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MBChB YR2: Opthalmology > Disease Profiles: Acute Red Eye > Flashcards

Disease Profiles: Acute Red Eye Flashcards

1
Q

Describe the clinical presentation of endopthalmitis

A

Very painful

Decreasing vision

Very red eye

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2
Q

Define scleritis

A

Full thickness inflammation of the sclera

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3
Q

Describe the management of chlyamydial conjunctivitis

A

Topical oxytetracycline

Adults may need oral azithromycin for genital chlamydia infection

Need contact tracing

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4
Q

Describe the clinical presentation of episcleritis

A

Typically not painful but there can be mild pain

Segmental redness (rather than diffuse) - there is usually a patch of redness in the lateral sclera

Foreign body sensation

Dilated episcleral vessels

Watering of eye

No discharge

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5
Q

What causes endopthalmitis?

A

Can be post-surgical or endogenous

Often caused by conjunctival commensal bacteria, most common causative organism is Staph. epidermidis

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6
Q

Describe the clinical features of acanthamoeba keratitis

A

Most often seen in contact lens wearers

Often extremely painful

Can be diagnosed late

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7
Q

Describe the management of anterior uveitis

A

Topical steroids

Mydriatics

Investigate for systemic associations if recurrent or chronic

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8
Q

Describe the management of preseptal cellulitis

A

Antibiotics (can be outpatient if orbital cellulitis definitively excluded)

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9
Q

Define preseptal cellulitis

A

Infection of the eyelid and surrouding skin anterior to the orbital septum

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10
Q

Describe the clinical presentation of a stye

A

An acute-onset painful, localized swelling (papule or furuncle) near the eyelid margin that develops over several days

Usually unilateral but can be bilateral

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11
Q

Describe the management of endopthalmitis

A

Intravitreal amikacin/ceftazidime/vancomycin and topical antibiotics

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12
Q

Define anterior uveitis

A

Inflammation in the anterior part of the uvea; the uvea involves the iris, ciliary body and choroid

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13
Q

Name the two types of anterior blepharitis

A

Bacteria, usually staphylococci

Seborrhoeic dermatitis

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14
Q

What is anterior blepharitis?

A

Refers to inflammation of the base of the eyelashes (located on the anterior margin of the eyelid)

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15
Q

Which type of keratitis is this picture demonstrating?

A

Herpetic keratitis (dendritic ulcer)

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16
Q

What are the most common causative organisms of bacterial conjunctivitis in a neonate?

A

Staph. aureus

Neisseria gonnorhoeae

Chlamydia trachomatis

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17
Q

Describe the clinincal presentation of allergic conjunctivitis

A

Watery, itchy eyes

Bilateral and symmetrical ocular involvement with global injection and chemosis

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18
Q

What is an external stye?

A

Appears on the eyelid margin, caused by infection of an eyelash follicle or associated gland

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19
Q

Name three autoimmune causes of anterior uveitis

A

Reiter’s, HLA B27-related diseases, sarcoidosis

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20
Q

Describe the clinical presentation of anterior uveitis

A

Usually presents with unilateral symptoms that start spontaneously without a history of trauma or precipitating events

May occur with a flare of an associated disease such as reactive arthritis (Reiter’s) - ‘can’t see, pee, or climb a tree’

Dull, aching, painful red eye

Vision may be reduced

Photophobia

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21
Q

Describe the clinical presentation of blepharitis

A

Burning, itching and/or crusting of the eyelids

Symptoms are worse in the mornings

Both eyes are affected

Recurrent hordeolum

Contact lens intolerance

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22
Q

How would you differentiate between anterior and posterior blepharitis?

A

Anterior blepharitis - lid margin redder than deeper part of lid

Posterior blepharitis - redness is in deeper part of lid, lid margin often looks normal

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23
Q

What causes scleritis?

A

There is an associated systemic condition in around 50% of patients presenting with scleritis e.g. rheumatoid arthritis, SLE, IBD, sarcoidosis, GPA

Surgery and infections can also be responsible

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24
Q

Name a form of malignancy which can cause anterior uveitits

A

Leukaemia

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25
What causes herpetic keratitis (dendritic ulcer)?
Herpes simplex virus (HSV)
26
Define orbital cellulitis
Infection of the orbital tissues posterior to orbital septum
27
Describe the clinical presentation of viral conjunctivitis
Sudden onset, rapidly progressive Typically bilateral, often manifests in one eye before spreading to the other Some patients will have associated URT - dry cough, sore throat and blocked nose Adenoviral - watery discharge Herpes simplex - cutaneous vesicles develop on the eyelids and on the skin around the eyes Herpes zoster - shingles rash
28
Describe the management of allergic conjunctivitis
Avoid triggers Cool compresses, oral/topical antihistamines for symptomatic relief Once control achieved - maintenance with a mast cell stabiliser (e.g. sodium cromoglycate)
29
Describe the clinical presentation of orbital cellulitis
Painful, especially on eye movements Proptosis Often associated with paranasal sinusitis Pyrexial Sight threatening
30
How would you investigate keratitis?
Examination - anaethetics if photophobic, fluorescein, corneal reflex Corneal scrape for gram stain and culture In acanthamoeba ketatitis also culture contact lens
31
Describe the management of orbital cellulitis
Broad spectrum antibiotics and monitor closely Sometimes an abscess will require drainage
32
Describe the clinical presentation of chlyamydial conjunctivitis
Often chronic history unresponsive to treatments Suspect in bilateral conjunctivitis in YAs May or may not have symptoms of urethritis, vaginitis Can be passed from mother to newborn
33
Define blepharitis
Common chronic inflammatory condition affecting the margin of the eyelids
34
Describe the management of blepharitis
Symptoms can usually be controlled with self-care measures such eyelid hygiene and warm compresses Treat associated condition e.g. supplementary tear drops for dry eye syndrome If eyelid measures ineffective - consider prescribing topical cloramphenicol for anterior blepharitis or oral doxycycline for posterior blepharitis
35
Why should you not treat herpetic keratitis with steroids?
Can cause corneal melt and perforation of the cornea
36
How would you investigate endopthalmitis?
Aqueous/vitreous for culture
37
Define conjunctivitis
Inflammation of the conjunctiva
38
How would you investigate orbital cellulitis?
CT scan to identify orbital abscesses If any suggestion of muscle restriction or optic nerve dysfunction - CT scan
39
What are the most common causative organisms of bacterial conjunctivitis in most age groups?
Staph. aureus Step. pneumoniae Hamophilus influenzae (especially in children)
40
What is an internal stye?
Occurs on the conjunctival surface of the eyelid, caused by infection of a Meibomian gland
41
Describe the examination findings in anterior uveitis
Circumcorneal red eye Ciliary injection Keratic precipitates Hypopyon Synechiae Cells and flare in the anterior chamber
42
What is posterior blepharitis?
Inflammation of the meibomian glands (often called meibomian gland dysfunction)
43
Define stye (hordeolum)
Acute localized infection or inflammation of the eyelid margin, usually caused by staphylococcal infection
44
Describe the clinical presentation of bacterial conjunctivitis
Even more abrupt onset than viral disease, spreads to both eyes within 48 hours Morning crusting Copious mucopurulent yellow discharge Papillae
45
What causes acute angle-closure glaucoma?
Acute angle-closure glaucoma occurs when the iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from being able to drain away, leading to a continual buildup of IOP
46
Describe the management of acanthamoeba keratitis
Anti-amoebic drops
47
What usually causes preseptal cellulitis?
Contiguous spread of infection from local facial or eyelid trauma e.g. insect bites
48
Describe the clinical presentation of acute angle-closure glaucoma
Severe pain and nausea Circumcorneal injection Cornea cloudy (oedematous) Pupil mid-dilated Eye stony hard
49
Describe the management of scleritis
Oral NSAIDs Oral steroids + steroid sparing agents
50
Name 3 causative organisms of viral conjunctivitis
Adenovirus, herpes simplex, herpes zoster
51
Name three infective causes of anterior uveitis
TB, syphilis, herpes simplex/zoster
52
Describe the management of herpetic keratitis
Treated with topical antiviral (ganciclovir)
53
Describe the clinical presentation of preseptal cellulitis
Tenderness, warmth, swelling, redness of the eyelid
54
Describe the clinical presentation of conjunctivitis
Inflammation - swelling, redness, pain, heat Gritty irritation/itchiness Watery/purulent discharge Does not cause pain, photophobia or reduced visual acuity
55
What is a hypopyon?
Aggregation of inflammatory cells within the anterior chamber resulting in visible 'sediment' in front of the eye inferiorly
56
Describe the management of bacterial conjunctivitis
Topical chloramphenical Swab and culture if unresponsive - fusidic acid for Staph. aureus, gentamicin for most gram negatives
57
Describe the management of episcleritis
Self limiting - lubricants and cold compresses, topical NSAIDs, mild steroids
58
Define cellulitis
Bacterial infection of the lower dermis and subcutaneous tissue
59
What causes anterior uveitis?
Involves inflammation and immune cells in the anterior chamber of the eye This is usually caused by an autoimmune process but can be due to infection, trauma, ischaemia or malignancy
60
Define episcleritis
Inflammation of the episclera, the thin vascular sheet which lies between the conjunctiva and sclera
61
Describe the management of fungal keratitis
Topical antifungals
62
What causes episcleritis?
Usually idiopathic, if no clear cause will be self-limiting Can be caused by underlying systemic disease e.g. IBD, rheumatoid arthritis, sarcoidosis
63
Define keratitis
Inflammation of the cornea
64
Describe the clinical features of adenoviral keratitis
Bilateral Usually follows URTI/conjunctivitis May affect vision
65
Describe the clinical presentation of scleritis
Severe pain that progresses over several days Pain with eye movement Photophobia Eye watering Reduced visual acuity Abnormal pupil reaction to light Tenderness to palpation of the eye
66
Describe the clinical presentation of keratitis
Photophobia Severe ocular pain and associated foreign body sensation Hypopyon
67
Name two complications of blepharitis
Stye (hordeolum), chalazion
68
Define endopthalmitis
Devastating infection inside of the eye that threatens sight
69
Describe the management of adenoviral keratitis
Can require steroids to speed up recovery if becomes chronic
70
Describe the management of a stye
Symptoms typically resolve within 5–7 days, once the stye has spontaneously ruptured or been drained Warm compresses can be used to encourage the stye to drain
71
Over 50% of patients with herpes simplex conjunctivitis will develop a ______ \_\_\_\_\_\_\_
Dendritic ulcer
72
How can you differentiate between staphylococcal blepharitis and seborrhoeic blepharitis?
Seborrhoeic blepharitis is characterized by less inflammation than staphylococcal blepharitis; however, it causes more excess oil or greasy scaling
73
Chlyamydial conjunctivitis can cause ______ scarring if not treated
Subtarsal scarring
74
How would you manage viral conjunctivitis caused by herpes simplex or herpes zoster?
Antivirals e.g. ganciclovir
75
What is the most common cause of conjunctivitis?
Viral aetiology, most commonly adenovirus
76
Which age group most commonly develops blepharitis?
Middle-age
77
Describe the management of bacterial keratitis
Patient needs to be admitted for hourly antibiotic drops, patients require daily review Ofloxin - treats most gram negatives Gentamicin and cefuroxime - treats most gram positive and gram negative organisms
78
What causes orbital cellulitis?
Direct extension from sinus Extension from focal orbital infection Post-operative
79
Describe the clinical features of fungal keratitis
Often chronic history Seen in those who work outside or have ocular surface disease Often corneal lesions more defined than its bacterial counterpart Often diagnosed late
80
Name two risk factors for the development of a stye
Chronic blepharitis and acne rosacea
81
How would you manage viral conjunctivitis caused by adenovirus (watery discharge)?
Lubrication, cold compress (self-limiting)
82
What typically causes allergic conjunctivitis?
Most cases seasonal as a result of pollen allergy, can occur due to allergens e.g. animal dander

MBChB YR2: Opthalmology (20 decks)

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