Acute red eye Flashcards
hat coniditons can cause a red eye?
Conjunctivitis Keratits Anterior uveitis Acleritis/Episcleritis Acute close angle glaucoma Subconjunctival haemorrhage Orbital disease (e.g. cellulitis)
What is the most common cause of a red eye?
Conjunctivitis
What is secreted from the lids in defence?
Mebomian
What is blepharitis?
Inflamed eyelids
What is a sty?
Staph infection involving the lash follicle
How do differentiate between anterior & posterior blepharitis?
Anterior - seborrhoeic scales on the lashed, lid margin redder than deeper part of lid
Posterior - redness is in deeper part of lid, lid margin often quite normal looking
What causes posterior blepharitis?
Meibomian gland dysfunction
Symptoms of blepharitis
Similar to conjunctivitis
Gritty eyes
Foreign body sensation
Mild discharge
What other causes of red eye is blepharitis associated with?
Conjunctivitis
Keratitis
Episcleritis
Signs of seborrhoeic anterior blepharitis
Lid margin red
Scales ++
Dandruff +
(No ulceration, lashes unaffected)
Sign of staphylococcal anterior blepharitis
Lid margin red Lashes distorted, loss of lashes, ingrowing lashes Styes ulcer of lid margin Corneal staining Marginal ulcers (due to axotoxin)
Signs of posterior blepharitis
Lid margin skin and lashes unaffected
MG openingspouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian cysts (chalazia)
What is posterior blepharitis associated with?
Acne Rosacea (50%) `
Management of Blepharitis
Lid hygiene - daily bathing/warm compresses
Supplementary tear drops
Oral doxycyine for 2-3 mnths
Infective causes of conjunctivitis
Viral
Bacterial
Chylamydial
Non-infective causes of conjunctivitis
Allergic
Chemical/drugs
Skin diseases - eczema
Symptoms of conjunctivitis
Red eye Foreign body sensation (gritty eye) Discharge - sticky eye Itch = allergy VISION UNAFFECTED
Signs of conjunctivitis
Red eye Discharge Papillae or follicles Sub conjunctival haemorrhage Chemosis
Which glands may be enlarged in viral conjunctivitis?
Pre-auricular glands
How long does acute bacterial conjunctivitis take to clear up without treatment?
14 days
What are the most common causative organism of acute bacterial conjunctivitis?
Staph. aureus
Strep. pneumoniae
H. influenzae
What causes follicular conjunctivitis?
Viral (adeno, HS, HZ)
Chlamydial
Drugs (e.g. propine, trusopt)
Causes of chronic conjunctivitis
Blepharitis
Chlamydial infection
Keratoconjunctivitis sicca
Lacrimal disease (chronic dacryocysitis)
Sensitivity to topical glaucoma medication
Sub-tarsal foreign body
How long does conjunctivitis have to last for to be termed chronic?
4 weeks
What are the 3 layers of the cornea?
Epithelium
Stroma
Endothelium
Causes of central cornea ulcers?
Viral
Fungal
Bacterial
Acanthamoeba
Causes of peripheral corneal ulcers
RA
Hypersensitivity e.g. marginal ulcers)
Symptoms of corneal ulcer
Pain + Photophobia Profuse lacrimation Vision may be reduced Circumcorneal red eye
Signs of corneal ulcer?
Redness Corneal reflex (reflection abnormal) Corneal opacity Staining with luroscein Hypopyon
Causes of exposure keratitis
Thyroid
VII palsy
In what condition does keratoconjunctivitis sicca occur?
Sjogren’s
What can cause neutrophic keratitis?
Herpes zoster V1
Deficiency of which vitamin can causes corneal ulcers?
Vitamin A
Investigation for corneal ulcers?
‘Corneal scrape’[ for gram stain & culture
Treatment of bacterial infected corneal ulcer?
Antimicrobial (e.g.ofloxacin hourly)
Treatment of herpetic corneal ulcer
Aciclovir ointment 5 x day
Autoimmune causes of anterior uveitis
Reiter’s
UC
Ankylosing spondylitis
Sarcoidosis
Infective causes of anterior uveitis
TB
Syphylis
Herpes Simplex
Herpes Zoster
Malignant cause of anterior uveitis
Leukemia
Symptoms of anterior uveitis
Achy pain (+ referred pain)
Vision may be reduced
Photophobia
Red eye (circumcorneal)
Signs of anterior uveitis
Ciliary injection Cells & flare in anterior chamber Keratic precipitates Hypopyn Synechia (small or irregular pupil)
Management of anterior uveitis
Topical steroids (pred forte 1% hourly tapering over 4-8 weeks)
Mydriatics
Investigate for systemic associations
What is episcleritis associated with?
Gout
Management of episcleritis
Self limiting
Lubricants/topical NSAIDs/ mild steroids
Which is more serious scleritis or episcleritis?
Scleritis
What is scleritis associated with?
Serious systemic vasculitides (e.g. RA, Wegners)
Presentation of scleritis
PAINFUL +
Injection of deep vascular plexus - violaceous hue
What other eye condition is scleritis commonly associated with?
Uveitis
What test can be used to confirm scleritis?
Phenylephrine test
Treatment of scleritis
Oral NSAIDs
Oral Steroids
Steroid sparing agents
WHat is acute closed angle galucoma?
IOP rises acutely due to drainage angle being closed
Features of glaucoma
Circumcorneal injection Cornea cloudy Pupil middilated Eye stony hard Severe pain + nausea
Which individuals are particularly predisposed to acute closed angle galucoma?
Elderly
Hypermetropic
What wrrants an urgent referral in a red eye?
Vision affected
Marked photophobia
