Acute red eye Flashcards

1
Q

A 40-year-old man presents to the emergency department complaining of red eye without purulent discharge. He also has pain, photophobia, blurred vision, and tearing. On slit-lamp examination, the attending ophthalmologist notices a small irregular pupil, conjunctival injection around the corneal limbus, and WBCs in the anterior chamber. What is the most likely diagnosis

A

anterior uevitis

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2
Q

A 6-year-old girl with no significant past medical history presents 4 days after developing a red, irritated left eye. Her mother states that she has been wiping thick whitish-yellow discharge from her eye, and the eye is matted shut in the morning. She denies any exposure to an infected person, upper respiratory tract symptoms, or contact lens use. She also denies any significant pain or light sensitivity. On examination, the patient’s pupils are equal and reactive. She does not have a tender pre-auricular lymph node. Penlight examination does not reveal any corneal opacity, but thick, whitish discharge is seen. what is the most likely diagnosis

A

bacterial conjunctivitis

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3
Q

A 14-year-old boy with no significant past medical history presents 3 days after developing a red, irritated right eye that spread to the left eye today. He has watery discharge from both eyes and they are stuck shut in the morning. He reports recent upper respiratory tract symptoms and that several children at his day camp recently had pink eye. He denies significant pain or light sensitivity and does not wear contact lenses. On examination, his pupils are equal and reactive and he has a right-sided, tender pre-auricular lymph node. Penlight examination does not reveal any corneal opacity. What is the most likely diagnosis

A

viral conjunctivitis

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4
Q

itchy and a watery discharge of the eye is associated with what

A

allergic conjunctivitis

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5
Q

a white/yellow purulent discharge in someone who is sexually active is typical of

A

chlamydial conjunctivitis

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6
Q

follicles are usually present in what type of conjunctivitis

A

chlamydial/fungal

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7
Q

papillae are usually present in which type of conjunctivitis

A

bacterial

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8
Q

Pre-auricular nodes are usually tender in what type of conjunctivitis

A

viral/chlamydial

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9
Q

A 65-year-old man presents with bilateral ocular itching, burning, and foreign body sensation, as well as crusting of his eyelids in the morning for the past several months. He also notes that his eyes are often red and feel dry. Physical examination demonstrates facial pustules, facial redness, and telangiectasia. Slit lamp examination shows lid collarettes, telangiectasia, and capped meibomian glands.
What is the most likely diagnosis

A

posterior blepharitis caused by meibomian gland dysfunction

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10
Q

What are the most likely causative organisms of anterior blepharitis

A

staph aureus
P. acnes (in rosacea)
corynebacterium

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11
Q

anterior blepharitis caused by seborrheic will present as what

A

lid margin red
scales
dandruff
lashes unaffected

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12
Q

What is seborrheic anterior blepharitis associated with

A

seborrheic dermatitis

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13
Q

What will anterior blepharitis caused by staph aureus infection of the lash follicle present as

A

lid margin red
lashes lost, distorted (collaretes) or ingrown (trichiasis)
styes or ulcers on lid margin

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14
Q

what percentage of posterior blepharitis caused by meibomian gland dysfunction is caused by acne rosacea

A

50%

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15
Q

what is the presentation of posterior blepharitis caused by meibomian gland dysfunction

A
redness in deeper part of lid 
skin and lashes normal
lid telangiectasia 
meibomian glands pouting and swollen - dried secretion at gland opening 
meibomian cysts (chalazia)
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16
Q

What is the treatment for blepharitis

A

lid hygiene
supplementary tear drops
if visual impairment secondary to corneal involvement - doxycycline + eyelid hygiene

17
Q

What is chemosis

A

oedema of the conjunctiva

18
Q

What are the layers of the cornea

A

epithelium
stroma
endothelium

19
Q

if a corneal ulcer is central, it is most likely to be

A

infective

20
Q

if a corneal ulcer is peripheral, it is most likely to be

A

autoimmune - CTD/RA associated

21
Q

if a corneal ulcer is central in a person that wears contact lenses, what is the most likely organism involved

A

acanthamoeba

22
Q

What does a corneal ulcer present as

A

needle like pain
photophobia
profuse lacrimation

23
Q

In a bacterial corneal ulcer, you treat with

A

ofloxacin

24
Q

In an autoimmune corneal ulcer, you treat it with

A

anti-inflammatories - steroids (oral/topical)

25
Q

What is anterior uveitis

A

inflammation of the iris and ciliary body

26
Q

Acute pain and photophobia with blurred vision and no purulent discharge =

A

anterior uveitis

27
Q

What would be seen on slit lamp of anterior uveitis

A

synechiae (small irregular pupil)
conjunctival injection around corneal limbus
hypopyon

28
Q

What is anterior uveitis associated with

A

Syphilis, ank spon, SLE, RA, vasculitis

29
Q

What is the investigation for anterior uveitis

A

clinical Dx

30
Q

What is the treatment for anterior uveitis

A

topical steroids - pred forte 1%
mydriatics
tx underlying disease

31
Q

what eye condition is associated with gout

A

episcleritis

32
Q

What is the treatment for episcleritis

A

self limiting

lubricants, topical NSAIDs, mild steroids

33
Q

what is scleritis associated with

A

SLE
RA
GPA
relapsing polychondritis

34
Q

scleritis will present as

A

painful

violaceous hue

35
Q

what is the investigation of scleritis

A

phenylephrine test - put it on sclera and it won’t blanch

36
Q

what is the treatment for scleritis

A

oral NSAIDs
oral steroids
steroid sparing agents