Acute Red Eye - Emergencies ****

Question 1

Scleritis - EMERGENCY:

What is it?

What type of disease are half the cases linked to?

Presentation:

• Type of eye pain?
• Do they have tenderness?
• Why may the eye go a bluish-red colour?
• What visual symptoms do you get? - 2

Management:

• What needs to be done if this is suspected?
• How to manage anterior S?
• How to manage posterior S or if there are necrotising changes that could lead to visual loss?

Answer 1

Inflammation of the sclera

Severe dull eye pain

Yes to the touch and movement

Vascular engorgement

Blurred vision
Photophobia
—-
Urgent referral

Oral NSAIDs +/- prednisolone

Immunosuppression +/- methylprednisolone

Question 2

Uveitis:

What 3 things make up the uvea?

What 2 things are affected in anterior uveitis (iritis)?

What 1 thing is affected in posterior U?

Answer 2

Iris, ciliary body and choroid

Iris and ciliary body inflammation

Choiroid inflammation

Question 3

Anterior uveitis:

You get 2 things - iritis and iridocyclitis - what do they both mean?

Causes:
- HLA-B27 disease is the commonest cause. Give examples of diseases like this?

Intermediate and posterior uveitis:
- How does it differ from anterior?

What is the

Answer 3

Inflammation of the anterior chamber and iris
Inflammation of the ciliary body

Ankylosing spondylitis 
Psoriatic arthritis 
Reactive arthritis 
IBD 
----
Affects different places:
- Intermediate - anterior vitreous and ciliary body
- Posterior - choroid 

They are both usually painless

Question 4

Anterior Uveitis:

Symptoms:

• Obvious symptom
• Type of pain they have?
• What do they see in their vision?
• What happens to the vision?
• One other symptom, you might find in meningitis?

Signs:

• What happens to the pupils
• What about their size and why?

Once referred urgently, the slit lamp exam is used. What do you see in the front of the eye which indicates it is AU?

Answer 4

Acute red eye

Deep aching pain

Floaters

Blurred vision

Small pupil - iris spasm
Non-reactive

Question 5

Anterior Uveitis:

Management:
- What is applied topically to prevent inflammation, hence helping with pain, redness and exudate?

• Why is cyclopentolate given?
• What is used to monitor inflammation and to monitor for any relapses?

Answer 5

Topical steroids (e.g. dexamethasone)

KEEPS PUPIL DILATED:

• To prevent adhesions between the lens and iris
• To prevent spasm of the ciliary body

Slit-lamp examination

Question 6

Acute angle-closure glaucoma:

Pathophysiology

What is meant by primary and secondary angle closure?

Onset?

Symptoms:

• Obvious symptom
• Where do they get headaches?
• What may happen systemically as a result of raised IOP?
• What do they see around the lights? - 2
• What will it eventually lead to?

Answer 6

Closure of the iridocorneal angle - closure of the trabecular meshwork

Patients with an anatomical predisposition

Arises from a pathological process (e.g. traumatic, haemorrhage, pushing the posterior chamber forwards) 
-----
Hours-days
-----
Painful red eye

Frontal headaches

N&V

Haloes and blurred vision

Visual loss

Question 7

Acute angle-closure glaucoma:

Signs:

• What might the cornea look like?
• What about the pupils?
• What may you see on optic disc?
• What may the eye feel like?

What muscarinic in the form of eye drops can precipitate it?

What should be avoided in order to prevent pupillary dilatation?

Investigations:

• What is used to measure IOP? - T
• What is classed as high IOP?
• Gonioscopy is the gold standard for diagnosis. What is it?

Answer 7

Hazy and oedematous

Non-reactive and mid-dilated pupils

Cupping of optic disc

Hard 
-----
Cyclopentolate
------
Eye patches and dark rooms 
------

Tonometry - the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients at risk from glaucoma.

> ## 30 mmHgA painless exam your ophthalmologist uses to check a part of your eye called the drainage angle.

Question 8

Acute angle-closure glaucoma:

Management:

• Who should they urgently be referred to?
• What can be given for pain and N&V?

TRIAD of Rx:

• What is used to suppress the production of aqueous humour which is also a cardiac drug?
• Why are patients given pilocarpine drops?
• Why are patients given IV acetazolamide?

What surgical Rx can be done if refractory?

Answer 8

Ophthalmology - eye unit

Beta-blocker (e.g. timolol)

Pilocarpine drops

IV acetazolamide

Peripheral iridotomy - a laser beam to create a small hole in your iris. This forms a permanent passage through which aqueous humour can flow through and pushes the iris tissue backwards, thus unblocking the drainage channels.