Acute Red Eye

Question 1

what is the acute red eye?

Answer 1

painless= conjunctivitis, episcleritis, subconjunctival haemorrhage 
painful= glaucoma, anterior uveitis, scleritis, corneal abrasions or ulceration, trauma etc

Question 2

what are cataracts?

Answer 2

lens opacification which reduces visual acuity by reducing the light that enters the eye

Question 3

what are the symptoms of cataracts?

Answer 3

usually asymmetrical, very slow reduction in vision, progressive burring of vision, change in colour vision with colours becoming more brown or yellow, “starbursts” can appear around lights- particularly at night time

Question 4

what is a key sign for cataracts?

Answer 4

loss of the red reflex- the lens can appear grey or white when testing the red reflex which might show up on photographs taken with a flash

Question 5

when do cataracts present and what are the risk factors?

Answer 5

can be congenital but most develop over years due to risk factors: increasing age, smoking, alcohol, diabetes, steroids, hypocalcaemia

Question 6

how are cataracts treated?

Answer 6

if symptoms are manageable then no intervention but can perform cataract surgery if needed which involves removing and replacing the lens

Question 7

what is glaucoma?

Answer 7

optic nerve damage caused by a significant rise in intraocular pressure caused by a blockage in aqueous humor trying to escape the eye- there are 2 types= open angle and closed angle

Question 8

what is the normal intraocular pressure and why is this created?

Answer 8

10-21mmHg and is created by the resistance to flow through the trabecular meshwork

Question 9

what is the pathophysiology of open angle glaucoma?

Answer 9

can be a gradual increase in resistance through the trabecular meshwork making it difficult for aqueous humor to exit the eye causes slow onset

Question 10

what are the risk factors of open angle glaucoma?

Answer 10

increasing age, FH, black ethnic origin, nearsightedness (myopia)

Question 11

how does open angle glaucoma present?

Answer 11

often asymptomatic for a long time and usually diagnosed by routine screening, it affects the peripheral vision first and gradually closes until they get tunnel vision, also maybe headache, blurred vision and fluctuating pain

Question 12

what happens to the optic disc due to increased pressure in the eye?

Answer 12

ophthalmoscopy view of the optic disc appears unhealthy, pale and cupped (small indent in the disc= optic cup becomes larger)

Question 13

how is open angle glaucoma diagnosed?

Answer 13

raised IOP (Goldman applanation tonometry), optic disc changes (fundoscopy), visual field defects (visual field assessment)

Question 14

how is open angle glaucoma managed?

Answer 14

prostaglandin analogue eyedrops (latanoprost) to reduce IOP= 1st line, beta-blockers carbonic anhydrase inhibitors can reduce production of aqueous humor

Question 15

what treatment is given if eyedrops are ineffective?

Answer 15

traveculectomy surgery which involves creating a new channel

Question 16

what is the pathophysiology of acute angle closure glaucoma?

Answer 16

iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing draining and the build up of pressure worsens the closure of the angle= ophthalmology emergency

Question 17

what are the risk factors for acute angle closure glaucoma?

Answer 17

increasing age, females x4, FH, Chinese and East Asian (unlikely black), shallow anterior chamber

Question 18

how does acute angle closeure glaucoma present?

Answer 18

sudden onset, red eye, teary, vision lost/blurred, headaches, fixed pupil size

Question 19

how is acute angle closure glaucoma managed?

Answer 19

referred to opthalmologist and given pilocarpine eye drops (constrictor), acetazolamide (carbonic anhydrase inhibitor) to reduce the pressure but laser iridotomy is usually required as a definitive treatment (hole in iris to allow aqueous humor flow)

Question 20

what is uveitis?

Answer 20

inflammation of the uvea (vascular layer of the eye= iris, choroid and ciliary body), can be anterior, intermediate or posterior

Question 21

what are the causes of uveitis?

Answer 21

isolated illness, HLA B27 related conditions= ankylosing spondylitis, IBD, reactive arthritis (acute anterior uveitis), chronic AU= sarcoidosis, syphilis, TB, herpes

Question 22

how does acute anterior uveitis present?

Answer 22

dull, aching, painful red eye, reduced visual acuity, watering eye with photophobia, floaters, exam will show cells in the anterior chamber

Question 23

how is acute anterior uveitis treated?

Answer 23

topical steroids and dilating drops

Question 24

what is scleritis?

Answer 24

inflammation of the full thickness of the sclera

Question 25

how does scleritis present?

Answer 25

it is normally associated with a systemic condition eg rheumatoid arthritis, acute, bilateral, severe pain, pain with eye movements, deep redness, photophobia, eye watering

Question 26

how is scleritis treated?

Answer 26

consider underlying systemic condition (immunosuppression?), NSAIDs, steroids

Question 27

what is orbital cellulitis?

Answer 27

infection of the orbital tissues

Question 28

how does orbital cellulitis present?

Answer 28

painful, red eye, blurred vision, diplopia, reduced eye movements, signs of sepsis

Question 29

how is orbital cellulitis treated?

Answer 29

IV antibiotics, urgent CT of orbit and surgical drainage of pus of subperiosteal abscess if needed

Question 30

what are corneal abrasions?

Answer 30

scratches or damage to the cornea eg due to contact lenses, finger nails, foreign bodies

Question 31

how does the patient present with corneal abrasions?

Answer 31

history of contact lenses or foreign body, painful red eye, watering eye, blurring vision, photophobia

Question 32

how are corneal abrasions diagnosed?

Answer 32

a fluorescein stain is applied to the eye- it is a yellow-orange colour and collects in the abrasions

Question 33

how are corneal abrasions managed?

Answer 33

analgesia, lubricating eye drops, antibiotic eye drops

Question 34

what is conjunctivitis?

Answer 34

inflammation of the conjunctiva

Question 35

what are the 3 main types of conjunctivitis?

Answer 35

bacterial, viral and allergic

Question 36

what are the important presenting factors to remember about conjunctivitis?

Answer 36

it does NOT cause pain, photophobia or reduces visual acuity (unless covered in discharge)

Question 37

how does bacterial conjunctivitis present?

Answer 37

purulent discharge and an inflamed conjunctiva, typically worse in the morning and eyes can stick together, usually starts in one eye and spreads to the other, highly contagious

Question 38

how does viral conjunctivitis present?

Answer 38

common and has clear discharge, often associated with other symptoms of a viral infection like dry cough, sore throat and is also contagious

Question 39

how is infective conjunctivitis treated?

Answer 39

usually resolves without treatment after 1-2 weeks, advise good hygiene to prevent spread, bacterial can give antibiotic eye drops

Question 40

what is allergic conjunctivitis

Answer 40

caused by contact with allergens and causes swelling of the conjunctiva. sac and eyelid with significant watery discharge and itch

Question 41

how is allergic conjunctivitis treated?

Answer 41

antihistamines, identifying and avoiding the allergen and mast-cell stabiliser eyedrops

Question 42

what are corneal ulcers?

Answer 42

infection of the cornea which needs aggressive management to prevent spread and scarring due to a vascularity or can be non-infectious due to trauma, corneal degenerations or dystrophy

Question 43

how would we exam an acute red eye?

Answer 43

assess the patients best corrected visual acuity using the Snellen chart, use direct ophthalmoscope or slit lamp, staining with fluroscene (outlines defects), fundal examination