Acute Red Eye Flashcards
Where does Acute Red Eye effect and where does Loss of Vision happen?
Acute Red Eye (Anterior Segment)
Loss of Vision (Posterior segment)
How is the assesment of red eye carried out?
- History
- Examination
- Differential diagnosis
- Management
What may the history of someone with acute red eye include?
Red - distribution, degree
Pain - gritty, itchy, stabbing, throbbing
Discharge - purulent, mucoid, watery
Photophobia - an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical sensitivity of the eyes
Flashing lights and floaters
Blurred vision - always ask
What is involved in the examination of acute red eye?
test with best corrected visual acuity and test using a Snellen chart - testing visual acuity is the first thing to do
Use a ophthalmoscope and a slit lamp to look at the eye
What may be used to stain the eye during examination?
Staining with fluroscene – outlines epithelial defects e.g. ulcer
shine blue light onto the eye
How is a fundal examination carried out?
direct ophthalmoscope
slit lamp & volk lens
What are different acute red eye conditions?
Infective Conjunctivitis
Allergic Conjunctivitis
Corneal Abrasion
Acute Anterior Uveitis
Scleritis
Acute Angle Closure Glaucoma
Orbital Cellulitis
What is infective conjunctivitis?
an infection of the thin skin (the conjunctiva) on the front of the eye
What are the symptoms and signs of Infective Conjunctivitis?
Gritty
Red
Discharge (purulent/watery)
Lashes crusted together in the morning
What is the treatment of inferctive conjuctivitis?
topical antibiotics
What is Allergic Conjunctivitis?
an eye inflammation caused by an allergic reaction to substances like pollen or mold spores
the inside of your eyelids and the covering of your eyeball have a membrane called the conjunctiva
the conjunctiva is susceptible to irritation from allergens, especially during hay fever season
What are the symptoms and signs of Allergic Conjunctivitis?
Itchy
Red
Discharge (mucoid/watery)
Acute
Lid swelling
Conjunctival swelling (chemosis - the swelling (or edema) of the conjunctiva. It is due to the oozing of exudate from abnormally permeable capillaries)
Do symptoms of allergic conjunctivitis come on rapidly or slowly?
rapidly
What is the treatment of allergic conjunctivitis?
Topical antihistamine
Avoid allergen
Mast cell stabilisers - used to prevent or control certain allergic disorders. They block mast cell degranulation, stabilizing the cell and thereby preventing the release of histamine and related mediators
What is corneal abrasion?
small scratch on the cornea, the clear window at the front of the eye. They are generally a result of trauma (injury) to the surface of the eye
common causes include a fingernail scratching the eye, walking into something, and getting grit in the eye
Every time you blind eye lid crosses open nerve endings
Scratch removing the epithelium of the cornea
What are the symptoms and signs of corneal abrasion?
Pain
Watering
Blurred vision
Epithelial defect
What is the treatment of corneal abrasion?
Topical antibiotics
Analgesia
Helas quickly
Topical anesthetic stop healing so don’t give
Fluroscene to expose the epithelial defect
What is acute anterior uveitis?
inflammation of iris and ciliary body
comes on suddenly
What are the symptoms and signs of acute anterior uveitis?
Pain
Watering
Photophobia - sensitivity to light as iris is inflammed
+/-Blurred vision
+/- floaters
Red
Cells in anterior chamber
Hypopyon - inflammatory cells in the anterior chamber of the eye
Small irregular pupil
May have previous history - it is a recurring condition
What is the treatment of acute anterior uveitis?
Topical steroids - inflammatory condition so steroids are used
Dilating drops
What is scleritis?
a severe, destructive, vision-threatening inflammation involving the deep episclera and sclera
What are the symptoms and signs of scleritis?
Pain++ - deep intense paina nd keeps people awake at night
Redness (deep scleral vessels)
Nodule (does not move over sclera)
Tender++
Sclera inflammed
What is the treatment of slceritis?
Systemic steroids
Carry out investigations to see if there is any underlying conditions
What produces aqueous humor?
ciliary body
What is acute angle closure glaucoma?
occurs when the flow of aqueous humour out of the eye is blocked and pressure inside the eye becomes too high very quickly. It is an emergency because if it is not treated quickly, it can lead to permanent loss of vision
These patients often have a short eye, hypermetropia - long-sightedness
Shallow anterior chamber so when they are reading in dim light and you constrict your pupil to read but it also dilated to let in light and if the pupil is in mid dilated phase then fluid may not be escaping into the anterior chamber easily
Pressure rises rapidly
What are the symptoms and signs of acute angle closure glaucoma?
Pain++
Redness
Blurred vision
Nausea & vomiting
Hazy cornea
Fixed mid dilated pupil
Hard eyeball
What is the treatment of acute angle closure glaucoma?
Lower intraocular pressure
Constrict pupil
Pulls iris away form the drainage angle and aqueous can start to flow again and pressure will come down
What is Orbital Cellulitis? and what is often the cause?
infection of orbital tissues
inflammation of the soft tissues of the eye socket
sinuses are near by and this is often where the infection starts
What are the symptoms and signs of orbital cellulitis?
Pain+
Redness
Blurred vision
Diplopia (double vision) - as they have reduced eye movement as the nerve supplying the muscles are affected by compression
Malaise (unwell)
Pyrexia - fever/high temperature
Proptosis - protrusion of the eyeball
Reduced eye movement
What is the treatmen for orbital cellulitis?
admit
IV antibiotics
CT scan - need to know where the infection has come from and if ther eis an abscess in any of the sinuses then the ENT surgeons would need to be involved
Drainage of pus
Emergency so treat promptly as
infection could tract backwards and can damage the brain and get meningitis and may more and may well die so take very seriously
