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Year 4 > Acute Red Eye and Trauma > Flashcards

Acute Red Eye and Trauma Flashcards

1
Q

important aspects of eye history?

A 
duration of symptoms
one eye or both?
visual loss?
pain?
discharge?
previous episodes/treatments?
past medical history
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2
Q

things to ask about discharge?

A

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

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3
Q

things to ask about pain?

A

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)

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4
Q

how to examine lids?

A

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

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5
Q

how is visual acuity assessed?

A

snellen chart

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6
Q

how is conjunctiva assessed?

A

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
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7
Q

things to look for in cornea?

A

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

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8
Q

how can cornea be examined?

A

flurescein dye and blue light

- stains any epithelial defect and shows easily

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9
Q

infectious causes of red eye?

A

conjunctivitis

corneal ulcers

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10
Q

trauma causes of red eye?

A

corneal foreign body

chemical injury

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11
Q

inflammatory causes of red eye?

A

episcleritis
scleritis
iritis

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12
Q

describe bacterial conjunctivitis

A

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

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13
Q

describe viral conjunctivitis

A 
watery discharge 
moderate chemosis (swelling)
gritty discomfort/burning
often associated with pre-auricular lymph nodes
often bilateral
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14
Q

treatment of bacterial vs viral conjunctivitis?

A 
bacterial = topical antibiotics (chloramphenicol)
viral = supportive (cool compress, lubricants etc)
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15
Q

other causes of conjunctivitis to be aware of?

A

chlamydia and gonorrhoea

be aware in young patients with unilateral follicular conjunctivitis

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16
Q

how is chlamydial conjunctivitis managed?

A

same as genital chlamydia

diagnose via PCR swab

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17
Q

how dangerous are bacterial corneal ulcers?

A

sight threatening

can become an abscess

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18
Q

risk factors for bacterial corneal ulcers?

A

corneal abrasion
contact lens wearer
dry eyes
iatrogenic

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19
Q

management of bacterial corneal ulcers?

A

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

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20
Q

what causes herpetic corneal ulcer?

A

HSV infection

causes a dendritic ulcer

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21
Q

management of dendritic ulcer?

A

topical aciclovir for 5 days (7-10 days)

22
Q

are topical steroids given in dendritic ulcer?

A

no

can lead to geographic corneal ulcer

23
Q

how do episcleritis and scleritis differ?

A

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

24
Q

what is scleritis associated with?

A

connective tissue disorders

25
Q

management of episcleritis?

A

doesnt really need treatment

topical lubricants or NSAIDs often given to help symptoms

26
Q

how is scleritis managed?

A

oral NSAIDs or systemic steroids/immunosuppression if necrosis present

27
Q

what is iritis/anterior uveitis?

A

inflammation in the anterior structures of the eye

28
Q

what causes iritis/anterior uveitis?

A

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

29
Q

symptoms of anterior uveitis/iritis?

A

ache
photophobia
lacrimation
blurred vision

30
Q

signs of iritis?

A

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

31
Q

what is posterior synechiae?

A

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

32
Q

how is iritis managed?

A

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

33
Q

what is acute angle closure glaucoma?

A

acute increase in intra-ocular pressure

ophthalmic emergency

34
Q

symptoms of acute angle closure glaucoma?

A 
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
35
Q

what increases risk of acute angle closure glaucoma?

A

being long sighted (small eye)

36
Q

how is acute angle closure glaucoma managed?

A

reduce pressure and prevent damage to optic nerve

  • IV diamox (acetazolomide) 500mg
  • topical antihypertensive drops
  • topical steroids
  • pilocarpine (once pressure <50mmHg)
  • surgery
37
Q

what surgery is done for acute angle closure glaucoma?

A

YAG laser peripheral iridotomy

punches a hole in iris creating alternative flow pathway for aqeous

38
Q

3 types of eye trauma?

A

penetrating
blunt
burns (chemical/physical)

39
Q

what is uveal prolapse?

A

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

40
Q

what is an iris/choroidal prolapse?

A

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

41
Q

examination of iris/choroidal prolapse?

A

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

42
Q

how does blunt trauma cause damage?

A

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

43
Q

signs of blunt trauma?

A 
hyphaema (pooling of blood in anterior chamber of eye between cornea and iris)
iris damage
lens dislocation
vitreous haemorrhage
retinal damage
scleral rupture
44
Q

what is a blowout fracture?

A

fracture of orbit in trauma

45
Q

which wall of orbit is most likely to fracture?

A

medial wall as its the thinnest

46
Q

how is chemical injury managed?

A

emergency

washout first before anything with at least a few litres

47
Q

which is worse, acid or alkali burn in eye?

A

alkali as it denatures proteins

48
Q

signs of alkali burns?

A

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

49
Q

how is corneal abrasion managed?

A

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

50
Q

what is a flash burn?

A

UV ray burn

can be from welding or sun beds

51
Q

management of flash burns?

A

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

52
Q

where can foreign body imbed in eye?

A

subtarsal
corneal
intra-ocular/orbital

Year 4 (83 decks)

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