Acute red eye

Question 1

List some common (4) + uncommon (5) causes of red eye

+ Which of these need an urgent referral

Answer 1

Common:
Subconjunctival haemorrhage
Conjunctivitis
Foreign bodies
Corneal ulcer → urgent referral

Uncommon:
Acute glaucoma → urgent referral
Acute uveitis → urgent referral
Scleritis → urgent referral
Retrobulbar haemorrhage → urgent referral
Episcleritis

Question 2

What are some causes of subconjunctival haemorrhage? (5)

Answer 2

Post-op
Trauma
Aspirin/warfarin
Raised pressure (breathing disorders/URTI)
Leptospira (e.g. white water rafting lol)

Question 3

What are some causes of retrobulbar haemorrhage? (2)

And some complications? (4)

Answer 3

Iatrogenic (anaesthetic injection)
Trauma (head/optic floor)

Ptosis
Restricted eye movements
Optic nn compression + Blindness

Question 4

What is usually the cause of episcleritis?
How does it present?
How is it treated?

Answer 4

Autoimmune (e.g. collagen vascular disease + RA)

Localised red patch, mild pain + normal vision (severe pain = scleritis)

Steroid drops / NSAIDs

Question 5

How does conjunctivitis present in

1. Viral
2. Bacterial
3. Allergic

Answer 5

Gritty eyes, watery discharge + LNs + FOLLICULAR (lymphocytes)
Gritty eyes, purulent discharge + LNs

Itchy eyes, stringy discharge + no LNs + PAPILLAR

Question 6

Where does the lymph from lateral 1/2 of eye drain into?

And the medial 1/2?

Answer 6

Lateral → pre-auricular LNS

Medial → Submandibular LNs

Question 7

What are some causes of anterior uveitis? (2)

Answer 7

Autoimmune:
Ank Spon / Sarcoid / IBD

Infective:
HIV, Herpes, TB, syphilis

→ Often no cause found

Question 8

What signs/symptoms would be seen in anterior uveitis? (4)

Answer 8

Red eye → circumcorneal/ciliary congestion
Reduced acuity → Corneal haze (aqueous precipitates)

Constricted pupil
Synechiae (irreg iris due to lens adhesion)

Question 9

How is anterior uveitis treated?

Answer 9

Dilate pupil (counteracting disease)
Steroid

Question 10

How does a corneal abrasion/ulcer occur?
What are the symptoms? (3)
How is Dx made?
How is it treated?

Answer 10

Trauma/Foreign body
Ulcer w. keratitis (Immune Mediated) occurs if abrasion gets infected

Pain, Photophobia ± Vision Loss

Dx using fluorescin drops + blue light

Tx: chloramphenicol ointment (prophylactic if abrasion)

Question 11

What instances may a hypopyon occur? (3)

Answer 11

Corneal ulcer
Severe anterior uveitis
Post-op endophthalmitis

Question 12

How does herpes simplex keratitis present?

How is it managed?

Answer 12

Photophobia
Eye watering
Dendritic ulcer

Dx with fluorescin stain
Aciclovir drops (NOT steroids)