Acute red eye Flashcards
most common cause of an acute red eye
conjunctivitis/blepharo-conjunctivitis
causes of an acute red eye (5)
conjunctivitis/blepharo-conjunctivitis keratitis anterior uveitis scleritis/episcleritis AACG
the reduction in ocular defenses that parkinsons causes
decreased blink rate
procedure for examining IOP digitally =
in glaucoma feels like :
ptnt closes eyes and looks down
ballot eye either side of sup rectus
“stony hard”
inflamed eyelids aka
blepharitis
blepharitis where lid margin is redder than the deeper part of the lid =
two types and their distinguishing features =
anterior
Seborrhoeic (squamous) - scales on lashes
Staph - infection of lash follicle
posterior blepharitis is red in the ___ part of the lid
caused by
deeper
MGD - meibomian gland dysfunction
symptoms of blepharitis
gritty eyes
FB sensation
mild discharge - crusting
seborrhoeic blepharitis signs
lid margin red
++ scales
+ dandruff
no ulcers and lashes are unaffected
staph blepharitis signs
lid margin red
lashes distorted (teepee sign)/lost/ingrowing (trichiasis)
styes
ulcers
corneal staining and marginal ulcers (due to exotoxin)
trichiasis =
ingrowing of eyelashes
signs of posterior blepharitis
50% associated with
lid margin skin and lashes unaffected MG openings pouting and swollen inspissated secretion at gland openings chalazia 50% Rosacea (may=> corneal ulcers)
chalazia =
Rx =
meibomian cysts
LA and curettage
treatment to control blepharitis
daily bathing and warm compresses for lids
supplementary tear drops
PO doxycycline for 2-3months
causes of conjunctivitis (5)
infective(bac>viral>chlamydial) allergic chemical drugs skin eg eczema
sign of severe conjunctivitis - most commonly allergic –
chemosis
conjunctivitis causes a red eye that is ___ +___
more towards the fornicles
diffuse
discharge in viral conjunctivitis is __
in bacterial is ___
viral = serous bac = mucopurulent
papillae in conjunctivitis suggest a __ cause
bacterial
follicular conjunctivitis suggest a __/___ cause
viral or chlamydial
pre-auricular glands are seen in ___ conjunctivitis
viral
features of bacterial conjunctivitis
red and sticky eye
papillae
self limiting roughly 14 days
unilateral (then bilateral due to rubbing eye)
causes of bacterial conjunctivitis
S. aureus (most common)
Strep pneum
H. influ
papillae have ___ blood vessels
follicles look like ____ with ___ blood vessels
papillae = central follicles = grain of rice - peripheral
drugs that can cause a follicular conjunctivitis
propine
trusopt
causes of chronic conjunctivitis (6)
blepharitis chlamydia keratoconjunctivitis sicca lacrimal disease (chronic dacrocystitis) sensitivity to topical glaucoma Rx subtarsal FB
2 types of corneal ulcers and their causes
central/infective (viral, bactrerial, acanthamoeba, fungal)
peripheral/AI (RA, hypersensitivity, GPA)
s+s of keratitis (9)
needle sharp pain photophobia profuse lacrimation circumcorneal red eye maybe decreased vision abnormal corneal reflex corneal opacity stain with fluorescein hypopyon
exposure keratitis 2 causes
thyroid, CNIII paly cause ectropion
neurotrophic keratitis underlying problem =
causes =
tears not stimulated
diabetes
HZV
CNV1
___ deficiency can cause keratitis
caused by __/___ possibly
vit A
liver disease
bariatric Sx
Ix for keratitis
cornela reflex?
fluorescein
opacity/oedema/vascularisation on exam?
corneal scrape for gram stain and culture
treatment for bacterial keratitis
ofloxacin hrly for at least 48hrs
treatment for herpetic keratitis
aciclovir ointment for 5 days /PO
AI keratitis Rx
oral / topical steroids
causes of anterior uveitis
AI (ank spond, Reiters UC, Sarcoid) infective (tb, HS/Z, syphilis) leukaemia idiopathic trauma
s+s of anterior uveitis (8)
dull ache often referred to brow maybe reduced vision photophobia circumcorneal red eye cells and flare in anterior chamber keratic precipitates hypopyon synechiae
synechiae =
iris adheres to cornea => small/irregular pupil
ciliary injection => what sign?
circumcorneal red eye
Rx for anterior uveitis
topical steroids (Pred Forte 1% hrly - taper over 4-8wks) mydriatics (cyclophentolate 1% bd - breaks synechiae)
Rx to break synechiae
cyclophentolate 1% bd (mydriatic)
phenylephrine test result in episcleritis
vessels blanch
Rx for episcleritis
time
or lubricants/topical NSAIDS/mild steroids
episcleritis/scleritis is serious?
scleritis
scleritis is very ___, associated with __+___, ___ => violaceous hue
painful
uveitis and systemic vasculitides (eg. RA, GPA)
injection of deep vascular plexus
phenylephrine test result in scleritis
vessels are deeper and so dont blanch
Rx for scleritis
PO NSAIDs /
PO steroids /
steroid sparing agents
____ precipitates acute closed angle glaucoma and so it is worse at ___
pupil dilatation
night
s+s of acute closed angle glaucoma
severe pain may lead to nausea circumcorneal injection oedematous/cloudy cornea pupil mid dilated eye stony hard
at risk groups for AACG (2)
elderly hypermetropic (small orbit = less space)
