acute red eye Flashcards
what is the most common cause of a red eye
conjunctivitis
what is conjunctivitis
inflammation of the conjunctiva
what is the most common type of conjunctivitis
viral
name 3 causative organisms of viral conjunctivitis and state the most common
- Adenovirus (most common)
- Herpes simplex
- Herpes zoster
clinical presentation of viral conjunctivitis
rapidly progressive
typically bilateral
associated with an URTI
feature of an adenoviral conjunctivitis
watery discharge
feature of herpes simplex conjunctivitis
cutaneous vesicles on the eyelids and skin around the eyes
feature of herpes zoster conjunctivitis
shingles rash
management of adenoviral conjunctivitis
lubrication (carbomer gel) and cold compress
management of herpes conjunctivitis
ganciclovir
complication of herpes simplex conjunctivitis
dendritic ulcer
name 3 causative organisms of bacterial conjunctivitis in neonates
- Staph. aureus
- Neisseria gonnorhoeae
- Chlamydia trachomatis
name 3 causative organisms of bacterial conjunctivitis in all other age groups
- Staph. aureus
- Step. pneumoniae
- Haemophilus influenzae (especially in children)
clinical presentation of bacterial conjunctivitis (3)
quick onset- bilateral by 48 hours
morning crusting
mucopurulent yellow discharge
management of bacterial conjunctivitis
broad spectrum antibiotics e.g. chloramphenicol
what can treat a staph aureus conjuctivitis
fusidic acid
what can treat gram negative conjunctivitis
gentamicin
what do we need to suspect in bilateral conjunctivitis in young adults
chlamydial conjunctivitis
clinical presentation of chlamydial conjunctivitis
chronic history often unresponsive to treatments
may have symptoms of urethritis, vaginitis
complication of untreated chlamydial conjunctivitis
subtarsal scarring
management of chlamydial conjunctivitis
topical oxytetracycline
what additional treatment may adults with chlamydial conjunctivitis need
oral azithromycin to treat genital infection
clinical features of allergic conjunctivitis
watery, ITCHY eyes
bilateral and symmetrical involvement
vision is usually fine
management of allergic conjunctivitis when under control
mast cell stabiliser
give an example of a mast cell stabiliser
sodium cromoglycate
what is keratitis
inflammation of the cornea
clinical presentation of keratitis (3)
photophobia
severe ocular pain and feeling of a foreign body
hypopyon
what is hypopyon
aggregation of inflammatory cells within the anterior chamber resulting in visible ‘sediment’ in front of the eye inferiorly
what is bacterial keratitis associated with
wearing contact lenses
management of gram negative bacterial keratitis
ofloxacin eye drops
what is another name for herpetic keratitis
dendritic ulcer
what causes dendritic ulcers
herpes simplex virus
management of dendritic ulcer
ganciclovir
what should we AVOID when managing dendritic ulcers and why
steroids as they cause corneal melt
clinical features of adenoviral keratitis
bilateral subepithelial infiltrates
usually follows URTI/conjunctivitis
who usually presents with fungal keratitis
people who work outside or have ocular surface disease
clinical presentation of fungal keratitis
chronic history
corneal lesions more defined than in bacterial
hypopyon
management of fungal keratitis
natamycin
who usually gets acanthamoeba keratitis
contact lens wearers
what is cellulitis
bacterial infection of the lower dermis and subcutaneous tissue
what is preseptal cellulitis
infection of the eyelid and surrounding skin anterior to the orbital septum
what usually causes preseptal cellulitis
contiguous spread of infection from local trauma e.g. insect bites
clinical features of preseptal cellulitis
tenderness, warmth, swelling and redness of the eyelid
what is orbital cellulitis
infection of the orbital tissues posterior to the orbital septum
3 main causes of orbital cellulitis
- Direct extension from sinus
- Extension from focal orbital infection
- Post-operative
clinical presentation of orbital cellulitis
painful, especially on eye movements
proptosis
pyrexial
what is orbital cellulitis associated with
paranasal sinusitis
investigations of orbital cellulitis
CT scan to identify orbital abscesses and asses optic nerve function
management of orbital cellulitis
broad spectrum antibiotics
some abscesses will need draining
what is the most common causative organism of endophthalmitis
staph epi
clinical presentation of endophthalmitis
very painful, V V red eye
decreasing vision
management of endophthalmitis
intravitreal amikacin/ceftazidime/vancomycin and topical antibiotics
what is scleritis
full thickness inflammation of the sclera
conditions associated with scleritis
rheumatoid arthritis, SLE, IBD, sarcoidosis, GPA
clinical presentation of scleritis
severe pain that progresses - enough to wake someone up, pain with eye movement
photophobia
watering eye
reduced visual acuity
abnormal pupillary response to light
management of scleritis
oral NSAIDs, steroids + steroid sparing agents
main complication of scleritis
potentially blinding
what is episcleritis
inflammation of the episclera
what is the episclera
thin vascular sheet which lies between the conjunctiva and the sclera
clinical presentation of episcleritis
segmented redness, usually in the lateral sclera
foreign body sensation
watery eye
management of episcleritis
self limiting so lubricants, cold compresses, topical NSAIDs
name some autoimmune causes of anterior uveitis (4)
- Reiter’s
- Ulcerative colitis
- Ankylosing spondylitis
- Sarcoidosis
name 3 infective causes of anterior uveitis
- TB
- Syphilis
- Herpes simplex, herpes zoster
name a malignancy that can cause anterior uveitis
leukaemia
symptoms of anterior uveitis
unilateral symptoms start spontaneously
may occur with the flare of a disease
dull, aching, painful red eye
vision reduced, photophobia
clinical signs of anterior uveitis
- Circumcorneal red eye
- Ciliary injection
- Keratic precipitates
- Hypopyon
- Synechiae
- Cells and flare in the anterior chamber
what is synechiae
small or irregular pupil due to adhesions pulling the iris into abnormal shapes
management of anterior uveitis
topical steroids and mydriatics
when does acute angle-closure glaucoma occur
iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from being able to drain away, leading to a continual build up of IOP
clinical presentation of acute angle-closure glaucoma (3)
severe pain and nausea
cloudy cornea
stony hard eye
when does blepharitis usually develop
middle-age
what is anterior blephitis
inflammation of the base of the eyelids
name the 2 most common types of anterior blepharitis
staphylococcal and seborrhoeic
what is posterior blepharitis
inflammation of the meibomian glands
symptoms of blepharitis
burning, itching and crusting of the eyelids
worse in the mornings
recurrent hordeolum
another name for a hordeolum
a stye
clinical sign of anterior blepharitis
lid margin redder than deeper part of the lid
clinical sign of posterior blepharitis
redness in the deeper part of the lid
management of unresolving anterior blepharitis
chloramphenicol
management of unresolving posterior blepharitis
oral doxycycline
name 2 complications of blepharitis
stye
chalazion
another name for chalazion
meibomian cyst
name 3 risk factors of chalaizon
pregnancy
blepharitis
seborrhoeic dermatitis
what causes chalazion
a foreign body reaction to sebum within a meibomian gland
clinical presentation of chalazion
firm, painless, localised eyelid swelling that has slowly developed
management of chalazion
warm compresses for several weeks
what is a stye
acute localised infection or inflammation of the eyelid margin
name 2 risk factors for a stye
rosacea
chronic blepharitis
clinical presentation of a stye
acute, painful localised swelling near the eyelid margin
management of stye
warm compresses to encourage it to drain
usually resolves within 5-7 days
