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Nervous System > Acute Red Eye > Flashcards

Acute Red Eye Flashcards

1
Q

what questions would you ask in the presenting complaint?

A

change in vision
redness
pain
discharge
double vision
change in appearance of eye

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2
Q

what would you ask in the history of presenting complaint?

A

time of onset
unilateral/bilateral
permanent /transient
relieving factors

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3
Q

what questions would you ask in relation to past ocular history?

A

previous similar episode
previous surgery
contact lens wear
amblyopia (“lazy eye”)

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4
Q

what questions would you ask in the past medical history?

A

ardiovascular risk factors – ischaemic optic neuropathies,
retinal vein occlusions, cranial nerve palsies

eczema/asthma/hayfever – allergic eye disease

joints – ankylosing spondylitis, rheumatoid arthritis – uveitis,

scleritis, episcleritis
bowels – inflammatory bowel disease – uveitis

infection – Lyme’s disease, TB, syphillis - uveitis

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5
Q

what eye conditions could cardiovascular risk factors be linked to?

A

ischaemic optic neuropathies,
retinal vein occlusions, cranial nerve palsies

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6
Q

what eye conditions would eczema/asthma/hayfever be linked to?

A

allergic eye disease

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7
Q

what eye conditions could joint problems such as ankylosing spondylitis, rheumatoid arthritis be related to?

A

uveitis,
scleritis, episcleritis

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8
Q

what eye conditions cpuld bowel issues be linked to?

A

uveitis

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9
Q

what eye conditions may infections such as lymes disease, TB and syphillis be linked to?

A

uveitis

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10
Q

what questions would you ask in drug history?

A

toxic – ethambutol, chloroquine

tamsulosin – intraoperative floppy iris syndrome

anticoaggulants

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11
Q

what questions would you ask the patient about their social history?

A

driver
smoking – CV risk factor, age related macular degeneration,
thyroid eye disease
alcohol – nutritional optic neuropathies
drug abuse – endogenous endophthalmitis
social context – lives alone, manage drops

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12
Q

how is vision in adults assessed?

A

snellens chart

best corrected acuity measured at 6 m (or closer)

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13
Q

how are results from snellens chart recorded?

A

Pinhole gives the best potential vision

recorded as 6/60 – 6/6
numerator = distance from chart

denominator = distance at which a normal eye should be able to see that font size

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14
Q

what are steps up from snellens chart if an adult is unable to see?

A

counts finger
hand movements
perception of light

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15
Q

how is vision assessed in babies?

A

preferential looking

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16
Q

how is vision assessed in toddlers?

A

matching Kay pictures

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17
Q

how is vision assessed in older children?

A

naming Kay pictures
or Snellen chart

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18
Q

on inspection of eyes what features are you looking for?

A

facial asymmetry - VII nerve palsy

rashes – HZO

lid position abnormalities – ptosis,
entropion, ectropion

globe position abnormalities
proptosis, enophthalmos

pupil asymmetry - anisocoria

  • lumps, bumps, redness, discharge
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19
Q

what is entropion?

A

a condition in which the eyelid is rolled inward against the eyeball, typically caused by muscle spasm or by inflammation or scarring of the conjunctiva (as in diseases such as trachoma), and resulting in irritation of the eye by the lashes (trichiasis

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20
Q

what is ectropion?

A

Ectropion is where the lower eyelid droops away from the eye and turns outwards. It’s not usually serious, but can be uncomfortable. Ectropion mainly affects the lower eyelid and can happen in 1 or both eyes.

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21
Q

what is enophthalmos?

A

Enophthalmos refers to your eyes sinking deeper in your eye socket. Hypoglobus is a downward displacement of your eyeball. Potential causes of either include trauma and silent sinus syndrome

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22
Q

what peices of equipment is commonlt used to examine the eye?

A

slit lamp
fundoscope

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23
Q

what are common causes of acute red eye?

A

infective conjunctivtis

subconjunctival haemorrhage

allergic conjunctivitis

corneal ulcer

corneal abrasion

acute anterior uveitis

acute angle closure glycoma

orbital cellulitis

endopthalmitis

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24
Q

what is infective conjunctivitis?

A

Infective conjunctivitis is an inflammation of the conjunctiva due to viral, bacterial or parasitic infection

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25
Q

what are symptoms and signs of infective conjunctivitis?

A

Gritty
Red
Discharge (purulent/watery)

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26
Q

what is treatment of infective conjunctivitis?

A

Topical antibiotics
(chloramphenicol/fucidic acid)

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27
Q

what is subconjunctival haemorrhage?

A

occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva)

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28
Q

what are symptoms and signs of subconjunctival haemorrage?

A

Red
Painless

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29
Q

what is treatment for Subconjunctival Haemorrhage?

A

Reassurance

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30
Q

what is allergic conjunctivitis?

A

Allergic conjunctivitis occurs when the conjunctiva becomes swollen or inflamed due to a reaction to pollen, dust mites, pet dander, mold, or other allergy-causing substances.

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31
Q

what are the symptoms and signs of allergic conjunctivitis?

A

Itchy
Red
Discharge (mucoid/watery)
Acute
Lid swelling
Conjunctival swelling
(chemosis)

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32
Q

what is the treatment of allergic conjunctvitis?

A

Topical antihistamine (olopatadine)
Avoid allergen
Mast cell stabilisers(sodium chromoglycate)

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33
Q

what is a corneal ulcer?

A

open sore in the outer layer of the cornea. It is often caused by infection.

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34
Q

what are symptoms and signs for corneal ulcer?

A

Pain
Red
Photophobia
Discharge (purulent/watery)
History of contact lens wear
Corneal defect with surrounding infiltrate
+/- Cells/pus in the anterior chamber

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35
Q

what is treatment of a corneal ulcer?

A

Corneal scrape - MCS
Topical antibiotics

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36
Q

what are the signs and symptoms for a corneal abrasion?

A

History of trauma
Pain
Red
Watering
Blurred vision
Epithelial defect

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37
Q

what is treatment for a corneal abrasion?

A

Topical antibiotics
(chloramphenicol/fucidic acid)
Analgesia

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38
Q

what is Acute Anterior Uveitis?

A

inflammation of iris and ciliary body

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39
Q

what are symptoms are signs for acute anterior uvietis?

A

Pain
Watering
Photophobia
+/-Blurred vision/floaters
Possible previous episode
Red (circumcorneal injection)
Keratic precipitates
Cells in anterior chamber
Hypopyon
Small irregular pupil (posterior
synaechiae)

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40
Q

what is treatment for acute anterior uveitis?

A

Topical steroids
(Prednisolone 1% hourly)
Dilating drops
(Cyclopentolate 1% 3 times daily)

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41
Q

what is scleritis?

A

inflammatory disease that affects the white part of the eye (sclera)

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42
Q

what are symptoms and signs for scleritis?

A

Pain++
Redness (deep scleral vessels)
Nodule (does not move over sclera)
Tender++

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43
Q

what is the treatment for scleritis?

A

Systemic steroids

44
Q

what are symptoms and signs for acute angle glycoma?

A

Pain++
Redness
Blurred vision
Nausea & vomiting
Hazy cornea
Fixed mid dilated pupil
Hard eyeball

45
Q

what is treatment for acute angle glycoma?

A

Lower intraocular pressure
(carbonic anhydrase inhibitors,
beta blockers, prostaglandins)

Constrict pupil (pilocarpine)
Laser iridotomy

46
Q

what is orbital cellulitis?

A

orbital cellulitis is an infection of the soft tissues of the eye socket behind the orbital septum

47
Q

what are symptoms and signs of orbital cellulitis?

A

Pain+
Redness
Blurred vision
Diplopia (double vision)
Generally unwell
Pyrexia
Proptosis
Reduced eye movement

48
Q

what is treatment of orbital cellulitis?

A

Admit
IV antibiotics
CT Scan
Drainage of pus

49
Q

what is endophthalmitis?

A

inflammation of the inner coats of the eye, resulting from intraocular colonization of infectious agents with exudation within intraocular fluids

50
Q

what are symptoms and signs for endopthalmitis?

A

Redness
Blurred vision
Pain
History or recent surgery/trauma

51
Q

what is treatment for endophthalmitis?

A

Admit
Topical antibiotics
Vitreous tap
Intravitreal antibiotics

52
Q

what is thyroid eye disease?

A

TED is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed

53
Q

what are symptoms and signs of thyroid eye disease?

A

Redness
Blurred vision
Pain
Diplopia
History of thyroid dysfunction
Proptosis
Lid retraction
Reduced eye movement

54
Q

what os treatment of thyroid eye disease?

A

Topical lubrication
Systemic steroids
Orbital radiotherapy
Orbital decompression

55
Q

If a patient is presenting with loss of vision what four topics must you cover?

A

History
Examination
Differential diagnosis
Management

56
Q

what would you cover in the history for a patient presenting with loss of vision?

A

Unilateral / bilateral

Onset: sudden / gradual (over what period of time)

Type of visual loss: (blurred / distorted / black)

Any associated symptoms (pain, redness, discharge)

57
Q

what examinations would you do on a patient presenting with loss of vision?

A

best corrected visual acuity

snellen chart

Fundal examination – direct ophthalmoscope, slit lamp & volk lens

58
Q

what are ancilliary tests?

A

Ancillary tests include tests of neuronal electrical function

59
Q

what anciliary tests would you do on a patient presenting with loss of vision?

A

Amsler Chart
Colour Vision
Visual field assessment
Fluorescein Angiography
Optical Coherence Tomography

60
Q

what is Fluorescein Angiography?

A

A fluorescein angiogram is a picture of the retina and helps show abnormal blood vessel growth and other conditions

61
Q

what is Optical Coherence Tomography?

A

Optical Coherence Tomography is a noninvasive imaging technology used to obtain high resolution cross-sectional images of the retina. The layers within the retina can be differentiated and retinal thickness can be measured to aid in the early detection and diagnosis of retinal diseases and conditions.

62
Q

what condition can cause sudden/complete loss of vision?

A

Central retinal artery occlusion

63
Q

what is management of central retinal artery occlusion?

A

identify and treat cardiovascular risk factors

64
Q

what other type of occlusion can cause loss of vision?

A

Branch retinal artery occlusion (BRAO)

65
Q

what is management of Branch retinal artery occlusion (BRAO)?

A

identify and treat cardiovascular risk factors

66
Q

what vein can cause sudden complete loss of vision?

A

Central retinal vein occlusion (CRVO)

67
Q

what is management for Central retinal vein occlusion (CRVO)?

A

identify and treat risk factors
intravitreal anti Vegf

68
Q

what is a differential diagnosis of a patient presenting with sudden complete loss of vision?

A

Anterior Ischaemic Optic Neuropathy (AION)

69
Q

what is anterior ischamic optic neuropathy?

A

Anterior ischemic optic neuropathy (AION) is a sudden loss of vision due to an interruption of blood flow to the front (anterior) of the optic nerve, also known as the optic nerve head

70
Q

what causes can Anterior Ischaemic Optic Neuropathy (AION) be divided into?

A

Arteritic :Giant Cell Arteritis

Non arteritic

71
Q

what is giant cell arteritis?

A

Giant cell arteritis (GCA), or temporal arteritis, is an inflammatory disease affecting the large blood vessels of the scalp, neck and arms.

72
Q

what are symptoms of giant cell arteritis?

A

loss of vision
unilateral temporal headache
loss of appetite/malaise
scalp tenderness
jaw claudication

73
Q

what are signs of giant cell arteritis?

A

tenderness of superficial temporal arteries
raised inflammatory markers (ESR CRP)
Platelets also raised

74
Q

what is management of giant cell arteritis?

A

High dose systemic steroids

75
Q

how is non artertic optic neuropathy managed/

A

identify and treat cardiovascular risk factors

76
Q

what causes rapid loss of vision?

A

Vitreous haemorrhage

77
Q

what can cause a vitreous haemorrhage?

A

conservative/vitrectomy

78
Q

what are risk factors of retinal detachment?

A

myopia
trauma
cataract surgery

79
Q

how is retinal detachment managed?

A

surgical repair

80
Q

what conditions cause loss of vision?

A

retinal detachment

Anterior Ischaemic Optic Neuropathy (non arteritic & giant cell arteritis)

Branch retinal artery occlusion (BRAO)

Central retinal artery occlusion (CRAO)

81
Q

what causes Sudden complete loss of vision (vascular)?

A

Central retinal vein occlusion (CRVO)

Anterior Ischaemic Optic Neuropathy (AION)

82
Q

what causes rapid loss of vision?

A

vitreous haemorrhage

Retinal detachment

83
Q

what conditions cause gradual loss of vision?

A

Cataract

Glaucoma

Age related macular degeneration

Diabetic retinopathy

84
Q

what is cataracts?

A

gradual opacification of the lens

85
Q

what are symptoms of cataracts?

A

loss of vision
dazzle/glare

86
Q

how is cataracts managed?

A

surgery (phacoemulsification
with intraocular lens implant)

87
Q

what is glaucoma?

A

optic neuropathy with typical optic nerve damage and associated visual field changes usually associated with raised intraocular pressure

88
Q

how is glaucoma classified?

A

open or closed angle
chronic or acute

89
Q

what are symptoms of glaucoma?

A

asymptomatic
gradual loss of peripheral
field of vision

90
Q

what are signs of chronic glaucoma?

A

raised intraocular pressure
visual field defects
optic disc damage

91
Q

how is chronic glaucoma managed?

A

topical treatment (prostaglandins,
beta blockers, carbonic anhydrase
inhibitors)

surgery (trabeculectomy, drainage
devices)

92
Q

what is age related macular degeneration?

A

eye disease that can blur your central vision. It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision.

93
Q

what are symptoms of age related macular degeneration?

A

progressive loss of central vision

distortion

94
Q

what are signs of age related macular degeneration?

A

distortion on amsler chart

drusen

95
Q

what percentage is age related macular degeneration wet and dry?

A

Dry AMD (90%)

Wet (neovascular) AMD (10%)

96
Q

what is Dry Age Related Macular Degeneration?

A

Dry age-related macular disease (AMD) is a slow deterioration of the cells of the macula, often over many years, as the retinal cells die off and are not renewed.

atrophy and drusen

97
Q

what are drusen?

A

yellow deposits under the retina

98
Q

what is the management options for dry age related macular degeneration?

A

low vision aids

registration (sight impaired/severely sight impaired)

99
Q

what is Wet (Neovascular) Age Related Macular Degeneration?

A

Wet AMD (also called advanced neovascular AMD) is a serious type of late AMD. It happens when a protein called vascular endothelial growth factor (VEGF) makes abnormal blood vessels grow in the wrong place in the back of your eye

100
Q

what are investigations for Wet (Neovascular) Age Related Macular Degeneration?

A

OCT
Fluorescein angiography

101
Q

what is the management for Wet (Neovascular) Age Related Macular Degeneration?

A

intravitreal antivegf

low vision aids

registration (SI/SSI)

102
Q

what is Diabetic Retinopathy?

A

commonest cause of visual impairment in working age population

103
Q

signs of diabetic retinopathy?

A

microaneurysms

retinal haemorrhages and exudates

neovascularisation (disc/retina – proliferative DR)

104
Q

what are investigations for diabetic retinopathy?

A

Fluorescein angiography

OCT

105
Q

what is management of diabetic retinopathy?

A

control BM, BP & cholesterol

intravitreal antivegf (DMO & PDR)

laser – panretinal photocoagulation (PRP)

low vision aids

registration (SI/SSI)

Nervous System (40 decks)

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