Acute Red Eye and Trauma Flashcards
important aspects of eye history?
duration of symptoms one eye or both? visual loss? pain? discharge? previous episodes/treatments? past medical history
things to ask about discharge?
sticky or watery
sticky indicates bacterial infection
watery more common in viral or surface irritation
things to ask about pain?
scratchy/gritty/discomfort indicates external or surface problem (lids, conjunctiva and cornea)
severe deep/aching pain indicates intra-ocular or orbital problem (eg iritis, scleritis, glaucoma)
how to examine lids?
assess position of lids (check if any entropion or ectropion)
evert upper lid if suspicion of foreign body
how is visual acuity assessed?
snellen chart
how is conjunctiva assessed?
distribution of redness
- redness mainly in fornices (inside lids) indicates surface infection or lid disease
- redness mainly around cornea (circumcorneal infection) indicates intra-ocular problem
things to look for in cornea?
clear or hazy?
foreign body present?
abrasion?
ulcer?
how can cornea be examined?
flurescein dye and blue light
- stains any epithelial defect and shows easily
infectious causes of red eye?
conjunctivitis
corneal ulcers
trauma causes of red eye?
corneal foreign body
chemical injury
inflammatory causes of red eye?
episcleritis
scleritis
iritis
describe bacterial conjunctivitis
purulent discharge
mild chemosis (swelling)
gritty discomfort
usually bilateral but can be unilateral
describe viral conjunctivitis
watery discharge moderate chemosis (swelling) gritty discomfort/burning often associated with pre-auricular lymph nodes often bilateral
treatment of bacterial vs viral conjunctivitis?
bacterial = topical antibiotics (chloramphenicol) viral = supportive (cool compress, lubricants etc)
other causes of conjunctivitis to be aware of?
chlamydia and gonorrhoea
be aware in young patients with unilateral follicular conjunctivitis
how is chlamydial conjunctivitis managed?
same as genital chlamydia
diagnose via PCR swab
how dangerous are bacterial corneal ulcers?
sight threatening
can become an abscess
risk factors for bacterial corneal ulcers?
corneal abrasion
contact lens wearer
dry eyes
iatrogenic
management of bacterial corneal ulcers?
do corneal scrape to determine causative organism (commonly staph/strep)
topical antibiotics given hourly which waiting on culture (eg ofloxacin)
what causes herpetic corneal ulcer?
HSV infection
causes a dendritic ulcer
management of dendritic ulcer?
topical aciclovir for 5 days (7-10 days)
are topical steroids given in dendritic ulcer?
no
can lead to geographic corneal ulcer
how do episcleritis and scleritis differ?
episcleritis is more superficial
pain more severe in scleritis
redness in episcleritis disappears when topical phenylephrine added to eye
redness more diffuse and deep with “violaceous hue” in scleritis and doesnt blanch with phenylephrine
what is scleritis associated with?
connective tissue disorders
management of episcleritis?
doesnt really need treatment
topical lubricants or NSAIDs often given to help symptoms
how is scleritis managed?
oral NSAIDs or systemic steroids/immunosuppression if necrosis present
what is iritis/anterior uveitis?
inflammation in the anterior structures of the eye
what causes iritis/anterior uveitis?
common in eye injury
50-60% are idiopathic
rest are related to systemic disorders such as IBD, psoriatic arthritis, HLA B27 ankylosing spondylitis etc
symptoms of anterior uveitis/iritis?
ache
photophobia
lacrimation
blurred vision
signs of iritis?
circumcorneal redness (red around the cornea)
cells and flare in anterior chamber
hypopion if severe
posterior synechiae
what is posterior synechiae?
iris starts sticking to the lens meaning the pupil cant dilate properly
happens in iritis if very inflamed
how is iritis managed?
hourly topical steroids at first then taper down and give less often as condition improves
topical mydratic also given
should investigate if bilateral, severe or highly recurrent
what is acute angle closure glaucoma?
acute increase in intra-ocular pressure
ophthalmic emergency
symptoms of acute angle closure glaucoma?
usually unilateral reduced visual acuity pain with headache and often with nausea and vomiting red eye cloudy/hazy cornea fixed mid-dilated cornea raised intra-ocular pressure
what increases risk of acute angle closure glaucoma?
being long sighted (small eye)
how is acute angle closure glaucoma managed?
reduce pressure and prevent damage to optic nerve
- IV diamox (acetazolomide) 500mg
- topical antihypertensive drops
- topical steroids
- pilocarpine (once pressure <50mmHg)
- surgery
what surgery is done for acute angle closure glaucoma?
YAG laser peripheral iridotomy
punches a hole in iris creating alternative flow pathway for aqeous
3 types of eye trauma?
penetrating
blunt
burns (chemical/physical)
what is uveal prolapse?
risk in penetrating injury where contents of eye can prolapse through penetrated hole
what is an iris/choroidal prolapse?
emergency
effect of eye trauma
seen as bulging iris or can just be seen as a distorted pupil
examination of iris/choroidal prolapse?
check pupil
use slit lamp
always palpate bone of orbit if lots of bruising present too to check for fracture
how does blunt trauma cause damage?
globe itself is intact but shockwave of trauma causes damage to structures
signs of blunt trauma?
hyphaema (pooling of blood in anterior chamber of eye between cornea and iris) iris damage lens dislocation vitreous haemorrhage retinal damage scleral rupture
what is a blowout fracture?
fracture of orbit in trauma
which wall of orbit is most likely to fracture?
medial wall as its the thinnest
how is chemical injury managed?
emergency
washout first before anything with at least a few litres
which is worse, acid or alkali burn in eye?
alkali as it denatures proteins
signs of alkali burns?
conjunctival ischaemia
corneal vascularisation (vessels form across cornea which is usually avascular obscuring vision)
scarring
how is corneal abrasion managed?
use topical anaesthetic to examine
examine with fluroscein to examine
usually settles in 24-48hrs but can give antibiotics to prevent infection
what is a flash burn?
UV ray burn
can be from welding or sun beds
management of flash burns?
depends on severity
just inflamed = anti-inflammatories
burn to epithelium = antibiotics to prevent infection
where can foreign body imbed in eye?
subtarsal
corneal
intra-ocular/orbital
