6.1.7 Red Eyes

Question 1

Signs of bacterial conjunctivitis

Answer 1

lid crusting

purulent or mucopurulent discharge
conjunctival hyperaemia – maximal in fornices

tarsal conjunctiva may show mild papillary reaction

cornea: usually no involvement (occasionally superficial punctate keratitis – mainly in lower third of cornea). If cornea significantly involved, consider possibility of gonococcal infection

Question 2

Bacterial conjunctivitis symptoms

Answer 2

discomfort, usually described as burning or grittiness

discharge (may cause temporary blurring of vision)

crusting of lids (often stuck together after sleep and may have to be bathed open)

Usually bilateral – one eye may be affected before the other (by one or two days)

Question 3

Bacterial conjunctivitis management

Answer 3

Self resolve 5-7 days without treatment

Antibiotics - chlorophenicol (0.5% eye drop or 1% ointment) or fuscidic acid 1% drops - weigh antibiotics resistance

If wearing contact lenses cease wear until clears

Tell px to return after 7 days if symptoms persist

Question 4

Signs of viral conjunctivitis

Answer 4

Pink
Watery
Follicles on palpebral conjunctiva

Question 5

Viral conjunctivitis symptoms

Answer 5

Discomfort - burning/gritty
Mild photophobia
Watering
1 eye first then other eye

Question 6

Viral conjunctivitis symptoms

Answer 6

Discomfort - burning/gritty
Mild photophobia
Watering
1 eye first then other eye

Question 7

Viral conjunctivitis management

Answer 7

Self resolve 2 weeks
Condition is contagious so don’t share towels
Cold compress may give some relief
Stop wearing contact lenses
Anti virals won’t work!!

Question 8

Episcleritis symptoms

Answer 8

Mild ache/burning
Sometimes watery
Acute onset
Keeps recurring

Question 9

Episcleritis signs

Answer 9

Does blanch will phenyl ephrenine

Dilated episcleral vessels follow a regular radiating pattern and are
largely immovable

No affect om visual acuity

Question 10

Episcleritis management

Answer 10

Leave if asymptomatic- clears after 7 - 10 days
If symptomatic use cooled artifical tears for 1-2 weeks eg topical NSAID Flurbiprofwn

Question 11

CLAPC

Answer 11

Type 1 and type 4 hypersensitivity is the cause + mechanical action of lens

Signs - all bilateral
Papilla - can be macro (0.3-1mm)
Hyperaemia
Mucous in tear film

Symptoms
Itching non specific irritation eg burning

Stop wearing CL especially if EW
Topical mast cell stabiliser - sodium cromogilate 2% when not wearing lenses
Replace lenses when wearing again