Acute red eye Flashcards
What are the differentials for an acute red eye
conjunctivitis subconjunctival haemorrhage episcleritis scleritis anterior uveitis acute closed-angle glaucoma corneal ulcer/abrasion
How does conjunctivitis present?
itchy
discharge
red eye
scratchy/gritty pain
How should conjunctivitis be treated?
viral –> educate its infectious
bacterial –> chloromphenicol drops
which out of episcleritis and scleritis is benign and more common?
episcleritis
How does episcleritis present?
inflammation, redness +/- inflammatory nodule
dull ache
vision not affected
How is episcleritis managed?
symptomatic
- NSAIDs
- artificial tears
How does scleritis present?
very inflamed, red with oedema
constant severe, boring ache
sore to move eye
How is scleritis managed?
urgent referral
not necrotising –> oral NSAIDs/steroids
necrotising –> systemic immunosuppression eg cyclophosphamide
What is scleritis associated with?
50% have systemic disease eg. rheumatoid
How can scleritis and episcleritis be differentiated?
episcleral vessels are more superficial so move when touched with cotton bud and blanch with phenylephrine
How does anterior uveitis present?
pain: deep ache blurred vision photophobia red eye lacrimation
How is anterior uveitis diagnosed?
inflammatory cells (leucocytes) in the anterior chamber on slit lamp
What can cause anterior uveitis?
ank spond
sarcoidosis
IBD
herpes, TB, syphilis
How is anterior uveitis managed?
control systemic disease
prednisolone drops and topical mydriatic to stop ciliary spasm
How can anterior uveitis progress?
inflammation disrupts flow of aqueous leading to glaucoma and adhesions between the iris and lens causing prolonged visual loss
How does acute closed angle glaucoma present?
generally unwell with N+V headache painful, red eye preceding blurred vision/haloes fixed, mid dilated pupil
What is acute closed angle glaucoma?
anterior chamber of the eye narrows causing an acute rise in intraocular pressure which causes damage to the optic nerve and visual loss
What is the difference between primary and secondary acute closed angle glaucoma?
primary- anatomical eg. shallow chamber
secondary - pathological eg trauma
How is acute closed angle glaucoma managed?
send to eye unit immediately
avoid dark rooms
start acetazolamide IV to dec aqueous production
start antihypertensive drops to reduce pressure
give pilocarpine to cause miosis and break fixed pupil
once IOP controlled do peripheral iridectomy (turn eye into one chamber)
What is an anterior uveitis?
inflamed iris
What is discharge like in
a) bacterial conjunctivitis?
b) viral conjunctivitis?
a) sticky
b) watery + more chemosis + burning
How can corneal abrasions be identified?
using fluoroscein dye + blue light
What can indicate viral conjunctivitis?
tender pre-auricular lymph nodes
How should bacterial corneal ulcer be treated?
topical ofloxacin
How do herpetic corneal ulcers appear?
dendritic corneal ulcer
How are herpetic corneal ulcers managed?
gancyclovir drops
What can make herpetic corneal ulcers worse?
steroids
A 35y/o man with long-sightedness has a painful red right eye for a week which is worse in the evenings. What is the likely diagnosis?
glaucoma
How should eye trauma with suspected penetrating injury be investigated?
CT orbits
A 35 year old man visits his GP with 3 days of a red, painful left eye with no discharge.There is a diffuse area of redness in the medial aspect of his left sclera. His pupils and visual acuity are normal.
?episcleritis
review at emergency eye clinic
