Acute Red Eye and Trauma

Question 1

important aspects of eye history?

Answer 1

duration of symptoms
one eye or both?
visual loss?
pain?
discharge?
previous episodes/treatments?
past medical history

Question 2

things to ask about discharge?

Answer 2

sticky or watery
sticky indicates bacterial infection
watery more common in viral or surface irritation

Question 3

things to ask about pain?

Answer 3

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)

Question 4

how to examine lids?

Answer 4

assess position of lids (check if any entropion or ectropion)
evert upper lid if suspicion of foreign body

Question 5

how is visual acuity assessed?

Answer 5

snellen chart

Question 6

how is conjunctiva assessed?

Answer 6

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

Question 7

things to look for in cornea?

Answer 7

clear or hazy?
foreign body present?
abrasion?
ulcer?

Question 8

how can cornea be examined?

Answer 8

flurescein dye and blue light

- stains any epithelial defect and shows easily

Question 9

infectious causes of red eye?

Answer 9

conjunctivitis

corneal ulcers

Question 10

trauma causes of red eye?

Answer 10

corneal foreign body

chemical injury

Question 11

inflammatory causes of red eye?

Answer 11

episcleritis
scleritis
iritis

Question 12

describe bacterial conjunctivitis

Answer 12

purulent discharge
mild chemosis (swelling)
gritty discomfort
usually bilateral but can be unilateral

Question 13

describe viral conjunctivitis

Answer 13

watery discharge 
moderate chemosis (swelling)
gritty discomfort/burning
often associated with pre-auricular lymph nodes
often bilateral

Question 14

treatment of bacterial vs viral conjunctivitis?

Answer 14

bacterial = topical antibiotics (chloramphenicol)
viral = supportive (cool compress, lubricants etc)

Question 15

other causes of conjunctivitis to be aware of?

Answer 15

chlamydia and gonorrhoea

be aware in young patients with unilateral follicular conjunctivitis

Question 16

how is chlamydial conjunctivitis managed?

Answer 16

same as genital chlamydia

diagnose via PCR swab

Question 17

how dangerous are bacterial corneal ulcers?

Answer 17

sight threatening

can become an abscess

Question 18

risk factors for bacterial corneal ulcers?

Answer 18

corneal abrasion
contact lens wearer
dry eyes
iatrogenic

Question 19

management of bacterial corneal ulcers?

Answer 19

do corneal scrape to determine causative organism (commonly staph/strep)
topical antibiotics given hourly which waiting on culture (eg ofloxacin)

Question 20

what causes herpetic corneal ulcer?

Answer 20

HSV infection

causes a dendritic ulcer

Question 21

management of dendritic ulcer?

Answer 21

topical aciclovir for 5 days (7-10 days)

Question 22

are topical steroids given in dendritic ulcer?

Answer 22

no

can lead to geographic corneal ulcer

Question 23

how do episcleritis and scleritis differ?

Answer 23

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

Question 24

what is scleritis associated with?

Answer 24

connective tissue disorders

Question 25

management of episcleritis?

Answer 25

doesnt really need treatment | topical lubricants or NSAIDs often given to help symptoms

Question 26

how is scleritis managed?

Answer 26

oral NSAIDs or systemic steroids/immunosuppression if necrosis present

Question 27

what is iritis/anterior uveitis?

Answer 27

inflammation in the anterior structures of the eye

Question 28

what causes iritis/anterior uveitis?

Answer 28

common in eye injury 50-60% are idiopathic rest are related to systemic disorders such as IBD, psoriatic arthritis, HLA B27 ankylosing spondylitis etc

Question 29

symptoms of anterior uveitis/iritis?

Answer 29

ache photophobia lacrimation blurred vision

Question 30

signs of iritis?

Answer 30

circumcorneal redness (red around the cornea) cells and flare in anterior chamber hypopion if severe posterior synechiae

Question 31

what is posterior synechiae?

Answer 31

iris starts sticking to the lens meaning the pupil cant dilate properly happens in iritis if very inflamed

Question 32

how is iritis managed?

Answer 32

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

Question 33

what is acute angle closure glaucoma?

Answer 33

acute increase in intra-ocular pressure | ophthalmic emergency

Question 34

symptoms of acute angle closure glaucoma?

Answer 34

``` 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 ```

Question 35

what increases risk of acute angle closure glaucoma?

Answer 35

being long sighted (small eye)

Question 36

how is acute angle closure glaucoma managed?

Answer 36

reduce pressure and prevent damage to optic nerve - IV diamox (acetazolomide) 500mg - topical antihypertensive drops - topical steroids - pilocarpine (once pressure <50mmHg) - surgery

Question 37

what surgery is done for acute angle closure glaucoma?

Answer 37

YAG laser peripheral iridotomy | punches a hole in iris creating alternative flow pathway for aqeous

Question 38

3 types of eye trauma?

Answer 38

penetrating blunt burns (chemical/physical)

Question 39

what is uveal prolapse?

Answer 39

risk in penetrating injury where contents of eye can prolapse through penetrated hole

Question 40

what is an iris/choroidal prolapse?

Answer 40

emergency effect of eye trauma seen as bulging iris or can just be seen as a distorted pupil

Question 41

examination of iris/choroidal prolapse?

Answer 41

check pupil use slit lamp always palpate bone of orbit if lots of bruising present too to check for fracture

Question 42

how does blunt trauma cause damage?

Answer 42

globe itself is intact but shockwave of trauma causes damage to structures

Question 43

signs of blunt trauma?

Answer 43

``` hyphaema (pooling of blood in anterior chamber of eye between cornea and iris) iris damage lens dislocation vitreous haemorrhage retinal damage scleral rupture ```

Question 44

what is a blowout fracture?

Answer 44

fracture of orbit in trauma

Question 45

which wall of orbit is most likely to fracture?

Answer 45

medial wall as its the thinnest

Question 46

how is chemical injury managed?

Answer 46

emergency | washout first before anything with at least a few litres

Question 47

which is worse, acid or alkali burn in eye?

Answer 47

alkali as it denatures proteins

Question 48

signs of alkali burns?

Answer 48

conjunctival ischaemia corneal vascularisation (vessels form across cornea which is usually avascular obscuring vision) scarring

Question 49

how is corneal abrasion managed?

Answer 49

use topical anaesthetic to examine examine with fluroscein to examine usually settles in 24-48hrs but can give antibiotics to prevent infection

Question 50

what is a flash burn?

Answer 50

UV ray burn | can be from welding or sun beds

Question 51

management of flash burns?

Answer 51

depends on severity just inflamed = anti-inflammatories burn to epithelium = antibiotics to prevent infection

Question 52

where can foreign body imbed in eye?

Answer 52

subtarsal corneal intra-ocular/orbital