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Acute red eye Flashcards

1
Q

What is bacterial conjunctivitis?

A

Inflammation of the conjunctiva (Outer layer of the eye, surrounding sclera) caused by bacterial infection

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2
Q

What is the most common cause of acute red eye?

A

Conjunctivitis

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3
Q

What are some causes of bacterial conjunctivitis in neonates?

A
  • Staphylococcus aureus
  • Neisseria gonorrhoea
  • Chlamydia trachomatis
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4
Q

What are some bacterial causes of conjunctivitis in children and adults?

A
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • Haemophilus influenza (Especially in children)
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5
Q

How does bacterial conjunctivitis present?

A
  • Inflammation (swelling, redness, pain, heat)
  • Gritty irritation/itchiness
  • Morning crusting
  • Copious mucopurulent yellow discharge
  • Does not cause pain, photophobia or reduced visual acuity
  • Abrupt onset
  • Spreads to both eyes within 48 hours
  • Papillae
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6
Q

How is bacterial conjunctivitis investigated?

A

If suspect infective aetiology, swab for culture - bacterial, chlamydial, viral

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7
Q

How should bacterial conjunctivitis be managed initially?

A

Topical broad spectrum antibiotic - Chloramphenicol

Treats most bacteria except pseudomonas

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8
Q

How is bacterial conjunctivitis managed if unresponsive to topical broad spectrum antibiotics?

A

Staph. aureus - Fusidic acid
Coliforms and pseudomonas - Gentamicin

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9
Q

What is viral conjunctivitis?

A

Inflammation of the conjunctiva (Outer layer of the eye, surrounding sclera) caused by viral infection

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10
Q

What are some causes of viral conjunctivitis?

A
  • Adenovirus (most common)
  • Herpes simplex
  • Herpes zoster
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11
Q

How does viral conjunctivitis present?

A
  • Inflammation (Swelling, redness, pain, heat)
  • Gritty irritation/itchiness
  • Does not cause pain, photophobia or reduced visual acuity
  • Sudden onset, rapidly progressive
  • Typically bilateral, often manifests in one eye before spreading to the other
  • Some patients will have associated URT - dry cough, sore throat and blocked nose
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12
Q

How does adenovirus conjunctivitis present?

A

Watery discharge

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13
Q

How does herpes simplex conjunctivitis present?

A

Cutaneous vesicles develop on the eyelids and on the skin around the eyes

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14
Q

How does herpes-zoster conjunctivitis present?

A

Shingles rash

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15
Q

What is shown?

A

Viral conjunctivitis - Adenovirus

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16
Q

What is shown?

A

Viral conjunctivitis - Herpes simplex

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17
Q

What is shown?

A

Herpes-Zoster (Shingles)

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18
Q

How is viral conjunctivitis investigated?

A

If suspect infective aetiology, swab for culture - bacterial, chlamydial, viral

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19
Q

How is adenovirus conjunctivitis managed?

A

Lubrication, cold compress (self-limiting)

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20
Q

How is herpes (Zoster or Simplex) managed?

A

Antivirals e.g. ganciclovir

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21
Q

What is a possible complication of herpes simplex conjunctivitis?

A

Dendritic ulcer (50% of patients)

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22
Q

How will chlamydial conjunctivitis present?

A
  • Often chronic history unresponsive to treatments
  • Suspect in bilateral conjunctivitis in YAs
  • May or may not have symptoms of urethritis, vaginitis
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23
Q

How can chlamydial conjunctivitis be passed?

A

From mother to newborn

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24
Q

How is chlamydial conjunctivitis managed?

A
  • Topical oxytetracycline
  • Adults may need oral azithromycin for genital chlamydia infection
  • Need contact tracing
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25
Q

What is a possible complication of chlamydial conjunctivitis?

A

Subtarsal scarring

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26
Q

What are some causes of allergic conjunctivitis?

A

Most cases seasonal as a result of pollen allergy, can occur due to allergens e.g. animal dander

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27
Q

How does allergic conjunctivitis present?

A
  • Watery, itchy eyes
  • Bilateral and symmetrical ocular involvement with global injection and chemosis
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28
Q

How is allergic conjunctivitis managed?

A
  • Avoid triggers
  • Cool compresses, oral/topical antihistamines for symptomatic relief
  • Once control achieved - maintenance with a mast cell stabiliser (e.g. sodium cromoglycate)
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29
Q

What is scleritis?

A

Full thickness inflammation of the sclera; more serious than episcleritis

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30
Q

What are some associations with scleritis?

A

Autoimmune conditions - RA, SLE, IBD, Sarcoidosis, GPA
Surgery
Infection

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31
Q

How will scleritis present?

A
  • Severe pain that progresses over several days
  • Pain with eye movement
  • Photophobia
  • Eye watering
  • Reduced visual acuity
  • Abnormal pupil reaction to light
  • Tenderness to palpation of the eye
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32
Q

What is shown?

A

Scleritis

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33
Q

How is scleritis managed?

A
  • Oral NSAIDs
  • Oral steroids + steroid sparing agents
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34
Q

What is the episclera?

A

The thin vascular sheet which lies between the conjunctiva and sclera

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35
Q

What is episcleritis?

A

Inflammation of the episclera; more superficial and less severe than scleritis

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36
Q

What causes episcleritis?

A
  • Idiopathic (Usually therefore self-limiting)
  • Systemic disease - IBD, RA, Sarcoidosis
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37
Q

How does episcleritis present?

A
  • Typically not painful but there can be mild pain
  • Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera.
  • Foreign body sensation
  • Dilated episcleral vessels
  • Watering of eye
  • No discharge
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38
Q

What is shown?

A

Episcleritis

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39
Q

How is episcleritis managed?

A

Self limiting - lubricants and cold compresses, topical NSAIDs, mild steroids

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40
Q

What is keratitis?

A

Inflammation of the cornea

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41
Q

What is a hypopiyn?

A

A hypopyon is an aggregation of inflammatory cells within the anterior chamber resulting in visible ‘sediment’ in front of the eye inferiorly

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42
Q

What is shown?

A

Hypopyon

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43
Q

What is shown?

A

Hypopyon

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44
Q

What types of organism can cause bacterial keratitis?

A

Both gram +ve and -ve bacteria

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45
Q

How does bacterial keratitis present?

A
  • Photophobia
  • Severe ocular pain and associated foreign body sensation
  • Hypopyon
  • Usually associated with other corneal pathology or contact lens wearing
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46
Q

What investigations are required in bacterial keratitis?

A
  • Examination - anaethetics if photophobic, fluorescein, corneal reflex
  • Corneal scrape for gram stain and culture
    • In acanthamoeba ketatitis also culture contact lens
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47
Q

How is bacterial keratitis managed?

A
  • Patient needs to be admitted for hourly antibiotic drops, patients require daily review
    • Ofloxin - treats most gram negatives
    • Gentamicin and cefuroxime - treats most gram positive and gram negative organisms
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48
Q

What is adenovirus keratitis?

A

Inflammation of the cornea caused by adenovirus

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49
Q

How does adenovirus keratitis present?

A
  • Bilateral inflammation
  • Following URTI or conjunctivitis
  • May affect vision
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50
Q

What is shown?

A

Adenoviral keratitis

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51
Q

How is adenovirus keratitis managed?

A
  • Normally self-limiting
  • Can require steroids if chronic
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52
Q

What are some causes of viral keratitis?

A

Adenovirus
Herpes-Simplex virus

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53
Q

How does herpetic keratitis present?

A
  • Dendritic ulcer
  • Very painful
  • Can be recurrent
  • Recurrences eventually result in reduced sensation
54
Q

What is shown?

A

Dendritic ulcer - Herpetic keratitis

55
Q

How is herpetic keratitis managed?

A
  • Treated with topical antiviral (ganciclovir)
  • DO NOT treat with steroids - can cause corneal melt and perforation of the cornea
56
Q

How does fungal keratitis present?

A
  • Often chronic history
  • Seen in those who work outside or have ocular surface disease
  • Often corneal lesions more defined than its bacterial counterpart
  • Often diagnosed late
57
Q

What is shown?

A

Fungal keratitis

58
Q

How is fungal keratitis managed?

A

Topical anti-fungals

59
Q

What causes acanthamoeba keratitis?

A

Acanthamoeba

60
Q

How does acanthamoeba keratitis present?

A
  • Most often seen in contact lens wearers
  • Often extremely painful
  • Can be diagnosed late
61
Q

What is shown?

A

Acanthamoeba keratitis

62
Q

How is acanthamoeba keratitis managed?

A

Anti-amoebic drops

63
Q

What is anterior uveitis?

A

Inflammation in the anterior part of the uvea; the uvea involves the iris, ciliary body and choroid

64
Q

How does anterior uveitis occur?

A

Inflammation and immune cells in the anterior chamber of the eye, usually caused by:
- Autoimmune process
- Infection
- Trauma
- Ischaemia
- Malignancy

65
Q

What are some autoimmune causes of anterior uveitis?

A
  • Reiter’s
  • Ulcerative colitis
  • Ankylosing spondylitis
  • Sarcoidosis
66
Q

What are some infective causes of anterior uveitis?

A
  • TB
  • Syphilis
  • Herpes simplex, herpes zoster
67
Q

What is a malignancy that can cause anterior uveitis?

68
Q

What are some other causes of anterior uveitis?

A
  • Idiopathic
  • Traumatic
  • Secondary to other eye disorders
69
Q

What are some symptoms of anterior uveitis?

A
  • Unilateral and spontaneous
  • Flare of associated disease
  • Dull, aching, painful red eye
  • Vision reduced
  • Photophobia
70
Q

What are some clinical signs of anterior uveitis?

A
  • Circumcorneal red eye
  • Ciliary injection
  • Keratic precipitates
  • Hypopyon
  • Synechiae
  • Cells and flare in anterior chamber
71
Q

What is synechiae?

A

Small or irregular pupil due to adhesions pulling the iris into abnormal shapes

72
Q

What is shown?

A

Anterior uveitis

73
Q

What is shown?

A

Keratin precipitates - Anterior uveitis

74
Q

What is shown?

A

Synechiae - Anterior uveitis

75
Q

What is shown?

A

Flare in anterior chamber - Anterior uveitis

76
Q

What is shown?

A

Cells in anterior chamber - Anterior uveitis

77
Q

How is anterior uveitis managed?

A
  • Topical steroids
  • Mydriatics
  • Investigate for systemic associations if recurrent or chronic
78
Q

What is cellulitis?

A

Bacterial infection of the lower dermis and subcutaneous tissue

79
Q

What are the 2 forms of cellulitis affecting the eye?

A

Pre-septal cellulitis
Orbital cellulitis

80
Q

What is pre-septal cellulitis?

A

Infection of the eyelid and surrouding skin anterior to the orbital septum

81
Q

What causes pre-septal cellulitis?

A

Usually caused by contiguous spread of infection from local facial or eyelid trauma e.g. insect bites

82
Q

How does pre-septal cellulitis present?

A

Tenderness, warmth, swelling, redness of the eyelid

83
Q

What is shown?

A

Pre-septal cellulitis

84
Q

How is pre-septal cellulitis managed?

A

Antibiotics (can be outpatient if orbital cellulitis definitively excluded)

85
Q

What is orbital cellulitis?

A

Infection of the orbital tissues posterior to orbital septum

86
Q

How does orbital cellulitis occur?

A
  • Direct extension from sinus
  • Extension from focal orbital infection
  • Post-operative
87
Q

What are some causative organisms of orbital cellulitis?

A
  • Staphylococci
  • Streptococci
  • Coliforms
  • H. influenzae
  • Anaerobes
88
Q

What are some clinical features of orbital cellulitis?

A
  • Painful, especially on eye movements
  • Proptosis
  • Often associated with paranasal sinusitis
  • Pyrexial
  • Sight threatening
89
Q

What is shown?

A

Orbital cellulitis

90
Q

What are some investigations required in orbital cellulitis?

A
  • CT scan to identify orbital abscesses
  • If any suggestion of muscle restriction or optic nerve dysfunction - CT scan
91
Q

How is orbital cellulitis managed?

A
  • Broad spectrum antibiotics and monitor closely
  • Sometimes an abscess will require drainage
92
Q

What is endophthalmitis?

A

Devastating infection inside of the eye that threatens sight

93
Q

What causes endophthalmitis?

A

Post-surgical or endogenous

94
Q

What are some causative organisms in endophthalmitis?

A

Often conjunctival commensal bacteria, most common causative organism is Staph. epidermidis

95
Q

How does endophthalmitis present?

A
  • Very painful
  • Decreasing vision
  • Very red eye
96
Q

What is shown?

A

Endophthalmitis

97
Q

What is shown?

A

Endophthalmitis

98
Q

What investigation is required in endophthalmitis?

A

Aqueous/vitreous for culture

99
Q

How is endophthalmitis managed?

A

Intravitreal amikacin/ceftazidime/vancomycin and topical antibiotics

100
Q

What is blepharitis?

A

Common chronic inflammatory condition affecting the margin of the eyelids

101
Q

When does blepharitis most commonly occur?

A

In middle-age

102
Q

What are the 2 main forms of blepharitis?

A

Anterior
Posterior

103
Q

What is anterior blepharitis?

A

Inflammation of the base of the eyelashes (located on the anterior margin of the eyelid)

104
Q

What are some causes of anterior blepharitis?

A
  • Bacteria - Staphylococcal blepharitis
  • Seborrhoeic dermatitis - Seborrhoeic blepharitis
105
Q

How can seborrhoeic and staphylococcal blepharitis be differentiated?

A

Seborrhoeic blepharitis has less inflammation but causes more excess oil or greasy scaling

106
Q

What is posterior blepharitis?

A

Inflammation of the meibomian glands (often called meibomian gland dysfunction)

107
Q

What are the meibomian glands?

A
  • The meibomian glands are a set of glands that run along the posterior eyelid margin
  • They produce a lipid secretion which provides the lipid layer of the tear film
108
Q

What are some symptoms of blepharitis?

A
  • Burning, itching and/or crusting of the eyelids
  • Symptoms are worse in the mornings
  • Both eyes are affected
  • Recurrent hordeolum
  • Contact lens intolerance
109
Q

What are some signs of anterior blepharitis?

A

Lid margin redder than deeper part of lid

110
Q

What are some signs of posterior blepharitis?

A

Redness is in deeper part of lid, lid margin often looks normal

111
Q

How is blepharitis managed?

A
  • Symptoms can usually be controlled with self-care measures such eyelid hygiene and warm compresses
  • Treat associated condition e.g. supplementary tear drops for dry eye syndrome
112
Q

How is blepharitis managed if it does not respond to symptom control methods?

A

Consider prescribing topical cloramphenicol for anterior blepharitis or oral doxycycline for posterior blepharitis

113
Q

What are some complications of blepharitis?

A
  • Stye (hordeolum)
  • Chalazion
114
Q

What is another name for a meibomian cyst?

115
Q

What is a meibomian cyst?

A

Sterile, chronic, inflammatory granuloma of the eyelid caused by a foreign body reaction to sebum within a meibomian gland

116
Q

What are some risk factors for meibomian cyst formation?

A

Pregnancy
Blepharitis
Seborrhoeic dermatitis

117
Q

How do meibomian cysts form?

A
  1. Gland obstruction
  2. Enlargement of the gland
  3. Rupture of the gland, causing the release of accumulated lipid contents into the surrounding tissue
  4. Triggered inflammatory reaction
  5. Cyst formation
118
Q

How does a meibomian cyst present?

A

Firm, painless, localized eyelid swelling that has developed slowly over several weeks

119
Q

What is shown?

A

Meibomian cyst

120
Q

How is meibomian cyst managed?

A
  • Warm compresses for several weeks
  • Most meibomian cysts resolve spontaneously or with conservative managment, although this may take weeks or months
  • Management of any co-existing risk factors to reduce risk of recurrence
121
Q

What is another name for a stye?

122
Q

What is a stye?

A

Acute localized infection or inflammation of the eyelid margin, usually caused by staphylococcal infection

123
Q

What are the 2 types of stye?

A

External
Internal

124
Q

What is an external stye?

A

Appears on theeyelid margin, caused by infection of an eyelash follicle or associated gland

125
Q

What is an internal stye?

A

Occurs on the conjunctival surface of the eyelid, caused by infection of a Meibomian gland

126
Q

What are some risk factors for stye formation?

A

Chronic blepharitis
Acne rosacea

127
Q

How does a stye present?

A
  • An acute-onset painful, localized swelling (papule or furuncle) near the eyelid margin that develops over several days
  • Usually unilateral but can be bilateral
128
Q

What is shown?

A

External stye

129
Q

What is shown?

A

Internal stye

130
Q

How is a stye managed?

A
  • Symptoms typically resolve within 5–7 days, once the stye has spontaneously ruptured or been drained
  • Warm compresses can be used to encourage the stye to drain
131
Q

What is an immune privilege site?

A

Areas in which foreign antigens can preside without immune detection, making them perfect sites for grafting or research

Corneal grafts therefore can be performed without systemic immunosuppression

132
Q

What are some immune privilege sites?

Ophthalmology (9 decks)

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