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Duke Elder: Finals Ophthalmology (Alice) > Acute red eye > Flashcards

Acute red eye Flashcards

1
Q

What are 8 causes of the acute red eye?

A
  1. conjunctivitis: bacterial, viral, allergic, chlamydia
  2. keratitis: bacterial, viral, marginal
  3. episcleritis/ scleritis
  4. Acute anterior uveitis/ iritis
  5. Angle closure glaucoma
  6. eyelid causes e.g. blepharitis, stye
  7. orbit causes
  8. trauma
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2
Q

What are 7 diseases that can affect the eyelids causing the acute red eye?

A
  1. blepharitis
  2. Meibomian cyst
  3. stye
  4. herpes simplex
  5. molluscum contagiosum
  6. herpes zoster ophthalmicus
  7. entropion
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3
Q

What is blepharitis?

A

chronic inflammation of the eyelid margins

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4
Q

What are the 2 most common bacterial causes of blepharitis?

A

Usually staph aureus or epidermidis

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5
Q

What is blepharitis commonly associated with that contributes to its cause?

A

skin disease: acne rosacea, seborrheic dermatitis

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6
Q

What are the symptoms of blepharitis?

A

sore, gritty, and occasionally red eyes

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7
Q

What are 4 things that examination will reveal in blepharitis?

A
  1. hyperaemic lid margins
  2. crusts on lashes
  3. blocked meibomian gland orifices
  4. meibomian cysts
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8
Q

What is a stye?

A

= hordeolum, infected hair follicle

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9
Q

What are 5 aspects of the treatment of blepharitis?

A
  1. lid hygiene
  2. warm compresses - gentle expression of lipids with cotton tipped applicator; gentle lid cleaning with a solution of sodium bicarbonate
  3. antibiotic ointment e.g. chloramphenicol onto lid margin
  4. lubricant
  5. low dose tetracyclines - antibiotics that are lipid soluble, protease inhibitors (e.g. doxycycline and tetracycline)
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10
Q

What is entropion?

A

inturning of the lower lid

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11
Q

What is ectropion?

A

eversion of the lower eyelid

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12
Q

What is herpes zoster ophthalmicus?

A

shingles; in ophthalmic branch of trigeminal nerve which serves forehead/ top of face, eye, down to tip of nose on that side

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13
Q

What are 5 types of conjunctivitis?

A
  1. cicratising
  2. bacterial
  3. viral
  4. allergic
  5. chlamydial
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14
Q

What is are the 3 commonest causes of bacterial conjunctivitis?

A

usually staphylococcus, streptococcus or haemophilus species

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15
Q

What symptoms will you get in bacterial conjunctivitis?

A

slight discomfort, red, sticky eyes (purulent discharge, eyelids sticking together), visual acuity not affected although slight blurring due to prurulent exudation, which clears when discharge blinked away

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16
Q

What is the treatment of bacterial conjunctivitis?

A

Note: most self limiting and resolve in 5-7 days without treatment. Can do delayed antibiotic treatment
1. frequent antibiotic drops - chloramphenicol, 2-hourly for 2 days then 4-hourly for 5 days.
2. another option is chloramphenicol ointment 1%, 4x daily for 2 days then 2x daily for 5 days
3. fusidic acid 1% eye drops 2nd line, 2x daily for 7 days
general hygiene by not sharing towels etc.

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17
Q

Symptoms of viral conjunctivitis

A

red, watery eyes, gritty, uncomfortable feeling

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18
Q

What are 6 aspects of a viral conjunctivitis examination

A
  1. vision unaffected unless cornea involved
  2. generalised conjunctival infection with watery discharge
  3. follicles (lymphoid aggregates) in tarsal conjunctiva (covers inner surface of eyelids)
  4. petechial conjunctival haemorrhages
  5. enlarged pre-auricular lymph node
  6. associated upper respiratory tract infection
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19
Q

Which type of conjunctivitis may have an associated upper respiratory tract infection?

A

Viral conjunctivitis

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20
Q

Which lymph node may be enlarged in viral conjunctivitis?

A

pre-auricular lymph node

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21
Q

What is a risk of viral conjunctivitis being highly contagious?

A

risk of epidemics, including nocosomial (originating in hospital) transfer

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22
Q

how long may viral conjunctivitis last?

A

several weeks

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23
Q

What is a possible complication of viral conjunctivitis?

A

small corneal opacities leading to photophobia and reduced vision (not seen in bacterial conjunctivitis)

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24
Q

What is the treatment for viral conjunctivitis?

A
  • nil, advise it’s self limiting; sterile saline or boiled and cooled water to bathe eye, cool compresses, lubricating eye drops
  • ?antibiotic drops to prevent secondary antibiotic infection
  • general hygiene not sharing towels, washing hands, avoiding close contact with others etc.
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25
Q

what is the classical presentation of chlamydial conjunctivitis?

A

unilateral conjunctivitis in a young male

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26
Q

What are 8 symptoms of chlamydial conjunctivitis?

A
  1. red eye
  2. watery eye
  3. vision unaffected
  4. gritty, foreign body sensation.
  5. history usually for at least 2 weeks.
  6. oedema, mechanical ptosis
  7. sticky discharge
  8. usually unilateral
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27
Q

What kind of illness could chlamydial conjunctivitis lead to and why?

A

chronic illness, due to follicular reaction

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28
Q

Who usually gets chalmydial conjunctivitis? 2 groups

A
  1. usually young adults as is sexually acquired

2. neonates (ophthalmia neonatorum due to chlamydia in birth canal)

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29
Q

What is the treatment for chlamydial conjunctivitis?

A

systemic antibiotics: single dose of azithromycin or short course of doxycycline. liaison with GUM clinic and treat sexual partners, test for other STIs

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30
Q

What is the onset like of allergic conjunctivitis?

A

acute onset

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31
Q

What are the symptoms in acute conjunctivitis?

A

red, itchy eyes; chemosis (conjunctival oedema), vision unaffected

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32
Q

What kind of reaction is allergic conjunctivitis?

A

Type I hypersensitivity reaction; seasonal, perennial

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33
Q

How does allergic conjunctivitis often settle?

A

spontaneously/ removal of allergen

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34
Q

What is cicatrising conjunctivitis?

A

conjunctivitis that causes scarring

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35
Q

what are 3 physical causes of cicatrising conjunctivitis?

A

physical causes:

  1. heat
  2. ionising radiation
  3. chemical injury
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36
Q

What are 2 types of drug-induced cicatrising conjunctivitis?

A

topical or systemic

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37
Q

What are 2 infectious causes of cicatrising conjunctivitis?

A
  1. trachoma

2. membranous conjunctivitis (bacterial and viral)

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38
Q

What are 4 oculocutaneous disorders that can cause cicatrising conjunctivitis?

A
  1. stevens-johnson syndrome
  2. toxic epidermal necrolysis
  3. mucous membrane pemphigoid
  4. chronic atopic kerato-conjunctivitis
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39
Q

What are 2 types of tumours that could cause cicatrising conjunctivitis?

A

squamous and sebaceous cell carcinomas

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40
Q

What are 6 broad types of causes of cicatrising conjunctivitis?

A
  1. physical causes
  2. infectious causes
  3. oculocutaneous causes
  4. systemic disorders
  5. tumours
  6. drug-induced
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41
Q

What are 4 systemic disorders that are associated with cicatrising conjunctivitis?

A
  1. acne rosacea
  2. sjögren’s syndrome
  3. inflammatory bowel disease
  4. immune complex disease
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42
Q

What are the three broad types of keratitis?

A
  1. autoimmune
  2. bacterial
  3. viral
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43
Q

What is bacterial keratitis?

A

bacterial infection of the cornea - ophthalmic emergency

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44
Q

What is the cause of bacterial keratitis?

A

large range of gram positive (pseudomonas, staphylococcus or streptococcus) or negative organisms

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45
Q

What are 4 predisposing factors to bacterial keratitis?

A
  1. corneal abrasion
  2. contact lenses (usually soft extended wear)
  3. topical steroids
  4. corneal anaesthesia e.g previous herpes zoster ophthalmicus
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46
Q

What are the clinical symptoms of bacterial keratitis?

A

red, sticky eye, pain, reduced vision, photophobia

47
Q

What 3 things will you find on examination in bacterial keratitis?

A
  1. conjunctival injection with purulent discharge
  2. corneal abscess (yellow/white area on cornea)
  3. may be activity (cells) in anterior chamber
48
Q

What are three possible complications of bacterial keratitis?

A
  1. severe sight-threatening intraocular infection (endophthalmitis)
  2. corneal perforation
  3. loss of eye
49
Q

What is the treatment for bacterial keratitis? 4 key aspects

A
  1. Admit
  2. Perform corneal scrape
  3. Gram stain, culture and sensitivities.
  4. First, sterilisation phase of management and then healing phase
50
Q

What happens during the sterilisation phase of management of bacterial keratitis?

A
  • hourly antibiotic, usually monotherapy with a fluoroquinolone day and night for 2 days
  • hourly antibiotics by day for 3 days
  • cycloplegics to paralyse the ciliary muscle of the eye
  • intraocular hypotensives
  • sub-conjunctival injections to be avoided
51
Q

What happens during the healing phase of bacterial keratitis treatment?

A

healing retarded in persistent inflammation; judicious use of topical glucocorticoids, treat ocular surface disease (dry eye, entropion, blepharitis)

52
Q

What is the commonest cause of viral keratitis?

A

herpes simplex type I

53
Q

What are the symptoms of viral keratitis?

A

reduced vision, unilateral red eye, pain, photophobia

54
Q

What would you find on an examination in viral keratitis? 3 key findings.

A
  1. conjunctival injection
  2. classical branching dendritic (epithelial) ulcer staining with fluoroscein
  3. reduced corneal sensation
55
Q

What are 5 possible complications of viral keratitis?

A
  1. corneal scarring
  2. may affect deeper corneal layers e.g. stroma (disciform keratitis)
  3. corneal perforation
  4. secondary bacterial infection
  5. ulcer
56
Q

Why musn’t you use steroids in viral keratitis?

A

geographical ulceration

57
Q

What is the treatment for viral keratitis?

A

antiviral ointment e.g. ganciclovir 0.15% gel - tapering over a few weeks. dilate pupil

58
Q

What are the causes of autoimmune keratitis?

A

idiopathic or related to systemic diseases

59
Q

What kind of keratitis do you get if it is autoimmne?

A

dry eye and ulcerative keratitis

60
Q

What are 2 causes of ulcerative autoimmune keratitis?

A
  1. systemic vasculitides - rheumatoid arthritis, SLE, PAN, GPA
  2. dermatological conditions - acne rosacea, topical kerato-conjunctivitis
61
Q

What are 3 causes of scleritis?

A
  1. Idiopathic:
  2. Infective: herpes zoster
  3. Systemic disease: collagen vascular disease (e.g. rheumatoid arthritis, ankylosing spondylitis, SLE, GPA, polyarteritis nodosa), IBD, sarcoidosis, gout
62
Q

What is scleritis?

A

inflammation of the outer (white) coat of the eye and can be a severe destructive, sight-threatening disease

63
Q

What kind of scleritis is commonest?

A

anterior scleritis is commonest but posterior involvement also occurs

64
Q

What 3 groups is anterior scleritis sub-divided into?

A
  1. diffuse
  2. nodular
  3. necrotising
65
Q

what is the most common cause of scleritis?

A

idiopathic

66
Q

What proportion of scleritis is associated with a connective tissue or vasculitis disease and what is the commonest?

A

25%; rheumatoid arthritis

67
Q

What are 4 types of infections that can cause scleritis?

A
  1. herpes zoster
  2. varicella zoster
  3. acanthamoeba
  4. bacterial endotoxins
68
Q

What are the symptoms of scleritis?

A

pain (may be so severe it wakes patient up at night), red eye(s), may be recurrent

69
Q

What are 3 possible findings on examination of scleritis?

A
  1. deep red colouration of anterior sclera - may be diffuse or localised
  2. visual acuity may be normal
  3. scleral thinning associated with bluish/black discolouration from underlying uveal tissue
70
Q

What is the treatment of scleritis?

A

oral NSAIDs for mild cases, topical steroids as supplementary therapy, oral prednisolone/ pulsed immunosuppression for severe cases, biologics e.g. TNF-alpha inhibitors, refer to rheumatologist if necessary. investigate for/treat underlying cause

71
Q

What are the 2 kinds of intraocular infection?

A

endophthalmitis

uveitis

72
Q

What is acute anterior uveitis (iritis)?

A

inflammtion of the iris

73
Q

What is generally the cause of acute anterior uveitis?

A

majority unknown; as 50% of patients are HLA B27 positive think there’s an association with ankylosing spondylitis

74
Q

What are the symptoms of acute anterior uveitis? (5 key things)

A
  1. red eye (usually unilateral)
  2. acute pain
  3. blurred vision (due to precipitates in aqueous)
  4. photophobia
  5. lacrimation (no discharge, not sticky)
75
Q

What is the only way uveitis can be accurately diagnosed?

A

with the aid of a slit lamp

76
Q

What are 6 things that might be found on examination in acute anterior uveitis (consult images)

A
  1. circumcorneal conjunctival injection (due to ciliary congestion)
  2. keratic precipitates (inflammatory cells) on corneal endothelium
  3. flare (albumin leakage from iris vessels)
  4. inflammatory cells in anterior chamber - hypopyon if severe
  5. miosis (due to iris spasms and adhesions)
  6. posterior synechiae (adhesions between iris and lens)
77
Q

what are three potential complications of anterior uveitis?

A
  1. may be associated with raised IOP
  2. may become chronic and develop secondary cataract with/without macular oedema leading to reduced vision
  3. likely to recur in either eye
78
Q

What is the treatment of acute anterior uveitis? 3 aspects

A
  1. dilate pupil to prevent ciliary spasm and break posterior synechiae.
  2. intensive topical steroids, initially 1-2 hourly then gradually reduce over the next 3-6 weeks.
  3. in severe cases a subconjunctival injection of steroid with/without mydicaine (dilating agent) is necessary
79
Q

What are the 2 types of raised IOP?

A
  1. some secondary glaucomas

2. angle-closure glaucoma

80
Q

What is usually the presentation of acute angle closure glaucoma?

A

usually sudden (hours) painful visual loss

81
Q

What are the primary and secondary causes of AACG?

A

primary: hypermetropia (commonest)
secondary: hypermature (swollen) cataract

82
Q

What are 5 things you would find on examination in AACG?

A
  1. reduced vision
  2. red eye(s)
  3. corneal oedema
  4. mid-dilated, oval pupil
  5. closed aqueous drainage angle (on gonioscopy)
83
Q

What is a possible complication of AACG?

A

blind eye(s)

84
Q

What is the approach to treatment of AACG?

A

initially medical treatment to lower IOP then laser or surgery is required to allow aqueous outflow

85
Q

What is the medical treatment of AACG? 3 aspects

A

acetazolamide oral/IV, pilocarpine drops, IV hypertonic mannitol

86
Q

What kind of laser treatment can be given in AACG?

A

YAG laser/ iridotomy

prophylactic laser/surgery also performed on unaffected eye to prevent an attack occurring at a later date

87
Q

What kind of surgery can be done in AACG?

A

surgical peripheral iridectomy, lensectomy

88
Q

What are 2 kinds of disease you can get in the orbit?

A
  1. orbital inflammatory disease

2. orbital cellulitis

89
Q

How dangerous is orbital cellulitis?

A

life-threatening i.e. very

90
Q

What will orbital cellulitis present like? 7 key features

A
  1. red oedematous conjunctiva
  2. reduced eye movements,
  3. PROPTOSIS,
  4. reduced vision (optic nerve involvement).
  5. unwell patient
  6. often associated with adjacent sinusitis
  7. (colour vision reduced and RAPD present in severe cases)
91
Q

What is post-septal cellulitis?

A

affects the whole orbit

92
Q

What is the treatment of orbital cellulitis?

A

admit, blood tests which may include microbial culture, IV antibiotics, urgent CT scan, ENT opinion

93
Q

What are 2 kinds of trauma that can affect the eye

A

chemical and mechanical

94
Q

What are 3 examples of surface injuries in eye trauma?

A
  1. sub-conjunctival haemorrhage
  2. abrasions
  3. foreign bodies
95
Q

What can sub-conjunctival haemorrhage be a clue for?

A

serious underlying problem (but not serious in itself)

96
Q

What are 3 possible things that could be underlying sub-conjucntival haemorrhge?

A
  1. intraocular haemorrahges in non-accidental injury of childhood
  2. foreign bodies - may lodge on the tarsal surface of the upper lid
  3. Perforation underlying haemorrhage
97
Q

What is an abrasion on the eye?

A

loss of corneal epithelium from a foreign object e.g. child’s finger nail

98
Q

When should you suspect penetration of the eye globe?

A

if no foreign body seen especially after drilling with power tools, even if minor/ no symptoms and normal vision

99
Q

What investigation should you do if you suspect penetration of the eye globe?

A

X-ray to exclude radio-opaque intraocular foreign body

100
Q

What can the location of conjunctival injection (redness) tell you about the location of the problem?

A

intensity of injection around periphery suggests conjunctival inflammation whereas injection around cornea suggests corneal or intra-ocular injection (ie. not conjunctivitis)

101
Q

What is the common pathogenic cause of viral conjunctivitis?

A

Adenovirus

102
Q

What must the treatment of chlamydial conjunctivitis be and why?

A

Immediate treatment as needed to preserve eye sight, sight-threatening if not

103
Q

What can a possible treatment for allergic conjunctivitis be?

A

May respond to antihistamines

104
Q

what are 4 more specific groups of causes of anterior uveitis?

A
  1. Seronegative arthropathies: ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis, Reiter’s syndrome
  2. Infection: TB, syphilis, HIV, herpes zoster, toxoplasmosis, toxocariasis
  3. Autoimmune: sarcoidosis, Behcet’s
  4. Maliganncy: non-Hodgkin’s lymphoma, leukaemia, retinoblastoma, ocular melanoma
105
Q

What is the anterior uvea?

A

coloured iris and ciliary body

106
Q

What is the key test that can be used to diagnose anterior uveitis/iritis on examination?

A

Positive Talbot’s test - pain when eyes converge + pupil constricts while focusing on object e.g. finger moving towards nose

107
Q

What are the symptoms of scleritis?

A

severely deeply boring pain that wakes patient at night, lacrimation, photophobia

108
Q

What is episcleritis?

A

superficial irritation and inflammation of the episclera, a thin layer of tissue covering the sclera of the eye

109
Q

What are the causes of episcleritis?

A

idiopathic, collagen vascular disorder (RA)

110
Q

What are the symptoms of episcleritis?

A

asymptomatic or mild pain

111
Q

What is the management of episcleritis?

A

self-limiting in 1-2 weeks or topical corticosteroid eye drops to help resolve symptoms quicker

112
Q

What is another name for a style?

A

Hordeolum

113
Q

What is another name for a meibomian cyst?

A

Chalazion

114
Q

What is the difference between a hordeolum and a chalazion?

A

Hordeolum=stye, causes you infection, usually painful and occurs along outer rim of eyelid (but sometimes inner). Chalazion = meibomian cyst, usually not painful

Duke Elder: Finals Ophthalmology (Alice) (20 decks)

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