Acute Red Eye

Question 1

What are the different types of haemorrhage?

Answer 1

Retrobulbar: homogenous red appearance. Can occur with restricted eye movements, ptosis, restricted pupil reactions and raised IOP. It can be a medical emergency as it can cause optic nerve compression and blindness
Sub-conjunctival haemorrhage: can see the posterior edge, less
Due to congestion, vascular engorgement.

Question 2

Different causes of congestion

Answer 2

:Localised congestion such as episcleritis

Generalised would be due to things like uveitis, conjunctivitis, acute glaucoma

Question 3

Causes of retrobulbar haemorrhage?

Answer 3

secondary to trauma (orbit floor fracture or head injury)

iatrogenic: anaesthetic usage

Question 4

Who is more likely to develop subconjunctival haemorrhage?

Answer 4

Those with chronic breathing difficulties, recent URTI, secondary to surgery, on aspriin or warfarin, recent trauma

Question 5

What is episcleritis

Answer 5

It’s a condition describing inflammation of the episclera (the vascular layer overlying the sclera). Common in collagen vascular disease and RA. The condition doesn’t affect sight and pain is mild. Treat with topical steroids or NSAIDs

Question 6

What is the sclera?

Answer 6

Irregular collagen fibres overlying the eye. The episclera is the vascular layer that sits on top

Question 7

Chlamydia: what would a history look like?

Answer 7

Resistant to antibiotic treatment for conjunctivitis and not viral
Sticky
Unilateral
Red eye
Follicles
Sexual health history: GUM symptoms
Lymph node swelling

Question 8

Two different types of chlamydial conjunctivitis ?

Answer 8

Trachoma (A,B, C) and acute conjunctivitis with follicles (D and K)

Question 9

What is the management plan for chlamydial infection?

Answer 9

Conjunctival swabs, in the meantime topical tetracycline 5 times a day for 3 weeks
If positive
Refer to GUM (PO tetracycline for 14 days or PO doxycycline for 10 days)

Question 10

Common viral cause of red eye?

Answer 10

Adenovirus

Question 11

Presentation for viral conjunctivitis?

Answer 11

Unilateral
Red
Painful
Gritty
Watery discharge
Follicles on lower fornix
Pre-auricular LN involvement
Hx of URTI 
FMH of conditon- very contagious

Question 12

Management for viral conjunctivitis?

Answer 12

Rule out being bacterial, otherwise give chlorophenicol
Hand hygiene advice
If any photophobia, blurring, PO prednisilone (ensure it’s not HSV first!!)

Question 13

Typical causative organisms of bacterial conjunctivitis?

Answer 13

Staph aureus, haemophilis, strep pneumoniae

Question 14

Presentation and management for bacterial conjunctivits?

Answer 14

Red eye
Bilateral
Purulent discharge
LN involvement

Topical chloramphenicol, fusidic acid (narrow spec for staplycocci + cultures)

Question 15

symptoms and signs of Herpes simplex keratitis

Answer 15

red eye (ciliary), photophobia, discharge, constricted pupil, quite to very painful

vesicular rash on the lids
conjunctivitis with follicles

Question 16

Investigation for HSK?

Answer 16

slit lamp–> dendritic ulcer

Question 17

Treatment for HSK?

Answer 17

topical aciclovir, topical steroid

Question 18

What are the 4 different types of immune conjunctivitis?

Answer 18

perennial, acute, seasonal, vernal catarrh

Question 19

How would you distinguish between an acute allergic and a seasonal allergic?

Answer 19

Acute = unilateral whereas seasonal (and perennial and vernal catarrh (?) ) is bilateral. Acute might not always be atopic

Question 20

Distinguish between seasonal and perennial?

Answer 20

Seasonal: younger patients, have symptoms of hay fever.
Perennial: eczema, triggers are often household and it can occur all year round!

Question 21

Treatment for all of these except for acute (which you treat how?)

Answer 21

Mast cell stabiliser, plus oral anti-histamine

Acute: reassurance

Question 22

Cause of chronic ulceration? What is a chronic ulcer??

Answer 22

Poor maintenance/application of contact lens

Question 23

What is the iris?

Answer 23

It’s comprised of two layers

• the stroma: thin avascular layer that contains the sphincter pupillae
• the pigemented layer: the second layer containing the dilator pupillae

Question 24

You mentioned that incorrect lens wear can cause corneal ulcers- what else?

Answer 24

o Giant papillary conjunctivitis (GPC)
o Cornealabrasion
o Infectivekeratitis
o Cornealulcers
o Neovascularisation
o Cornealhypoxia
o Solutionhypersensitivity

Question 25

What is uveitis?

Answer 25

Inflammation of the iris and the ciliary body. It causes a red eye, keratic precipitates, a constricted pupil and synaechiae. Treatment is by dilating drops and topical steroids

Question 26

One more condition to not forget!

Answer 26

Acute glaucoma

Question 27

What is the difference between HSV-1 and 2?

Answer 27

1 is in 90% of people (UK), acquired in childhood

2 is sexually transmitted