Acute Red Eye Flashcards
What is the most common cause of red eye?
conjunctivits
In who is conjuctivitis more serious?
contact lens wearers
Should you give antibiotics to patients with conjunctivitis?
No - unless chlamydia
Is a Subconjunctival haemorrhage very serious?
No - benign
Is orbital cellulitis a serious cause of red eye?
yes
What is anterior blepharitis?
inflamed eyelids where lid margin redder than deeper part of lid
What is posterior blepharitis?
inflamed eyelids where redness is in deeper part of lid
lid margin often quite normal looking
What causes posterior blepharitis?
Meibomian gland dysfunction
M.G.D.
What causes anterior blepharitis?
Seborrhoeic (squamous) scales on the lashes
Staphylococcal – infection involving the lash follicle
What are signs of seborrhoeic blepharitis?
Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)
What are signs of staphylococcal blepharitis?
lid margin red
Lashes distorted, loss of lashes, ingrowing lashes - trichiasis
Styes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)
What is MGD associated with?
Acne Rosacea
What are the signs of posterior blepharitis (MGD)?
Lid margin skin and lashes unaffected
M.G. openings pouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian Cysts (chalazia)
Describe the treatment for blepharitis.
Lid hygiene – daily bathing / warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
Very difficult to eradicate
List the main symptoms of conjunctivitis.
red eye
foreign body sensation – gritty eye
discharge – sticky eye
Itch = allergy
Is vision affected in conjunctivitis?
no
What is the pattern of red eye like in conjunctivitis?
diffuses more towards the fornices
Which organisms most commonly cause bacterial conjunctivitis?
Staph. aureus, Str. pneumoniae, H. infuenzae
Give examples of drugs which can lead to conjunctivitis.
propine, trusopt
Which viruses can cause conjunctivitis?
adenovirus, herpes simplex, herpes zoster
What is chemosis?
conjunctival oedema
What are the layers of the cornea?
Epithelium
Stroma
Endothelium
What is keratitis?
inflammation of cornea
What are the bacterial causes of keratitis?
Viral
Fungal
Bacterial
Acanthamoeba
What are the autoimmune causes of keratitis?
rheumatoid arthritis
hypersensitivity e.g. marginal ulcers
(+ rarely Wegener’s granulomatosis, polyarteritis etc)
What are the symptoms of a corneal ulcer?
needle like severe pain Photophobia Profuse lacrimation Vision may be reduced Red eye - circumcorneal
What are the signs of a corneal ulcer?
Redness – circumcorneal Corneal reflex (reflection abnormal) Corneal opacity Staining with fluorescein hypopyon
What is a hypopyon?
inflammatory (WBCs) in anterior chamber of eye
What is the difference between uveitis and iritis?
Nothing - they are the same thing
What classic pattern is seen in herpes simplex eye infection?
dendritic ulcer (green spidery shape)
Who may get corneal ulcers due to Vit A deficiency?
autistic patients - refusing to eat groups of food
What is the treatment for a corneal ulcer?
Identify cause – ‘corneal scrape’
Antimicrobial if bacterial infection (ofloxacin)
Antiviral if herpetic - Aciclovir
Anti-inflammatory if autoimmune (Oral / topical steroids)
What are the autoimmune causes of uveitis?
Reiter’s, Ulcerative colitis, Ank Spondylitis, Sarcoidosis
What are the infective causes of uveitis?
T.B. Syphylis, Herpes simplex, Herpes zoster
What are the symptoms of uveitis?
Pain (+ referred pain)
Vision may be reduced
Photophobia
Red eye (circumcorneal)
Give the signs of uveitis.
Ciliary injection (i.e. circum-corneal ) Cells & flare in anterior chamber Keratic precipitates Hypopyon Synechiae Small/irregular pupils
What is the treatment for uveitis?
Topical steroids - Pred Forte 1% Hourly tapering over 4-8 weeks
Mydriatics eg Cyclopentolate 1% BD
(Also investigate for systemic associations if recurrent or chronic)
What is Episcleritis associated with?
gout
Does Episcleritis have serious complications?
No
Is scleritis painful?
Yes
What may be seen in scleritis?
Injection of deep vascular plexus – ‘violaceous hue’
What is the treatment for scleritis?
Oral NSAIDs
Oral Steroids
Steroid Sparing Agents
Who are likely to get an open angle closure glaucoma?
Long sighted old people
What are signs of glaucoma?
Circumcorneal injection
Cornea cloudy (oedematous)
Pupil mid dilated
Eye stony hard
Symptoms of glaucoma?
severe pain
nausea
