Acute red/painful eye/vision loss IAIs

Question 1

Acute red/painful eye/vision loss IAIs

Hx/exam:

Answer 1

Hx/exam: pain or painless?, assoc sx, SAMPLE hx, HA, N/V, VA/elds, pupils, EOM, SL and fundo exam, IOP, HEENT, neuro

Question 2

Acute red/painful eye/vision loss IAIs

Keratitis:

Answer 2

Keratitis: inflammation of cornea. Can be sight threatening. Severe pain, photophobia, irritation, tearing
UV light, herpesvirus, chemical, ischemic (contacts)
Tx: acyclovir

Question 3

Acute red/painful eye/vision loss IAIs

Iritis:

Answer 3

Iritis: inflammation of iris. Anterior uveitis (inflammation of iris and ciliary body). Often u/l
Trauma, infection, autoimmune
Photophobia, acuity moderately depressed, redness (enlarged deep arteries, limbic flush), cell (WBC) and flare(protein)
Tx: prednisolone drops q 2 hrs, cycloplegics (homatropine) to prevent ciliary muscle spasm, ophtho follow up

Question 4

Acute red/painful eye/vision loss IAIs

Hyphema:

Answer 4

Hyphema: blood in anterior chamber. Larger ones maybe painful or impair vision, sickle cell
Tx: > 50 % admission, 100% risk for glaucoma, avoid NSAIDs, HOB 45

Question 5

Acute red/painful eye/vision loss IAIs

Answer 5

Endophthalmitis: infection of aqueous and vitreous humor. Usually after sx or truama
Pain out of proportion, redness, deceased vision, lid swelling, diminished red reflex, may have hypopyon
Tx: emergent ophthalmology consult

Question 6

Acute red/painful eye/vision loss IAIs

Acute angle closure glaucoma:

Answer 6

Acute angle closure glaucoma: painful eye, headache, blurry vision, onset may be rapid, may start in dimly lit room, contraction of iris to dilate eye
precipitates, nausea, vomiting
IOP > 30, limbic flush, cornea may be cloudy/edematous, pupil mid-dilated and frozen
Tx:
Emergent ophtho consult
30 HOB
Beta blockers (timolol): decrease aqueous production. 1 drop, repeat in 5 min
Carbonic anhydrase inhibitor (dorzolamide): decrease aqueous production
Alpha-2 agonist (brimonidine): constricts pupil
Cholinergics (pilocarpine): constrict pupil- can only be used after pupil is unstuck. 1 drop q 15 min, 1 drop other eye
IV antibiotics, PO acetazolamide 100 mg , osmotic agents

Question 7

Acute red/painful eye/vision loss IAIs

Orbital Cellulitis:

Answer 7

Orbital: deeper infection, Pain with EOM, proptosis, binocular diplopia, papilledema, chemosis
Tx: broad spectrum ABX(2nd or 3rd generation cephalosporin, augmentin, zosyn, carbapenems), CT head/orbits, check IOP, admit with ophtho
consult

Question 8

Acute red/painful eye/vision loss IAIs

Optic neuritis…

Answer 8

Optic neuritis… (more in women, unilateral, loss of central vision, rapidly progressive, pain ↑ w/
movement, SLE normal). MS. Red desaturation test
–Tx: Solumedrol 1 gm IV in consult with stat ophtho consult

Question 9

Acute red/painful eye/vision loss IAIs

CRAO…

Answer 9

CRAO… sudden, monocular, Afferent Pupillary Defect, cherry red spot at fovea, pale retina box-carring
–Tx: Ocular massage 5 sec on, 5 sec off to dislodge embolus, ↓ IOP as in glaucoma, HBOT, stat ophtho
consult.

Question 10

Acute red/painful eye/vision loss IAIs

CRVO …

Answer 10

CRVO … monocular, “blood and thunder” retina on SLE, optic disc edema
1 ggt in the affected eye
1 ggt in the affected eye
–no specific tx, can try above, call ophtho. poss ASA

Question 11

Acute red/painful eye/vision loss IAIs

TA…

Answer 11

TA… HA, age > 50, likely PMR pt, ↑ESR.
–Tx: Prednisone 1mg/kg/d PO and NSAIDs, call ophtho.