CNS/HN - Eye Redness Flashcards
Differential Diagnosis of Eye Redness
- HSV Keratitis
- Zika Virus
Eye, red and tender
Probability diagnosis Conjunctivitis:
•bacterial
•adenovirus
•allergic
Serious disorders not to be missed
Acute glaucoma
Uveitis:
•acute iritis
•choroiditis
Corneal ulcer Corneal injury: abrasion/foreign body Herpes simplex keratitis Microbial keratitis (e.g. fungal, amoeba, bacterial) Herpes zoster ophthalmicus Penetrating injury Endophthalmitis Orbital cellulitis
Pitfalls (often missed) Scleritis/episcleritis Foreign body (esp. IOFB) Trauma Ultraviolet light ‘keratitis’ Blepharitis
Rarities:
•cavernous sinus arteriovenous fistula
•primary tumour of eye
Masquerades checklist
Drugs (hypersensitivity)
Thyroid disorder (hyperthyroidism)
History - Microbial/ HSV Keratitis
History
- Eye Redness - HOPI
- which eye?
- Associated symptoms:
- eye discomfort? dry and irritated eyes? FB sensation?
- swelling, discharge, pain, blurring of vision, sensitivity to light
- fever and rash
- 1st time?
- Do you wear glasses?
Risk factors: - contact lens (wearing habits, no of hours/day, no of days /week, replacement schedule. cleaning agents and methods. storage and disinfection) - hx of underlying eye problem - Trauma - Ever been in close contact with others with same condition? - Have you been putting any drops, ointments, or cosmetics around the eye? - Do you suffer from hay fever? - Travel? Bush walking? Joint pains? - Occupation? - Allergy? - Exposure? - Sexual hx? STI? Cold sore? - Chicken pox? - FH of eye problem (glaucoma) - SADMA
Physical Examination - Microbial/ HSV Keratitis
Examination
-GA
- VS
- BMI
- Eyes:
- visual acuity (done with glasses or contact lenses),
- pinhole test,
- eyelid
- conjunctiva
- cornea (foreign bodies, haze, infiltrates or ulceration)
instillation of fluorescein dye and the use of a cobalt blue light. It is important to note the size and location of any corneal ulcers.
- eyelid eversion
- ant chamber - looking for hypopyon or endophthalmitis
- pupils - posterior synechiae (ant. uveitis)
- ocular tension/tonometry (21-22), fundoscopy
- Cranial nerve examination
- OT - UDS, BSL
Management - Microbial Keratitis / HSV Keratitis
TREATMENT:
- Discontinue contact lenses and wear glasses
- Refer to ophtha
- they may perform scrapings of the ulcer and sent for microscopy and sensitivity
- Bring contact lens, storage case and solution bottles and sent for culture.
- Broad spectrum antibiotic, once identified change ab
- Eye hygiene
If HSV Keratitis:
- Acyclovir 3% ointment 5x a day x 14 days or for at least 3 days after healing
- Atropine 1% 1 drop , q12 hourly, for duration of treatment will prevent reflex spasm of the pupil (specialist supervision)
- Debridement by a consultant
- Refer to ophtha: especially if central ulcer; if peripheral may treat but must review after 24-48 hours.
- Do not dilate eye (as GP)!!!
- May result in blindness if not treated properly.
Key Diagnostic tips - Red Eye
Diagnostic tips
•A purulent discharge indicates bacterial conjunctivitis.
•A clear or mucus discharge indicates viral or allergic conjunctivitis.
•Be alert for the unilateral red eye: think beyond the conjunctivitis trio. It may be a corneal ulcer, keratitis, foreign body, trauma, uveitis or acute glaucoma.
Key Diagnostic tips - Red Eye
Diagnostic tips
•A purulent discharge indicates bacterial conjunctivitis.
•A clear or mucus discharge indicates viral or allergic conjunctivitis.
•Be alert for the unilateral red eye:
- think beyond the conjunctivitis trio.
- It may be a corneal ulcer, keratitis, foreign body, trauma, uveitis or acute glaucoma.
Diagnosis - Microbial Keratitis
Condition - Microbial Keratitis
Common
Cause/ Risk factor
- Contact Lens
- Trauma
- Preexisting eye problem
- Foreign body
- Exposure to contaminated water
Clinical feature - symptoms are what you are having - Early ocular symptoms include • general ocular discomfort • dry or irritated eyes • foreign body sensation. • Increased eyelid swelling and lacrimation • difficulty opening their eyes • decrease in vision. - Later symptoms include • severe pain • photophobia • noticeable eye discharge with significant decrease in visual acuity
Complication It is a medical emergency and should be manage promptly. If left untreated: - scarring of cornea - perforation of cornea -permanent loss of vision -if severe, loss of the eye
Differential Diagnosis - Zika Virus
Can be as Red eyes, Fever and Rash
Differentials
- Zika Virus
- Dengue Virus
- Chikungunya fever
- Lyme Virus
- Ross River Fever
- Yellow Fever
- Meningococcemia
- Measles
- CMV
- EBV
- ITP
- HSP
- Arthritis
- CTD
- Autoimmune disorders
History - Zika Virus
History - HOPI - Red eyes, Fever or Rash - Red eyes (blurring of vision, pain, discharge, swelling, sensitivity to light) - Fever (intermittent or continuous, meds, night sweats, chills and rigors) - Rash (sites, color, itchy, discharge, blanchable or non blanchable) - Associated symptoms - headache - - trauma to eyes > wearing contact lens - cough and colds - neck stiffness - vomiting - tummy pain - joint pains> swelling>stiffness - LOA, LOW, LBB
Risk factors - Travel > bushwalking> mosquito bites >travel advise - Occupation - Pets and Carpets - Exposure - Sexual hx If female ask 5P
PMH
PSH
SADMA
Diagnosis - Zika Virus
Condition -
Zika Virus or Dengue Virus
Common
Cause
Viral infection
Clinical feature
Usually transmitted by a mosquito or insect that commonly present in tropics and subtropics areas.
usually presented with tiredness, aches, joint pain, sore eyes, rashes and fever. As you have recently returned from travel that is why I am suspecting. They are usually self-limiting conditions.
Complication
self-limiting conditions.
Management - Zika Virus
-I need to do Ix to rule out these causes: FBE (platelet for dengue), BSL, LFT, UCE thick and thin blood film hepatitis serology serology for ross river fever serology for dengue fever, lyme, zika
