Acute red eye Flashcards
Blepharitis
inflammation fo the eyelid margins
symptoms of blepharitis
sore eyes, gritty, occassionaly red
examination of blepharitis
- hyperaemic lid margins
- crusts on lashes
- blocked merbomian gland orifices
- merbomian cysts (when glands get really blocked)
Complications of blepharitis
- conjunctivitis
- merbomian cysts
- marginal keratitis (inflammation of outer edge of cornea)
Treatment of blepharitis
- warm compresses to remove trapped lipids from glands
- lid hygeine
- antibiotic ointment
- sub-antimicrobial dose of tetracyclines for 3 months to reduce inflammation
- occular lubricants
stye
- infected hair folicule
- treat with lid hygeine, doesn’t need Abx
entropion/ectropion
entropion - in-turning of lower lid - lashes irritate surface of eye
ectropion - eversion of lower lid
both require surgical correction
Symptoms and signs of corneal abscess
symptoms - moderate/severe pain, photophobia, reduced vision, discharge
Signs - generalised deep redness, yellow patch on cornea, iris features indistinct
Scleritis
inflammation of sclera
- Symptoms - severe pain, awake at night, worse on movement, vision may be reduced
- Signs - intensely red eye, sectoral or generalised
Conjunctivitis
inflammation of conjunctiva
- Symptoms - sticky/gritty/stringy discharge, vision not affected
- Signs - mild redness of entire eye surface, normal pupil, clear cornea
Episcleritis
inflammation of episclera (clear layer on top of sclera)
- Symptoms - irritation, vision not affected
- Signs - sectoral redness, visual acuity normal
Anterior uveitis
Inflammation of iris
- Symptoms: moderate pain, photophobia, watery discharge, vision may be reduced
- Signs: circumcorneal redness, constricted pupil
Acute angle close glaucoma
Raised IOP due to blocked draingage of aqueous humour
- Symptoms: sudden painful loss of vision, vomiting
- Signs: generalised redness, oval mid-dilated pupil
Bacterial conjunctivitis
- sticky/gritty/stringy discharge, vision not affected
- mild redness of entire surface of eye, normal pupil, clear cornea, purulent discharge
- cause: staph/strep/haemophilius
- treatment: antibiotic drops, general hygeine
Viral conjunctivitis
- symptoms: watery discharge, gritty, vision not affected, associated with URTI
- signs: gneralised redness, small corneal erosions, watery discharge and enlarged preauricular lymph nodes
- cause: adenovirus
- treatment: general hygeiene, lubricants
Chlamydial conjunctivitis
- unilateral red eye in young male
- red watery eye, gritty, foreign body sensation, follicular reaction
- chronic
- sexually acquired
- requires systemic antibiotics
Allergic conjunctivits
- acute red itchy eye, chemosis, vision not affected
- no treatment required
Cicatrising conjunctivitis
- conjunctivitis that causes scarring
- causes: physical (heat/radiation/chemicals), infections, drugs, eye disorders, tumours, systemic disorders
Keratits
inflammation of the cornea
Bacterial keratitis
- Symptoms - moderate pain, photophobia, reduced vision, discharge
- Signs - generalised deep redness, yellow patch on cornea
- diagnosis - corneal scrape - MC&S
- cause - wide range of bacteria
- intense treatment:
- —- sterilisation: broad spectrum Abx, cylopegics, intraoccular hypotensives, ——healing: steroids and lubricants
Viral ketatitis
- cause - herpes simplex type 1
- symptoms - reduced vision, unliateral red eye, pain, photopobia
- examination - reduced corneal sensation, branching ulcer
- treatment: antiviral ointment (aciclovir), dilate pupil. DO NOT use steroids
Scleritis - what is it? symptoms? signs?
- inflammation of the sclera
- symptoms - severe pain that is worse at night/on movement, vision may be reduced, may be recurrent
- signs - intensely red eye, scleral involvement and thinning
Cause of scleritis
mainly idiopathic, but..
- connective tissue or vasculitic disease e.g. RA
- infections
Treatment of scleritis
- oral NSAIDs for mild cases
- topical steroids as supplementary therapy
- systemic steroids/pulsed immunosupression for severe cases
Complications of scleritis
- visual loss
- scleral thinning
- perforation of the globe
- optic disc and macular oedema
Endopthalmitis
infection inside the eye
serious complication of catarcts surgery that can lead to loss of vision
Uveitis - symptoms, signs, cause
inflammation of iris
- moderate unilateral pain, photophobia, watery discharge, blurred vision
- circumcorneal redness, constricted pupil, keratic preciptates
- causes - mainly unknown, occurs 20-50 and associated with ankylosing spondylitis
Uveitis examination
examined using slit lamp
- flare (albumin leaks from iris vessels)
- inflammatory cells in the anterior chamber
- miosis
- posterior synechiae (ahesions between iris and lens)
Complications of uveitis
- raised IOP
- recurrence
- if becomes chronic –> secondary cataract and macular oedema –> r
Treatment of uveitis
dilate pupil to prevent ciliary spasm (using cyclopegic) and then break posterior synechiae
Symptoms and signs of acute angle closure glaucoma
symp: sudden loss of vision, nausea and vomiting, occular pain, headache, haloes when IOP high
signs: generalised redness, oval and mid-dilated pupil, cloudy cornea
Cause of acute ange closure glaucoma
iris attached to lens - aqueous humour can’t drain properly
- primary hypermetropia
- secondary hypermature cataract
Treatment of acute angle closure glaucoma
initially medical to reduce IOP, then surgery/laser to allow aqueous outflow
- medical: acetazolamide, pilocarpine, IV hypertonic mannitorl
- laser: iridotomy
- surgery: iridectomy, lensectomy
Orbital cellulitis
infection of orbit - life-threatening as infection can track back to brain
signs and symptoms of orbital cellulitis
red oedematous conjunctiva, reduced eye movements, proptosis (eye moves forward), reduced vision (optic nerve involvement), unwell, associated with adjacent sinusitis
Treatment of orbital cellulitis
admit
IV antibiotics
urgent CT
ENT referral
