Acute Red Eye Flashcards
what questions would you ask in the presenting complaint?
change in vision
redness
pain
discharge
double vision
change in appearance of eye
what would you ask in the history of presenting complaint?
time of onset
unilateral/bilateral
permanent /transient
relieving factors
what questions would you ask in relation to past ocular history?
previous similar episode
previous surgery
contact lens wear
amblyopia (“lazy eye”)
what questions would you ask in the past medical history?
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
what eye conditions could cardiovascular risk factors be linked to?
ischaemic optic neuropathies,
retinal vein occlusions, cranial nerve palsies
what eye conditions would eczema/asthma/hayfever be linked to?
allergic eye disease
what eye conditions could joint problems such as ankylosing spondylitis, rheumatoid arthritis be related to?
uveitis,
scleritis, episcleritis
what eye conditions cpuld bowel issues be linked to?
uveitis
what eye conditions may infections such as lymes disease, TB and syphillis be linked to?
uveitis
what questions would you ask in drug history?
toxic – ethambutol, chloroquine
tamsulosin – intraoperative floppy iris syndrome
anticoaggulants
what questions would you ask the patient about their social history?
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
how is vision in adults assessed?
snellens chart
best corrected acuity measured at 6 m (or closer)
how are results from snellens chart recorded?
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
what are steps up from snellens chart if an adult is unable to see?
counts finger
hand movements
perception of light
how is vision assessed in babies?
preferential looking
how is vision assessed in toddlers?
matching Kay pictures
how is vision assessed in older children?
naming Kay pictures
or Snellen chart
on inspection of eyes what features are you looking for?
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
what is entropion?
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
what is ectropion?
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.
what is enophthalmos?
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
what peices of equipment is commonlt used to examine the eye?
slit lamp
fundoscope
what are common causes of acute red eye?
infective conjunctivtis
subconjunctival haemorrhage
allergic conjunctivitis
corneal ulcer
corneal abrasion
acute anterior uveitis
acute angle closure glycoma
orbital cellulitis
endopthalmitis
what is infective conjunctivitis?
Infective conjunctivitis is an inflammation of the conjunctiva due to viral, bacterial or parasitic infection
what are symptoms and signs of infective conjunctivitis?
Gritty
Red
Discharge (purulent/watery)
what is treatment of infective conjunctivitis?
Topical antibiotics
(chloramphenicol/fucidic acid)
what is subconjunctival haemorrhage?
occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva)
what are symptoms and signs of subconjunctival haemorrage?
Red
Painless
what is treatment for Subconjunctival Haemorrhage?
Reassurance
what is allergic conjunctivitis?
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.
what are the symptoms and signs of allergic conjunctivitis?
Itchy
Red
Discharge (mucoid/watery)
Acute
Lid swelling
Conjunctival swelling
(chemosis)
what is the treatment of allergic conjunctvitis?
Topical antihistamine (olopatadine)
Avoid allergen
Mast cell stabilisers(sodium chromoglycate)
what is a corneal ulcer?
open sore in the outer layer of the cornea. It is often caused by infection.
what are symptoms and signs for corneal ulcer?
Pain
Red
Photophobia
Discharge (purulent/watery)
History of contact lens wear
Corneal defect with surrounding infiltrate
+/- Cells/pus in the anterior chamber
what is treatment of a corneal ulcer?
Corneal scrape - MCS
Topical antibiotics
what are the signs and symptoms for a corneal abrasion?
History of trauma
Pain
Red
Watering
Blurred vision
Epithelial defect
what is treatment for a corneal abrasion?
Topical antibiotics
(chloramphenicol/fucidic acid)
Analgesia
what is Acute Anterior Uveitis?
inflammation of iris and ciliary body
what are symptoms are signs for acute anterior uvietis?
Pain
Watering
Photophobia
+/-Blurred vision/floaters
Possible previous episode
Red (circumcorneal injection)
Keratic precipitates
Cells in anterior chamber
Hypopyon
Small irregular pupil (posterior
synaechiae)
what is treatment for acute anterior uveitis?
Topical steroids
(Prednisolone 1% hourly)
Dilating drops
(Cyclopentolate 1% 3 times daily)
what is scleritis?
inflammatory disease that affects the white part of the eye (sclera)
what are symptoms and signs for scleritis?
Pain++
Redness (deep scleral vessels)
Nodule (does not move over sclera)
Tender++
what is the treatment for scleritis?
Systemic steroids
what are symptoms and signs for acute angle glycoma?
Pain++
Redness
Blurred vision
Nausea & vomiting
Hazy cornea
Fixed mid dilated pupil
Hard eyeball
what is treatment for acute angle glycoma?
Lower intraocular pressure
(carbonic anhydrase inhibitors,
beta blockers, prostaglandins)
Constrict pupil (pilocarpine)
Laser iridotomy
what is orbital cellulitis?
orbital cellulitis is an infection of the soft tissues of the eye socket behind the orbital septum
what are symptoms and signs of orbital cellulitis?
Pain+
Redness
Blurred vision
Diplopia (double vision)
Generally unwell
Pyrexia
Proptosis
Reduced eye movement
what is treatment of orbital cellulitis?
Admit
IV antibiotics
CT Scan
Drainage of pus
what is endophthalmitis?
inflammation of the inner coats of the eye, resulting from intraocular colonization of infectious agents with exudation within intraocular fluids
what are symptoms and signs for endopthalmitis?
Redness
Blurred vision
Pain
History or recent surgery/trauma
what is treatment for endophthalmitis?
Admit
Topical antibiotics
Vitreous tap
Intravitreal antibiotics
what is thyroid eye disease?
TED is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed
what are symptoms and signs of thyroid eye disease?
Redness
Blurred vision
Pain
Diplopia
History of thyroid dysfunction
Proptosis
Lid retraction
Reduced eye movement
what os treatment of thyroid eye disease?
Topical lubrication
Systemic steroids
Orbital radiotherapy
Orbital decompression
If a patient is presenting with loss of vision what four topics must you cover?
History
Examination
Differential diagnosis
Management
what would you cover in the history for a patient presenting with loss of vision?
Unilateral / bilateral
Onset: sudden / gradual (over what period of time)
Type of visual loss: (blurred / distorted / black)
Any associated symptoms (pain, redness, discharge)
what examinations would you do on a patient presenting with loss of vision?
best corrected visual acuity
snellen chart
Fundal examination – direct ophthalmoscope, slit lamp & volk lens
what are ancilliary tests?
Ancillary tests include tests of neuronal electrical function
what anciliary tests would you do on a patient presenting with loss of vision?
Amsler Chart
Colour Vision
Visual field assessment
Fluorescein Angiography
Optical Coherence Tomography
what is Fluorescein Angiography?
A fluorescein angiogram is a picture of the retina and helps show abnormal blood vessel growth and other conditions
what is Optical Coherence Tomography?
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.
what condition can cause sudden/complete loss of vision?
Central retinal artery occlusion
what is management of central retinal artery occlusion?
identify and treat cardiovascular risk factors
what other type of occlusion can cause loss of vision?
Branch retinal artery occlusion (BRAO)
what is management of Branch retinal artery occlusion (BRAO)?
identify and treat cardiovascular risk factors
what vein can cause sudden complete loss of vision?
Central retinal vein occlusion (CRVO)
what is management for Central retinal vein occlusion (CRVO)?
identify and treat risk factors
intravitreal anti Vegf
what is a differential diagnosis of a patient presenting with sudden complete loss of vision?
Anterior Ischaemic Optic Neuropathy (AION)
what is anterior ischamic optic neuropathy?
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
what causes can Anterior Ischaemic Optic Neuropathy (AION) be divided into?
Arteritic :Giant Cell Arteritis
Non arteritic
what is giant cell arteritis?
Giant cell arteritis (GCA), or temporal arteritis, is an inflammatory disease affecting the large blood vessels of the scalp, neck and arms.
what are symptoms of giant cell arteritis?
loss of vision
unilateral temporal headache
loss of appetite/malaise
scalp tenderness
jaw claudication
what are signs of giant cell arteritis?
tenderness of superficial temporal arteries
raised inflammatory markers (ESR CRP)
Platelets also raised
what is management of giant cell arteritis?
High dose systemic steroids
how is non artertic optic neuropathy managed/
identify and treat cardiovascular risk factors
what causes rapid loss of vision?
Vitreous haemorrhage
what can cause a vitreous haemorrhage?
conservative/vitrectomy
what are risk factors of retinal detachment?
myopia
trauma
cataract surgery
how is retinal detachment managed?
surgical repair
what conditions cause loss of vision?
retinal detachment
Anterior Ischaemic Optic Neuropathy (non arteritic & giant cell arteritis)
Branch retinal artery occlusion (BRAO)
Central retinal artery occlusion (CRAO)
what causes Sudden complete loss of vision (vascular)?
Central retinal vein occlusion (CRVO)
Anterior Ischaemic Optic Neuropathy (AION)
what causes rapid loss of vision?
vitreous haemorrhage
Retinal detachment
what conditions cause gradual loss of vision?
Cataract
Glaucoma
Age related macular degeneration
Diabetic retinopathy
what is cataracts?
gradual opacification of the lens
what are symptoms of cataracts?
loss of vision
dazzle/glare
how is cataracts managed?
surgery (phacoemulsification
with intraocular lens implant)
what is glaucoma?
optic neuropathy with typical optic nerve damage and associated visual field changes usually associated with raised intraocular pressure
how is glaucoma classified?
open or closed angle
chronic or acute
what are symptoms of glaucoma?
asymptomatic
gradual loss of peripheral
field of vision
what are signs of chronic glaucoma?
raised intraocular pressure
visual field defects
optic disc damage
how is chronic glaucoma managed?
topical treatment (prostaglandins,
beta blockers, carbonic anhydrase
inhibitors)
surgery (trabeculectomy, drainage
devices)
what is age related macular degeneration?
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.
what are symptoms of age related macular degeneration?
progressive loss of central vision
distortion
what are signs of age related macular degeneration?
distortion on amsler chart
drusen
what percentage is age related macular degeneration wet and dry?
Dry AMD (90%)
Wet (neovascular) AMD (10%)
what is Dry Age Related Macular Degeneration?
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
what are drusen?
yellow deposits under the retina
what is the management options for dry age related macular degeneration?
low vision aids
registration (sight impaired/severely sight impaired)
what is Wet (Neovascular) Age Related Macular Degeneration?
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
what are investigations for Wet (Neovascular) Age Related Macular Degeneration?
OCT
Fluorescein angiography
what is the management for Wet (Neovascular) Age Related Macular Degeneration?
intravitreal antivegf
low vision aids
registration (SI/SSI)
what is Diabetic Retinopathy?
commonest cause of visual impairment in working age population
signs of diabetic retinopathy?
microaneurysms
retinal haemorrhages and exudates
neovascularisation (disc/retina – proliferative DR)
what are investigations for diabetic retinopathy?
Fluorescein angiography
OCT
what is management of diabetic retinopathy?
control BM, BP & cholesterol
intravitreal antivegf (DMO & PDR)
laser – panretinal photocoagulation (PRP)
low vision aids
registration (SI/SSI)
