Acute Red Eye

Question 1

What is the most common cause of red eye?

Answer 1

conjunctivits

Question 2

In who is conjuctivitis more serious?

Answer 2

contact lens wearers

Question 3

Should you give antibiotics to patients with conjunctivitis?

Answer 3

No - unless chlamydia

Question 4

Is a Subconjunctival haemorrhage very serious?

Answer 4

No - benign

Question 5

Is orbital cellulitis a serious cause of red eye?

Answer 5

yes

Question 6

What is anterior blepharitis?

Answer 6

inflamed eyelids where lid margin redder than deeper part of lid

Question 7

What is posterior blepharitis?

Answer 7

inflamed eyelids where redness is in deeper part of lid

lid margin often quite normal looking

Question 8

What causes posterior blepharitis?

Answer 8

Meibomian gland dysfunction

M.G.D.

Question 9

What causes anterior blepharitis?

Answer 9

Seborrhoeic (squamous) scales on the lashes

Staphylococcal – infection involving the lash follicle

Question 10

What are signs of seborrhoeic blepharitis?

Answer 10

Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)

Question 11

What are signs of staphylococcal blepharitis?

Answer 11

lid margin red
Lashes distorted, loss of lashes, ingrowing lashes - trichiasis
Styes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)

Question 12

What is MGD associated with?

Answer 12

Acne Rosacea

Question 13

What are the signs of posterior blepharitis (MGD)?

Answer 13

Lid margin skin and lashes unaffected
M.G. openings pouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian Cysts (chalazia)

Question 14

Describe the treatment for blepharitis.

Answer 14

Lid hygiene – daily bathing / warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
Very difficult to eradicate

Question 15

List the main symptoms of conjunctivitis.

Answer 15

red eye
foreign body sensation – gritty eye
discharge – sticky eye
Itch = allergy

Question 16

Is vision affected in conjunctivitis?

Answer 16

no

Question 17

What is the pattern of red eye like in conjunctivitis?

Answer 17

diffuses more towards the fornices

Question 18

Which organisms most commonly cause bacterial conjunctivitis?

Answer 18

Staph. aureus, Str. pneumoniae, H. infuenzae

Question 19

Give examples of drugs which can lead to conjunctivitis.

Answer 19

propine, trusopt

Question 20

Which viruses can cause conjunctivitis?

Answer 20

adenovirus, herpes simplex, herpes zoster

Question 21

What is chemosis?

Answer 21

conjunctival oedema

Question 22

What are the layers of the cornea?

Answer 22

Epithelium
Stroma
Endothelium

Question 23

What is keratitis?

Answer 23

inflammation of cornea

Question 24

What are the bacterial causes of keratitis?

Answer 24

Viral
Fungal
Bacterial
Acanthamoeba

Question 25

What are the autoimmune causes of keratitis?

Answer 25

rheumatoid arthritis hypersensitivity e.g. marginal ulcers (+ rarely Wegener’s granulomatosis, polyarteritis etc)

Question 26

What are the symptoms of a corneal ulcer?

Answer 26

``` needle like severe pain Photophobia Profuse lacrimation Vision may be reduced Red eye - circumcorneal ```

Question 27

What are the signs of a corneal ulcer?

Answer 27

``` Redness – circumcorneal Corneal reflex (reflection abnormal) Corneal opacity Staining with fluorescein hypopyon ```

Question 28

What is a hypopyon?

Answer 28

inflammatory (WBCs) in anterior chamber of eye

Question 29

What is the difference between uveitis and iritis?

Answer 29

Nothing - they are the same thing

Question 30

What classic pattern is seen in herpes simplex eye infection?

Answer 30

dendritic ulcer (green spidery shape)

Question 31

Who may get corneal ulcers due to Vit A deficiency?

Answer 31

autistic patients - refusing to eat groups of food

Question 32

What is the treatment for a corneal ulcer?

Answer 32

Identify cause – ‘corneal scrape’ Antimicrobial if bacterial infection (ofloxacin) Antiviral if herpetic - Aciclovir Anti-inflammatory if autoimmune (Oral / topical steroids)

Question 33

What are the autoimmune causes of uveitis?

Answer 33

Reiter's, Ulcerative colitis, Ank Spondylitis, Sarcoidosis

Question 34

What are the infective causes of uveitis?

Answer 34

T.B. Syphylis, Herpes simplex, Herpes zoster

Question 35

What are the symptoms of uveitis?

Answer 35

Pain (+ referred pain) Vision may be reduced Photophobia Red eye (circumcorneal)

Question 36

Give the signs of uveitis.

Answer 36

``` Ciliary injection (i.e. circum-corneal ) Cells & flare in anterior chamber Keratic precipitates Hypopyon Synechiae Small/irregular pupils ```

Question 37

What is the treatment for uveitis?

Answer 37

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)

Question 38

What is Episcleritis associated with?

Answer 38

gout

Question 39

Does Episcleritis have serious complications?

Answer 39

No

Question 40

Is scleritis painful?

Answer 40

Yes

Question 41

What may be seen in scleritis?

Answer 41

Injection of deep vascular plexus – ‘violaceous hue’

Question 42

What is the treatment for scleritis?

Answer 42

Oral NSAIDs Oral Steroids Steroid Sparing Agents

Question 43

Who are likely to get an open angle closure glaucoma?

Answer 43

Long sighted old people

Question 44

What are signs of glaucoma?

Answer 44

Circumcorneal injection Cornea cloudy (oedematous) Pupil mid dilated Eye stony hard

Question 45

Symptoms of glaucoma?

Answer 45

severe pain | nausea