Acute Red Eye Flashcards
what is the acute red eye?
painless= conjunctivitis, episcleritis, subconjunctival haemorrhage painful= glaucoma, anterior uveitis, scleritis, corneal abrasions or ulceration, trauma etc
what are cataracts?
lens opacification which reduces visual acuity by reducing the light that enters the eye
what are the symptoms of cataracts?
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
what is a key sign for cataracts?
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
when do cataracts present and what are the risk factors?
can be congenital but most develop over years due to risk factors: increasing age, smoking, alcohol, diabetes, steroids, hypocalcaemia
how are cataracts treated?
if symptoms are manageable then no intervention but can perform cataract surgery if needed which involves removing and replacing the lens
what is glaucoma?
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
what is the normal intraocular pressure and why is this created?
10-21mmHg and is created by the resistance to flow through the trabecular meshwork
what is the pathophysiology of open angle glaucoma?
can be a gradual increase in resistance through the trabecular meshwork making it difficult for aqueous humor to exit the eye causes slow onset
what are the risk factors of open angle glaucoma?
increasing age, FH, black ethnic origin, nearsightedness (myopia)
how does open angle glaucoma present?
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
what happens to the optic disc due to increased pressure in the eye?
ophthalmoscopy view of the optic disc appears unhealthy, pale and cupped (small indent in the disc= optic cup becomes larger)
how is open angle glaucoma diagnosed?
raised IOP (Goldman applanation tonometry), optic disc changes (fundoscopy), visual field defects (visual field assessment)
how is open angle glaucoma managed?
prostaglandin analogue eyedrops (latanoprost) to reduce IOP= 1st line, beta-blockers carbonic anhydrase inhibitors can reduce production of aqueous humor
what treatment is given if eyedrops are ineffective?
traveculectomy surgery which involves creating a new channel
what is the pathophysiology of acute angle closure glaucoma?
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
what are the risk factors for acute angle closure glaucoma?
increasing age, females x4, FH, Chinese and East Asian (unlikely black), shallow anterior chamber
how does acute angle closeure glaucoma present?
sudden onset, red eye, teary, vision lost/blurred, headaches, fixed pupil size
how is acute angle closure glaucoma managed?
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)
what is uveitis?
inflammation of the uvea (vascular layer of the eye= iris, choroid and ciliary body), can be anterior, intermediate or posterior
what are the causes of uveitis?
isolated illness, HLA B27 related conditions= ankylosing spondylitis, IBD, reactive arthritis (acute anterior uveitis), chronic AU= sarcoidosis, syphilis, TB, herpes
how does acute anterior uveitis present?
dull, aching, painful red eye, reduced visual acuity, watering eye with photophobia, floaters, exam will show cells in the anterior chamber
how is acute anterior uveitis treated?
topical steroids and dilating drops
what is scleritis?
inflammation of the full thickness of the sclera
how does scleritis present?
it is normally associated with a systemic condition eg rheumatoid arthritis, acute, bilateral, severe pain, pain with eye movements, deep redness, photophobia, eye watering
how is scleritis treated?
consider underlying systemic condition (immunosuppression?), NSAIDs, steroids
what is orbital cellulitis?
infection of the orbital tissues
how does orbital cellulitis present?
painful, red eye, blurred vision, diplopia, reduced eye movements, signs of sepsis
how is orbital cellulitis treated?
IV antibiotics, urgent CT of orbit and surgical drainage of pus of subperiosteal abscess if needed
what are corneal abrasions?
scratches or damage to the cornea eg due to contact lenses, finger nails, foreign bodies
how does the patient present with corneal abrasions?
history of contact lenses or foreign body, painful red eye, watering eye, blurring vision, photophobia
how are corneal abrasions diagnosed?
a fluorescein stain is applied to the eye- it is a yellow-orange colour and collects in the abrasions
how are corneal abrasions managed?
analgesia, lubricating eye drops, antibiotic eye drops
what is conjunctivitis?
inflammation of the conjunctiva
what are the 3 main types of conjunctivitis?
bacterial, viral and allergic
what are the important presenting factors to remember about conjunctivitis?
it does NOT cause pain, photophobia or reduces visual acuity (unless covered in discharge)
how does bacterial conjunctivitis present?
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
how does viral conjunctivitis present?
common and has clear discharge, often associated with other symptoms of a viral infection like dry cough, sore throat and is also contagious
how is infective conjunctivitis treated?
usually resolves without treatment after 1-2 weeks, advise good hygiene to prevent spread, bacterial can give antibiotic eye drops
what is allergic conjunctivitis
caused by contact with allergens and causes swelling of the conjunctiva. sac and eyelid with significant watery discharge and itch
how is allergic conjunctivitis treated?
antihistamines, identifying and avoiding the allergen and mast-cell stabiliser eyedrops
what are corneal ulcers?
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
how would we exam an acute red eye?
assess the patients best corrected visual acuity using the Snellen chart, use direct ophthalmoscope or slit lamp, staining with fluroscene (outlines defects), fundal examination
