Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD2 Opthalmology > Assessment and Diagnosis of the Red Eye > Flashcards

Assessment and Diagnosis of the Red Eye Flashcards

1
Q

What should be considered in the initial approach to red eye?

A

Is there a life threatening problem concurrent with the red eye?

Does the red eye suggest a broader life or sight threatening problem? E.g. endogenous endopthalmitis, viral retinitis, scleritis, panuveitis, retinal vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mx of ectropion secondary to Bells palsy

A

Ocular lubricants

Consider surgical repair if lid position does not improve over next 3/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is ectropion?

A

Eversion of the eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is entropion?

A

Inversion of the eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mx of entropion

A

Surgical repair to prevent lashes rubbing on ocular surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hx: my eyes have been red and itchy for a few weeks now

O/E: note crust formation around lashes and associated inflammation

Dx?

Mx?

A

Dx: blepharitis

Mx: daily routine of lid margin hygiene (warm face washer applied over eyelids to open clogged meibomian glands, mechanical removal of lid debris, avoidance of makeup, topical Abx in refractory cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

“Is it a stye, doc?”

O/E: swelling located above eyelash margin

Dx? How do they differ from styes?

Mx?

A

Dx: chalazion (meibomian gland lipogranuloma; a cyst in theeyelid that is caused by inflammation of a blocked meibomian gland)

Differ from styes (hordeola) in that they are subacute and usually painless

Mx: often self-resolving, incision and curette for refractory cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hx: my eye has been painful, red and sore over the past 2-3/7

O/E: R VA 6/6, L VA 6/6, PEARL, normal IOP

Dx? Cause?

A

Periorbital (preseptal) cellulitis

Common infectious agents include staph aureus and strept pyogenes from skin, sinuses or meibomian glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mx of periorbital (preseptal) cellulitis

A

Oral Abx (e.g. augmentin duo forte)

More aggressive treatment in children because of greater risk of progression to orbital cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hx: onset over a few days, painful red eye +/- diplopia and visual impairment, systemic symptoms of nausea, fever, malaise

O/E: HR 110bpm, temp 38.6 degrees, L VA 6/18, left pupil sluggish, L IOP 25mmHg

Dx? Causes?

A

Orbital (postseptal) cellulitis; this problem is potentially life and sight threatening!

Common infectious agents include staph aureus, strept pyogenes, Hib which are most often spread from sinuses but can arise from tear ducts, trauma to orbit or preseptal cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx of orbital (postseptal) cellulitis

A

CT orbits/brain to confirm Dx

Swab purulent d/c (if present)

Hospital admission

IV Abx

ENT r/v

May need surgical drainage if an abscess has performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hx: my eyes are often red and sore, sometimes they become very watery

O/E: fluorescain staining viewed under cobalt blue light filter shows punctute epithelial erosions (PEEs) in the lower 1/3 of the cornea

Dx?

A

Dry eyes (reflex tears are produced in response to ocular surface irritation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Solve the following clinical scenario

What Ix should be ordered?

A

Sjogrens syndrome: reduced aqueous tear production due to presence of systemic auto-Abs

Ix: rheumatoid factor (RF), anti-nuclear Abs (ANA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A

MCS

Adenovirus, HSV, VZV and RSV PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Identify these different types of conjunctivitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contrast the clinical findings seen in bacterial, viral and allergic conjunctivitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hx: my eye has been red for years, especially after I have been out in the sun, but I think it’s getting worse

O/E: triangular membrane on ocular surface arising from medial canthal region

Dx?

Mx and rationale for Mx?

A

Dx: pterygium (fleshy overgrowth of the conjunctiva)

Mx: surgical removal

3 reasons for surgical removal, including 1) threat to vision (by growth over visual axis or by distorting the cornea, causing astigmatism), 2) Sx relief, or 3) cosmetic reason (pt preference)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Possible Hx:

1) I was injured in an accident
2) I have had a cough recently and have been on Abx; I also happen to take warfarin tablets

Dx? Mx? Prognosis?

A

Sub-conjunctival haemorrhage

Mx: self-resolving

Prognosis: common and usually non-serious, however may suggest serious pathology in some clinical contexts (e.g. base of skull #, supra-therapeutic warfarin dose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Chemosis

A

Oedema of the conjunctiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Features of low flow carotid-cavernous fistula

A

Chronic red eye

Unilateral IOP rise

Orbital venous congestion

Can be pulsatile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

RFs for low-flow carotid-cavernous fistula

A

HTN

Arteriosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prognosis of low-flow carotid-cavernous fistula

A

Often resolves spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Low-flow vs high-flow carotid-cavernous fistula

A

Low-flow: meningeal branches of carotid arteries to cavernous sinus

High-flow: ICA to cavernous sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does carotid-cavernous fistula present?

A

Unilateral red eye with chemosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Features of high-flow carotid-cavernous fistula

A

Usually secondary to trauma (i.e. base of skull #)

Decreased visual acuity

Pulsatile proptosis

Bruit

Raised IOP

Can have ocular ischaemia

Can have associated cranial nerve palsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Ix for carotid-cavernous fistula

A

Neuroimaging: CT is preferred initially but MRA if unclear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Mx of high-flow carotid-cavernous fistula

A

Radiological coiling/embolisation to close defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of red eye by structures involved

A

Eyelids

Tear film

Conjunctiva

Episclera and sclera

Cornea

Anterior chamber

Fundus

29
Q

Mild eye discomfort, itching and watering but no visual disturbance

Dx?

A

Episcleritis (can be diffuse or sectoral)

30
Q

Causes of episcleritis

A

Often idiopathic (~66% of the time)

May be associated with vasculitic and CTDs

31
Q

Mx of episcleritis

A

Usually self-limiting

Sometimes requires ocular lubricants or topical NSAIDs

32
Q

Hx: severe aching that disturbs sleep, tender globe, vision may be affected

O/E: violaceous hue and injection of scleral vessels

Dx?

Associated conditions?

Mx?

A

Dx: scleritis

Associated conditions: RA, Wegener’s granulomatosis, relapsing polychondritis, polyarteritis nodosa, SLE (rare)

Mx: requires urgent opthalm referral

33
Q

What is the abnormality? Mx?

A
34
Q

When should topical anaesthetics be prescribed?

A

They shouldn’t; they temporarily remove pain to enable clinical examination but should not be prescribed as they delay healing of the cornea

35
Q

What shape of corneal abrasian might a sub-tarsal foreign body such as this one cause?

A
36
Q

Hx: “welding flash” followed by painful red eye

O/E: fluorescain dye administered and lights out, cornea viewed under blue light

Describe the result

Dx?

Mx?

A

Dx: penetrating eye injury

Mx: urgent opthalm referral for dilated fundus examination and surgical opinion

37
Q

How does acid chemical injury differ from an alkali injury?

A

Acid tends to denature protein, creating a barrier and preventing further spread

Alkali pentrates more deeply

38
Q

Acute Mx of chemical eye injury

A

Immediate copious irrigation after injury

Continue for at least 30 mins

Determine pH on arrival to hospital

Continue irrigation until pH is normal (pH 7-7.5)

Topical anaesthesia to cornea, lid eversion and removal of particulate matter with a swab

Additional early Mx includes topical Abx cover, topical steroids and IOP control

39
Q

Hx: my eye is sore, it feels like there is something in it, and my vision is also blurred, I haven’t been able to tolerate wearing my contact lens today

O/E: fundoscopy performed

Describe findings on fundoscopy

Dx? Cause?

A

Dx: bacterial keratitis

Common causative organisms: Gram +ives (staph aureus, strept pneumoniae), Gram -ives (pseudomonas aeruginosa)

40
Q

What causative organism for bacterial keratitis is the most pathogenic?

A

Pseudomonas; can cause perforation in less than 72 hrs; attaches to epithelial breaks due to its biofilm

41
Q

Mx of bacterial keratitis

A

Corneal swab and MCS

Intensive broad spectrum topical antimicrobial therapy (i.e. hourly eye drops day and night for 2/7, then gradually taper)

Consider systemic antimicrobial therapy if threat of perforation exists (to reduce risk of endopthalmitis)

42
Q

Identify one alternative Dx to contact lens-related microbial keratitis

A

Ancathamoeba keratitis

43
Q

Hx: swimming whilst wearing contact lenses

O/E: corneal stromal infection with dense ring infiltrate

Dx?

Mx?

A

Dx: acanthamoeba keratitis

Mx: topical antiseptics (i.e. chlorhexidine) plus propamidine isethionate (Brolene), can require corneal transplant once infection cleared (due to corneal scarring/threatened perforation)

44
Q

What findings would be expected O/E early and late in acanthamoeba keratitis?

A

Early: epithelial irregularity/erosions, infiltrates around corneal nerves (radial keratoneuritis)

Later: corneal stromal infection, dense ring infiltrate

45
Q

Describe the corneal epithelial defect seen here

Dx and pathophysiology?

Mx?

A

Dx: herpes simplex keratitis

HSV very common and survives in sensory ganglion in latent phase; when reactivated, virus is transported down axons to sensory nerve endings and ocular surface becomes infected, with repeated infection can lead to corneal scarring and blindness

Mx: topical anti-viral therapy (i.e. acyclovir) for 2/52 +/- oral anti-virals

46
Q

Types of keratitis

A
47
Q

Hx: gradual onset of foreign body sensation, watering and reduced vision

O/E: red eye, peripheral corneal stromal thinning and ulceration

PHx: RA

Dx? Mx?

A

Dx: corneal melt (progressive loss of stroma in a dissolving fashion)

Mx: urgent opthalm referral due to imminent risk of perforation

48
Q

Describe the corneal sign below

Dx?

A

Multiple pale, round deposits on corneal endothelial surface

Name of clinical sign: keratic precipitates

Dx: iritis (AKA anterior uveitis; chronic)

49
Q

Hx: painful red eye, with blurred vision and photophobia

O/E: flare and cells in the anterior chamber

Dx?

What other possible examination findings might be seen in this condition?

A

Dx: iritis (anterior uveitis)

50
Q

What is iritis?

A

Inflammation of the iris and anterior chamber

51
Q

Mx of iritis

A

Topical glucocorticoids

Cycloplegics (e.g. homatropine)

52
Q

Potential complications of iritis

A

Cataract

Glaucoma

Macular oedema

53
Q

Infectious causes of iritis

A

HSV/HZV

Tuberculosis

Syphilis

Lyme disease

54
Q

Systemic diseases associated with iritis

A

Spondyloarthropathies (often HLA-B27 positive): ankylosing spondylitis (30% also suffer from iritis), reactive arthritis (20%), psoriatic arthritis

Juvenile idiopathic arthritis

UC

Crohn’s

Tubulointerstitial nephritis

IgA glomerulonephritis

Sarcoidosis

Bechet’s disease

And more…

55
Q

Precautions for prescribing steroids

A

Pts receiving topical steroid prescription MUST be followed up by an opthalmologist

56
Q

What is hyphaema?

A

Blood in anterior chamber

57
Q

Causes of hyphaema

A

Usually trauma but can occur spontaneously (e.g. secondary to neovascularisation)

58
Q

Complications of hyphaema

A

Glaucoma

Corneal staining

Re-bleed (highest risk 5 days post-injury)

59
Q

Mx of hyphaema

Other appearances of hyphaema

A

Topical steroids and cycloplegics

Patient to sleep at 45 degrees or sitting up, to reduce risk of corneal staining until hyphaema resolved

60
Q

Hx: severe pain and loss of vision, recent intra-ocular surgery or penetrating eye injury

O/E: inflammation of multiple ocular structures (note evidence of recent surgery)

Dx?

A

Endopthalmitis

Can be exogenous or endogenous; finding the source and achieving a tissue Dx is imperative!

61
Q

Mx of endophthalmitis

A

Targeted antimicrobial therapy: intravitreal (plus systemic therapy if systemic source of infection is present)

Pars plana vitrectomy may be required

Enucleation for a blind and painful eye

62
Q

How does exogenous endophthalmitis arise?

A

Usually secondary to surgery, trauma or intra-ocular foreign body

63
Q

How does endogenous endophthalmitis occur? What are the typical causative organisms?

A

From systemic infection

Most common pathogens: fungal (candida albicans), Gram +ives (staph aureus), Gram -ives (E. coli)

64
Q

List 4 potential posterior segment-involving causes of red eye

What do these call for?

A

Trauma

Penetrating eye injury

Inflammatory disorders: uveitis, scleritis

Infective: viral, bacterial

All require a dilated fundal examination!

65
Q

6 causes of unilateral red eye

A

Sub-conjunctival haemorrhage

Pterygium

Ectropion

Corneal foreign body

Herpes simplex keratitis

Iritis

66
Q

3 causes of bilateral red eyes

A

Viral conjunctivitis

Dry eyes

Blepharitis

67
Q

3 causes of red eye requiring immediate emergency measurement

A

Chemical eye injury

Penetrating eye injury

Acute angle closure glaucoma

68
Q

Causes of red eye requiring referral to an opthalmologist

A

Any presentation with unexplained decreased function should be referred (decreased VA of unknown cause, decreased visual field, decreased colour vision, abnormal pupils reactions, increased IOP, any potential intra-ocular or orbital pathology)

MD2 Opthalmology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions