q

why does uv cause pterygium ?

A

Uv damages DNA = mutations + abnormal growth of the conj tissue

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9
Q

why does dusty enviroments cause pyterigum?

A

particles get trapped under eyelids = inflammation - ongoing / longterm = promotes grwoth of ptergium by initating inflammatory pathways

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10
Q

what are the signs of it

A

often bilateral
starts with scarring –> thickening of the bulbar conj –> small grey opacity near the limbus –> conj overgrows the opacties+ gorwths onto the cornea

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11
Q

when do we refer this?

A

affecting the visual pathway

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12
Q

what is a pingueculua?

A

yellow/white deposite on the conj

due to a degeneration of collagen fibres of the conjunctival stroma
uv protection / ocular lubricants / cold compress

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13
Q

What is epislceritis?

A

This si idiopathic inflammation of the vascular connective tissue (episclera) under the sclera + conjunctiva

may be linked to systemics like RA, Lupus , crohns disease

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14
Q

why does episcleritis have an acute onset?

A

Rapid as it is due to rapid localised immune responses. –> when the body realises there is a threat it will quickly send cytokines, prostgandins ect

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15
Q

why is there mild ache / burning?

A

irriation of the nerve endings inn the episcleral tissues to inflammation

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16
Q

Why is it recurrent?

A

oNCE IS HAS INFLAMMED –> it makes it more susceptble ot more redidual changes in the future

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17
Q

Does episcleritis blanch with phenlyephrine?

A

Yes - becasue the blood vessels will vasoconstrict (narrow) –> if it does not then the bleed it deeper then episclera –> scleritis

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18
Q

what is simple episcleritis?

A

NO nodule - diffuse or sectoral

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19
Q

What is nodular episcleritis

A

Presence of a nodule –> this is more painful

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20
Q

Why is the Ac quiet and clear in episclertisis?

A

the inflammation does not involve the anterior chamber of the eye.

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21
Q

how to resolve episcleritis/

A
  1. self limiting 7-10 days and reassurance andd apply cold compress
    nodule - refer as may need steroids
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22
Q

what is scleritis?

A

this is inflammation of the sclera and it is 50% of the time bilateral.H

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23
Q

Why is there pain on eye movmenrts of scleritis?

A

the sclera is more denser / innervated then the episclera. movement of the inflammed sclera tissue = more pain

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24
Q

does pain disturb sleep in scleritis?

A

yes it does lol

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25
is slceritis a more graual onset or quick?
It is more gradual as the inflmmation builds up slowly -- episclera = thin = inlfmmaed quick .... sclera = thick = slower
26
why is the globe tender with scleritis
the inflammation is wide spread in comparision to episclera
27
why do you get blue sclera affect?
becasu the sclera is now thin --> can see more of the uvea whihc is rich in melanin = blue sclera effect --> once inflmmation has occoured
28
what is necrotising scleritis?
this is the most sever form and can lead to imaairment
29
What is bacterial conjunctivitis caused by?
staplococcus epidermidi/ aurus
30
what are the symtoms?
1. acute onset 2. redness 3. gritty 4. discomfort 5. mucous discharge 6. crusting bilaterl
31
What are the signs?
1. crusting 2. conjunctival redness 3. discharge 5-7 resolve with anything clean with wipes and advice contagious no lens wear chloramphenicol if needed after 7 days
32
What is viral conjunctivis caused by?
adenvirus
33
What does the px normall have?
a cold or a lung infection
34
why is viral water discharge ?
irritation + inflam = lacrimal gland makes more tears --> serous not thick and bright
35
why do you get follciels with viral conjuncitvitis?
white small nodules - LYMPOD tissues
36
can viral conj cause corneal involment?
somtimes --> superfical keritisi small lesions
37
can viral conjuncitvits casue pseudo-membrane on trasal plate
yes - this is when andeo virus type 8 + 19 cause intesne inflmmation this psudeo memerbane is filled with fibrin + inflam cells
38
management
high contagous self resolving if corneal = emergency / psudo membrane
39
what hypersensivity reaction causes allergic conjuncitvitis?
type 1 SEASONAL - POLLEN PERENNIAL - DUST
40
WHAT ARE THE SYMPTOMS
1. re , itchy eyes 2. watery eyes 3. sneezing
41
what happens to the lids in allergic conjunc?
they become swollen
42
what happens to the conj?
becomes red
43
is the cornea involved in type 1 allergic conjunctiis?
no - if it does then it is atopic / vernal keratoconjunctivis
44
what is vernal conjucntivitis?
this is commoen in young males and most liekly if the px is atopic --> the px has a GENTIC tendacy to developallergic diseases - bilaterl bu asym
45
why do vernal keratoconjucntivs get blepharospams?
this is a protective attempt by the eye to reduce exposure ot the enviroemtns irriative nature
46
why do you get papillae on the tarsal plate ?
this is 1mm and flat topped and due to severe form on inflammation
47
what does the limbus look like in venous kertaconjunct?
1. thickening 2. Trantas dots 3. neovas
48
what happens to the cornea?
1. punctate epithelium erson 2. plaques of fribrin 3. mucous
49
why do you get punctate epithelium ersoins?
1. direct inflmmation 2. Rough eyelids = secondary trauma
50
Why does a macro erosion occour?
larger areas of ersoin - more suceptible to infection
51
WHy do you fibrin later / mucous forming sheild ulcer?
chronic inflammation -> lead to a formation of a sheild ulcer
52
why do you get a ring shaped subepi scar?
healing responses in the cornea --> they will form under the cornea and can lead to distortion in visionHWa
53
what is a secondary complicaiton?
keratoconus --> rubbingof the eyes
54
atropic vs vernal
atopic --> lower taral and vernal is at the top --> atopic ~ 50 years
55
is herpes simplex commmon?
yes - but latent
56
what does the px feel?
1. pain - cornea nerves = sensitive - inflammation 2. burning - inflammation 3. photophobia - cornea inflammed 4. redness 5 . unilateral - localised virus in one eye 6. reduced va = corneal oedma
57
why do you get dendriform pattern?
becasue the virus will replicate and infect the next cell and so on - this occours in the epithlium
58
what is a geographc ulcer?
this happens late stage - large / map like and irregular -- geographic as shape is like a map
59
what happens to the stromaa?
this can be invaded and cell death occours
60
can u get stomal infiltrates with herpee sismplex?
yes - stromal infiltrates
61
Can you get KP in herepes simplex?
yes - inflam deposits
62
what is disciform keratitis?
1. oedma in the stroma 3. Stromal thickening 3. folds in descemets membranes 4. KPs
63
herpes simplex ..
1 week urgent and emergency if stromal / infant
64
what is herpes zoster?
this is when the chciken pox infection stays dormant --> manifest as shingles --> 60/70 years old but also immunosuppressed px
65
what are the signs?
unilateral, painful and red.
66
what are the signs of herpes zoster virus
rash on the forhead/upper eyelid --> corresponds to the trigeminal nerve
67
when does crusting occour in herpe zoster?
2-3 weeks
68
why does periorbital oedma occour?
inflmamtion / lymphatic obstruction
69
What is hutchinson sign?
lesion on the nose --> following the trigenminal nerve --> more risk of ocular compliation
70
what corneal signs >
1. Kp 2. pseudodendrites - more central + broader 3. puncate staining 4. desciment membrane folds
71
if zoster is deep = emergency

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