Approach to Red Eye Flashcards

Question

What is the discharge in bacterial, viral, and allergic conjunctivitis?

Answer 1

``` Bacterial = mucopurulent in younger children Viral = mild/watery/"sleepers" Allergic = rare ```

Answer 2

``` Bacterial = common in older children, uncommon in infants and toddlers Viral = usually Allergic = usually ```

Answer 3

``` Bacterial = 1/3 Viral = 10% Allergic = no ```

Answer 4

``` Bacterial = no Viral = no Allergic = yes ```

Answer 5

"My eye has been red for years, especially after I have been out in the sun. I think it's getting worse" Triangular membrane on ocular surface from medial canthal region

Answer 6

``` Threat to vision by - Growth over visual axis - Distorting cornea > astigmatism Symptom relief Cosmetic reasons ```

Answer 7

"I was injured in an accident" "I've had a cough recently, and been on antibiotics. I also take warfarin" Common

Answer 8

Self-resolving

Answer 9

Usually, no May suggest serious pathology in some cases - Base of skull fracture - Supra-therapeutic warfarin dosage

Answer 10

Unilateral red eye with chemosis Types - Low flow - High flow

Answer 11

Meningeal branches of carotid arteries > canvernous sinus

Answer 12

``` Chronic red eye Unilateral intraocular pressure rise Orbital venous congestion Can be pulsatile Risk factors - HTN - Arteriosclerosis ```

Answer 13

Often resolves spontaneously

Answer 14

Internal carotid artery > cavernous sinus

Answer 15

``` Secondary to trauma Decreased visual acuity Pulsatile proptosis Bruit Raised intraocular pressure Can have ocular ischaemia Can have associated cranial nerve palsies ```

Answer 16

Radiological coiling/embolisation to close defect

Answer 17

``` Mild eye discomfort Itching Watering No visual disturbance Can be diffuse/sectoral ```

Answer 18

Idiopathic May be associated with - Vasculitis - Connective tissue disorders

Answer 19

Usually self-limiting Sometimes needs - Ocular lubricants - Topical NSAIDs

Answer 20

Severe aching pain > disturbs sleep Tender globe Vision may be affected Violaceous hue and injection of scleral vessels

Answer 21

``` Rheumatoid arthritis Granulomatosis with polyangiitis Relapsing polychondritis Polyarteritis nodosa Lupus - rare ```

Answer 22

Urgent referral to ophthalmologists

Answer 23

Copious topical anaesthesia Removal with bevel of needle Rust ring removed with dental burr Removal over axis of vision should be attempted by an ophthalmologist

Answer 24

Foreign body can be sub-tarsal | Scratches over cornea

Answer 25

"Welding flash" > painful red eye Fluorescein dye administered > switch off lights > cornea viewed under blue light Positive Seidel's sign

Answer 26

Aqueous humour displacing fluorescein dye on corneal surface

Answer 27

Urgent ophthalmological referral for - Dilated fundus exam - Surgical opinion

Answer 28

Acid tends to denature protein > barrier created > prevents further spread Alkali penetrates more deeply

Answer 29

Immediate copious irrigation for at least 30 min Determine pH on arrival to hospital Continue irrigation until pH normal Topical anaesthesia to cornea > lid eversion > removal of particulate matter with swab Topical antibiotic cover Topical steroids Intraocular pressure control

Answer 30

"My eye is sore, and it feels like there's something in it" "My vision is also blurred" "I can't wear my contact lenses today" Focal dense stromal infiltrate of neutrophils and bacteria Sharply demarcated epithelial defect Corneal oedema

Answer 31

S aureus S pneumoniae Pseudomonas aeruginosa

Answer 32

Corneal swab > MSC Intensive broad spectrum topical antimicrobial therapy Consider systemic antimicrobial therapy if threatened perforation exists

Answer 33

Endophthalmatitis

Answer 34

Bacterial keratitis | Acanthamoeba keratitis

Answer 35

``` Swimming whilst wearing contact lenses Gradual increase in discomfort over weeks Early exam - Epithelial irregularity/erosions - Infiltrates around corneal nerves = radial keratoneuritis Late exam - Corneal stromal infection - Dense ring infiltrate ```

Answer 36

Topical antiseptics = chlorhexidine Propamidine isethionate Can need corneal transplant once infection cleared

Answer 37

Dendritic ulcer

Answer 38

Corneal scarring | Blindness

Answer 39

Topical acyclovir for 2 weeks | +/- oral antivirals

Answer 40

``` Gradual onset of - Foreign body sensation - Watering - Reduced vision Red eye Peripheral corneal stromal thinning and ulceration ```

Answer 41

Urgent referral to ophthalmologist

Answer 42

Painful red eye Blurred vision Photophobia Flare and cells in anterior chamber

Answer 43

Inflammation of iris and anterior chamber

Answer 44

Topical glucocorticoids | Cycloplegics

Answer 45

Cataract Glaucoma Macular oedema

Answer 46

HSV/HZV TB Syphilis Lyme disease

Answer 47

Blood in anterior chamber

Answer 48

Usually trauma | Can occur spontaneously; eg: secondary to neovascularisation

Answer 49

Glaucoma Corneal staining Re-bleed

Answer 50

Topical steroids and cycloplegics | Sleep at 45 degrees/sitting up > reduce risk of corneal staining until hyphaema resolved

Answer 51

Severe pain Vision loss Recent intraocular surgery/penetrating eye injury Inflammation of multiple ocular structures

Answer 52

Find source of inflammation > tissue diagnosis imperative

Answer 53

Targeted antimicrobial therapy Intravitreal (+ systemic if infection systemic) Pars plana vitrectomy may be needed Enucleation for blind and painful eye

Answer 54

Secondary to - Surgery - Penetrating eye injury - Intraocular foreign body

Answer 55

``` Systemic infection Most common pathogens - Candida albicans - S aureus - E coli ```

Answer 56

``` Few hours of painful unilateral red eye Worsening vision If to touch eye, would be hard Cloudy oedematous cornea Mid-dilated pupil Raised intraocular pressure ```

Answer 57

Intraocular pressure reduction Acetazolamide IV and oral STAT Topical beta-blocker Topical steroids

Answer 58

Dilated fundal examination

Answer 59

``` Trauma Penetrating eye injury Inflammatory disorders - Uveitis - Scleritis Infection ```

Answer 60

``` Sub-conjunctival haemorrhage Pterygium Ectropion Corneal foreign body Herpes simplex keratitis Iritis ```

Answer 61

Viral conjunctivitis Dry eye Blepharitis

Answer 62

Chemical eye injury Penetrating eye injury Acute angle closure glaucoma

Answer 63

Unexplained decreased function - Visual acuity - Visual field - Colour vision - Abnormal pupil reactions - Increased intraocular pressure - An potential intra-ocular/-orbital pathology