Acute Red Eye Flashcards
What can predispose a patient to a subconjunctival haemorrhage?
antiplatelets
trauma
clotting problem
High blood pressure with poor control
How long does a subconjunctival haemorrhage take to disappear?
1-2 weeks (stays red for this amount of time)
What is the definition of orbital cellulitis?
Infection of soft tissues around the eye and of the orbit
What consequences can orbital cellulitis have?
- Infection can track to brain and cause abscess
- Can cause visual loss if severe
`What are the most common causes of orbital cellulitis?
- Insect bites
- eyelid trauma
PAEDs = Sinus infection through the nasal orbital wall
What components of tears make them important in immune defence?
- Tear flow/drainage
- Mucous trapping
- Lysozyme
- IgA and IgG
- Complement
What should be asked about in a specific eye history?
- Pain
- Foreign body sensation (grittiness, dryness)
- Itch
- Discharge / Tearing
- Photophobia
- Visual loss?
- Past ocular disorders
- Contact lenses?
Eye pain radiating to the brow suggests what?
Intra-ocular inflammation
A report of itch in an eye history indicates what?
The cause of inflammation is likely to be an allergy
What severe infection can result from contact lens wear?
Acanthomoeba
What facial signs should be looked for in an eye examination?
muscle wasting due to a CN VII palsy which could affect functions of the eyes
What other structures should be observed on the face during an eye examination?
- Lids (lid margins, lashes)
- Conjunctivae – (tarsal and bulbar)
- Cornea
- Anterior chamber
- Iris / pupil
- Intra-ocular pressure
What is blepharitis and what are the two subtypes?
Inflamed eyelid
ANTERIOR vs POSTERIOR
What are the two causes of anterior blepharitis?
Seborrhoeic cause (scales on lashes) Staph. (lash follicle involved)
What causes posterior blepharitis?
- Meibomian gland dysfunction
redness is in deeper part of lid
How does staph blepharitis usually present?
- Lashes distorted/loss of lashes/ingrowing lashes
- Styes (ulcers of lid margin)
- corneal staining
- marginal ulcers (due to exotoxin)
What sign is distinctive of seborrhoeic blepharitis?
Teepee Sign
lashes are stuck together in groups which look like Teepee’s
What signs are present in Meibomian Gland disease?
- Dried secretion at gland openings
- Meibomian Cysts due to gland blockage
Meibomian gland disease is related to what dermatological condition?
Acne rosacea
How is blepharitis treated?
- Lid hygiene – daily bathing / warm compresses
- Supplementary tear drops
- Oral doxycycline for 2-3 months
Papillae are present in bacterial conjunctivitis, whereas follicles can be seen viral and chlamydial conjunctivitis. TRUE/FALSE?
TRUE
Vision can be affected in conjunctivitis. TRUE/FALSE?
FALSE
vision is unaffected
What lymph nodes become enlarged in viral and chlamydial conjunctivitis?
pre-auricular
If Herpes Zoster ophthalmica extends to the tip of the nose, what does this normally indicate?
Nasociliary nerve involvement
What is chemosis?
Conjunctival oedema
Give an example of a drug which can cause chronic conjunctivitis?
Alphagan (used in glaucoma)
25% of patients have a drug reaction after using for 12 months
What causes corneal ulcers in the centre?
Viral
Fungal (rare in UK)
Bacterial
Acanthamoeba
What causes peripheral corneal ulcers?
rheumatoid arthritis
hypersensitivity e.g. marginal ulcers
Why is a local anaesthetic required to do a corneal exam?
Highest density of sensory nerves
What symptoms and signs indicate a corneal ulcer?
Pain Photophobia Profuse lacrimation Red Corneal opacity Staining hypopyon
Why are patients with thyroid eye disease or a CN VII palsy at increased risk of eye infection?
Increased exposure due to eyelid not closing properly
How are corneal ulcers treated?
Bacterial = ofloxacin hourly Herpetic = Antiviral = Aciclovir ointment 5 x day Autoimmune = Anti-inflammatory = Oral / topical steroids
What malignancy can cause anterior uveitis?
leukaemia
What autoimmune conditions can cause anterior uveitis?
Ulcerative colitis
Ankylosing Spondylitis
Sarcoidosis
What is synechiae?
Irregular shaped pupil as iris is stuck to crystalline lens
How is anterior uveitis treated?
Steroids suppress inflammation Pupil dilatation (Mydriatics) => prevent it from being stuck down
How do we differentiate between episcleritis and scleritis?
Scleritis = painful!
Also phenylephrine test
- episcleritis blanches
- scleritis does not as inflammation is deeper
What is the treatment for episcleritis?
Lubricants / topical NSAIDs / mild steroids
the condition is self limiting
How is scleritis treated?
- Oral NSAIDs
- Oral Steroids
- Steroid Sparing Agents
