Acute red eye

Question 1

Blepharitis

Answer 1

inflammation fo the eyelid margins

Question 2

symptoms of blepharitis

Answer 2

sore eyes, gritty, occassionaly red

Question 3

examination of blepharitis

Answer 3

• hyperaemic lid margins
• crusts on lashes
• blocked merbomian gland orifices
• merbomian cysts (when glands get really blocked)

Question 4

Complications of blepharitis

Answer 4

• conjunctivitis
• merbomian cysts
• marginal keratitis (inflammation of outer edge of cornea)

Question 5

Treatment of blepharitis

Answer 5

• 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

Question 6

stye

Answer 6

• infected hair folicule

- treat with lid hygeine, doesn’t need Abx

Question 7

entropion/ectropion

Answer 7

entropion - in-turning of lower lid - lashes irritate surface of eye
ectropion - eversion of lower lid
both require surgical correction

Question 8

Symptoms and signs of corneal abscess

Answer 8

symptoms - moderate/severe pain, photophobia, reduced vision, discharge
Signs - generalised deep redness, yellow patch on cornea, iris features indistinct

Question 9

Scleritis

Answer 9

inflammation of sclera

• Symptoms - severe pain, awake at night, worse on movement, vision may be reduced
• Signs - intensely red eye, sectoral or generalised

Question 10

Conjunctivitis

Answer 10

inflammation of conjunctiva

• Symptoms - sticky/gritty/stringy discharge, vision not affected
• Signs - mild redness of entire eye surface, normal pupil, clear cornea

Question 11

Episcleritis

Answer 11

inflammation of episclera (clear layer on top of sclera)

• Symptoms - irritation, vision not affected
• Signs - sectoral redness, visual acuity normal

Question 12

Anterior uveitis

Answer 12

Inflammation of iris

• Symptoms: moderate pain, photophobia, watery discharge, vision may be reduced
• Signs: circumcorneal redness, constricted pupil

Question 13

Acute angle close glaucoma

Answer 13

Raised IOP due to blocked draingage of aqueous humour

• Symptoms: sudden painful loss of vision, vomiting
• Signs: generalised redness, oval mid-dilated pupil

Question 14

Bacterial conjunctivitis

Answer 14

• 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

Question 15

Viral conjunctivitis

Answer 15

• 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

Question 16

Chlamydial conjunctivitis

Answer 16

• unilateral red eye in young male
• red watery eye, gritty, foreign body sensation, follicular reaction
• chronic
• sexually acquired
• requires systemic antibiotics

Question 17

Allergic conjunctivits

Answer 17

• acute red itchy eye, chemosis, vision not affected

- no treatment required

Question 18

Cicatrising conjunctivitis

Answer 18

• conjunctivitis that causes scarring

- causes: physical (heat/radiation/chemicals), infections, drugs, eye disorders, tumours, systemic disorders

Question 19

Keratits

Answer 19

inflammation of the cornea

Question 20

Bacterial keratitis

Answer 20

• 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

Question 21

Viral ketatitis

Answer 21

• 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

Question 22

Scleritis - what is it? symptoms? signs?

Answer 22

• 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

Question 23

Cause of scleritis

Answer 23

mainly idiopathic, but..

• connective tissue or vasculitic disease e.g. RA
• infections

Question 24

Treatment of scleritis

Answer 24

• oral NSAIDs for mild cases
• topical steroids as supplementary therapy
• systemic steroids/pulsed immunosupression for severe cases

Question 25

Complications of scleritis

Answer 25

- visual loss - scleral thinning - perforation of the globe - optic disc and macular oedema

Question 26

Endopthalmitis

Answer 26

infection inside the eye | serious complication of catarcts surgery that can lead to loss of vision

Question 27

Uveitis - symptoms, signs, cause

Answer 27

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

Question 28

Uveitis examination

Answer 28

examined using slit lamp 1. flare (albumin leaks from iris vessels) 2. inflammatory cells in the anterior chamber 3. miosis 4. posterior synechiae (ahesions between iris and lens)

Question 29

Complications of uveitis

Answer 29

- raised IOP - recurrence - if becomes chronic --> secondary cataract and macular oedema --> r

Question 30

Treatment of uveitis

Answer 30

dilate pupil to prevent ciliary spasm (using cyclopegic) and then break posterior synechiae

Question 31

Symptoms and signs of acute angle closure glaucoma

Answer 31

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

Question 32

Cause of acute ange closure glaucoma

Answer 32

iris attached to lens - aqueous humour can't drain properly - primary hypermetropia - secondary hypermature cataract

Question 33

Treatment of acute angle closure glaucoma

Answer 33

initially medical to reduce IOP, then surgery/laser to allow aqueous outflow - medical: acetazolamide, pilocarpine, IV hypertonic mannitorl - laser: iridotomy - surgery: iridectomy, lensectomy

Question 34

Orbital cellulitis

Answer 34

infection of orbit - life-threatening as infection can track back to brain

Question 35

signs and symptoms of orbital cellulitis

Answer 35

red oedematous conjunctiva, reduced eye movements, proptosis (eye moves forward), reduced vision (optic nerve involvement), unwell, associated with adjacent sinusitis

Question 36

Treatment of orbital cellulitis

Answer 36

admit IV antibiotics urgent CT ENT referral