Acute Red Eye Flashcards
General symptoms to ask about
- RED = DISTRIBUTION, DEGREE
- PAIN - GRITTY (e.g. from foreign body), ITCHY, STABBING, THROBBING (deep seated)
- DISCHARGE = PURULENT, MUCOID, WATERY
- PHOTOPHOBIA (pain when looking at bright lights - when iris inflamed cannot constrict w/o pain)
- FLASHING LIGHTS & FLOATERS
- BLURRED VISION (need to ask)
Past Ocular Hx + PMH (inflammatory conditions of the eye can be systemic)
General Examination
- BEST CORRECTED VISUAL ACUITY (once they wear glasses - should be fine)
- SNELLEN CHART (binocular vision better than 6/ = can drive)
- FUNDOSCOPY (direct ophthalmoscope, slit lamp & volk lens)
- COBALT LIGHT + STAINING W/ FLUOROSCOPE (OUTLINES EPITHELIAL DEFECTS)
Infective conjunctivitis presentation
- GRITTY
- May be DIFFICULT TO OPEN EYE
- RED, WATERING
- DISCHARGE = PURULENT, WATERY
Infective conjunctivitis management
- WASH OUT
- TOPICAL ANTIBIOTICS
- SELF-LIMITING = ANALGESIA + OBSERVE
Allergic conjunctivitis presentation
- ACUTE
- ITCHY
- RED
- DISCHARGE (MUCOID, WATERY)
- LID SWELLING (OEDEMA)
- CONJUNCTIVAL SWELLING (CHEMIOSIS)
Allergic conjunctivitis management
- TOPICAL ANTIHISTAMINE
- AVOID ALLERGEN
- MAST CELL STABILISERS
Corneal abrasion presentation
• PAIN (nn. endings under cornea - can cause watering)
• WATERING
• BLURRED VISION
EPITHELIAL DEFECT
Corneal abrasion management
- TOPICAL ANTIBIOTICS
- ANALGESIA/ANAESTHETIC
TELL PT. IT WILL BE V. PAINFUL FOR NEXT 24HRS - NO TOPICAL ANAESTHETIC AS IMPAIRS HEALING
CAN TAKE ORAL PARACETAMOL etc.
CAN HEAL IN 24 - 48HRS; IF UNHEALED BY 24HRS = COME BACK
Acute anterior uveitis presentation
Inflammation of iris +/- ciliary body
* RED (particularly ~ ciliary body) * PAIN, PHOTOPHOBIA * WATERING * ± VISUAL LOSS - BLURRED VISION (as iris leaks plasma & WBCs into anterior chamber) * CELLS IN ANTERIOR CHAMBER (use slit lamp, may precipitate - keratic precipitate) * ± FLOATERS * HYPOPYON (cells settle in anterior chamber) * SMALL IRREGULAR PUPIL (becomes sticky + small) * May have PREVIOUS Hx
Acute anterior uveitis management
- TOPICAL STEROIDS - even most serious presentation can be treated topically
- DILATING DROPS - break down adhesions of iris, can reduce pain; CYCLOPENTALATE
- ANALGESIA
Scleritis presentation
- PAIN++ (deep, radiates)
- REDNESS (DEEP SCLERAL VESSELS, reddish purply)
- NODULE (DOESN’T MOVE OVER SCLERA - therefore not is episclera)
- TENDER++
Scleritis management
• SYSTEMIC STEROIDS - need to be admitted to hospital as life-threatening as can be ass. w/ systemic inflammation
Acute angle closure glaucoma presentation
Acute obstruction to aqueous humour drainage
* SUDDEN ONSET & PAIN++ * LOSS of VISION/BLURRINESS * HEADACHES - often confused w/ migraines * NAUSEA & VOMITING
ON/E:
* RED EYE, INFLAMED * HAZY/OPAQUE CORNEA = raised IOP drives fluid into cornea, oedematous * AC SHALLOW & ANGLE CLOSED * PUPIL MID-DILATED & FIXED * HARD EYEBALL (raised IOP, rock hard + tender) * IOP SEVERELY RAISED
Acute angle closure glaucoma management
- DECREASE IOP & CONSTRICT PUPIL
a. IV INFUSION w/ or w/o ORAL THERAPY = CARBONIC ANHYDRASE INHIBITORS e.g. ACETAZOLAMIDE b. ANALGESIS, ANTIEMETICS c. CONSTRICTOR EYE DROPS = PILOCARPINE d. IF NO CI = BETA-BLOCKERS e.g. TIMOLOL e. STEROID EYE DROPS e.g. DEXAMETHASONE
- IRIDOTOMY (LASER) BOTH EYES - to BYPASS BLOCKAGE
Acute angle closure glaucoma risk factors
hypermetropic/short eyeball
ageing - stiffer lens
constricted pupil
