Corneal Abrasions/keratitis/subconjunctival haemorrhages/ other random things

Question 1

What is a corneal abrasion?

Answer 1

Scratches or damage to the cornea

Question 2

What are the causes of corneal abrasions?

Answer 2

. Foreign body 
. Entropion 
. Eyelashes 
. Finger nails 
. CONTACT LENSES

Question 3

What is an important differential of corneal abrasions?

Answer 3

Herpes keratitis

Question 4

What may be the cause for infection if the abrasion is associated with contact lenses use?

Answer 4

Infection with pseudomonas

Question 5

What is the presentation of corneal abrasions?

Answer 5

History of contact lens use or foreign body 
Painful red eye
Foreign body sensation 
Watering eye
Blurring vision 
Photophobia

Question 6

How is corneal abrasion diagnosed?

Answer 6

A fluorescein stain is applied to the eye to diagnose a corneal abrasion (yellow- orange colour), the stain collects in abrasions or ulcers and highlights them

Slit lamp examination may be used in more significant abrasions

Question 7

What is the management of corneal abrasions?

Answer 7

Uncomplicated corneal ulcers usually heal over 1-2 days

Simple analgesia

Lubricating eye drops

Abx eye drops- chloramphenicol

Bring the patient back after 1 week to check it’s healed

Question 8

What is a subconjunctival haemorrhage?

Answer 8

This is a relatively common condition where one of the small blood vessels within the conjunctiva ruptures and releases blood into the space between the sclera and the conjunctiva.

They often appear after episodes of strenuous activity- heavy coughing, weight lifting or straining when constipated, it can also be caused by trauma to the eye

Question 9

What conditions may have contributed to a subconjunctival haemorrhage?

Answer 9

Hypertension 
Bleeding disorders- thrombocytopenia 
Whooping cough 
Medications (warfarin, NOACS, antiplatelets) 
Non accidental injury

Question 10

How would subconjunctival haemorrhage present?

Answer 10

Bright red blood underneath the conjunctiva and in front of the sclera, covering the white of the eye
It is painless and doesn’t affect vision

There may be a hx of a precipitating event- coughing fit, heavy lifting

It can be confidently diagnosed based on a simple hx and examination.

Question 11

What is the management of a subconjunctival haemorrhage?

Answer 11

They are harmless and will resolve spontaneously without any treatment, this takes around 2 weeks
Possible causes like hypertension and bleeding disorders may need further investigation

Lubcricating eye drops can help with symptoms if there is a foreign body sensation

Question 12

What is the vitreous body?

Answer 12

The gel inside the eye that maintains the structure of the eyeball and keeps the retina pressed on the choroid
The vitreous body is made up of collagen and water
With age it becomes less firm and less able to maintain its shape

Question 13

What is posterior vitreous detachment?

Answer 13

This is a condition where the vitreous gel comes away from the retina, it is very common, particularly in older patients.

Question 14

What is the presentation of posterior vitreous detachment?

Answer 14

Painless
Spots of vision loss
Floaters
Flashing lights

Question 15

What is the management of posterior vitreous detachment?

Answer 15

There is no management however

This can predispose patients to developing retinal tears and retinal detachment, so this must be checked for

Question 16

What is retinal detachment?

Answer 16

This is where the retina seperates from the choroid underneath, usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid

Question 17

Why is retinal detachment sight threatening?

Answer 17

The outer retina relies on the blood vessels of the choroid for its blood supply.

Question 18

What are the risk factors for retinal detachment?

Answer 18

Posterior vitreous detachment 
Diabetic retinopathy 
Trauma to the eye
Retinal malignancy 
Older age 
Family history

Question 19

What is the presentation of retinal detachment?

Answer 19

Peripheral vision loss- sudden and like a shadow coming across the vision
Blurred or distorted vision
Flashes and floaters

Question 20

What is the management of retinal detachment?

Answer 20

Immediate referral to opthalmology

Management of retinal tears aims to create adhesions between the retina and the choroid to prevent detachment, this can be done using laser therapy and cryotherapy.

Management of retinal detachment aims to reattach the retina and reduce any traction or pressure that may cause it to detach again.
There are 3 options for reattaching the retina…

1) vitrectomy (removing the relevant pars of the vitreous body and replacing it with oil or gas)
2) scleral buckling (using a silicone buckle to put pressure on the outside of the eye)
3) pneumatic retinopexy- injecting a gas bubble into the vitreous body