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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
Q

What causes herpetic keratitis (dendritic ulcer)?

A

Herpes simplex virus (HSV)

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26
Q

Define orbital cellulitis

A

Infection of the orbital tissues posterior to orbital septum

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27
Q

Describe the clinical presentation of viral conjunctivitis

A

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

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28
Q

Describe the management of allergic conjunctivitis

A

Avoid triggers

Cool compresses, oral/topical antihistamines for symptomatic relief

Once control achieved - maintenance with a mast cell stabiliser (e.g. sodium cromoglycate)

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29
Q

Describe the clinical presentation of orbital cellulitis

A

Painful, especially on eye movements

Proptosis

Often associated with paranasal sinusitis

Pyrexial

Sight threatening

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30
Q

How would you investigate keratitis?

A

Examination - anaethetics if photophobic, fluorescein, corneal reflex

Corneal scrape for gram stain and culture

In acanthamoeba ketatitis also culture contact lens

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31
Q

Describe the management of orbital cellulitis

A

Broad spectrum antibiotics and monitor closely

Sometimes an abscess will require drainage

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32
Q

Describe the clinical presentation of chlyamydial conjunctivitis

A

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

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33
Q

Define blepharitis

A

Common chronic inflammatory condition affecting the margin of the eyelids

34
Q

Describe the management of blepharitis

A

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
Q

Why should you not treat herpetic keratitis with steroids?

A

Can cause corneal melt and perforation of the cornea

36
Q

How would you investigate endopthalmitis?

A

Aqueous/vitreous for culture

37
Q

Define conjunctivitis

A

Inflammation of the conjunctiva

38
Q

How would you investigate orbital cellulitis?

A

CT scan to identify orbital abscesses

If any suggestion of muscle restriction or optic nerve dysfunction - CT scan

39
Q

What are the most common causative organisms of bacterial conjunctivitis in most age groups?

A

Staph. aureus

Step. pneumoniae

Hamophilus influenzae (especially in children)

40
Q

What is an internal stye?

A

Occurs on the conjunctival surface of the eyelid, caused by infection of a Meibomian gland

41
Q

Describe the examination findings in anterior uveitis

A

Circumcorneal red eye

Ciliary injection

Keratic precipitates

Hypopyon

Synechiae

Cells and flare in the anterior chamber

42
Q

What is posterior blepharitis?

A

Inflammation of the meibomian glands (often called meibomian gland dysfunction)

43
Q

Define stye (hordeolum)

A

Acute localized infection or inflammation of the eyelid margin, usually caused by staphylococcal infection

44
Q

Describe the clinical presentation of bacterial conjunctivitis

A

Even more abrupt onset than viral disease, spreads to both eyes within 48 hours

Morning crusting

Copious mucopurulent yellow discharge

Papillae

45
Q

What causes acute angle-closure glaucoma?

A

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
Q

Describe the management of acanthamoeba keratitis

A

Anti-amoebic drops

47
Q

What usually causes preseptal cellulitis?

A

Contiguous spread of infection from local facial or eyelid trauma e.g. insect bites

48
Q

Describe the clinical presentation of acute angle-closure glaucoma

A

Severe pain and nausea

Circumcorneal injection

Cornea cloudy (oedematous)

Pupil mid-dilated

Eye stony hard

49
Q

Describe the management of scleritis

A

Oral NSAIDs

Oral steroids + steroid sparing agents

50
Q

Name 3 causative organisms of viral conjunctivitis

A

Adenovirus, herpes simplex, herpes zoster

51
Q

Name three infective causes of anterior uveitis

A

TB, syphilis, herpes simplex/zoster

52
Q

Describe the management of herpetic keratitis

A

Treated with topical antiviral (ganciclovir)

53
Q

Describe the clinical presentation of preseptal cellulitis

A

Tenderness, warmth, swelling, redness of the eyelid

54
Q

Describe the clinical presentation of conjunctivitis

A

Inflammation - swelling, redness, pain, heat

Gritty irritation/itchiness

Watery/purulent discharge

Does not cause pain, photophobia or reduced visual acuity

55
Q

What is a hypopyon?

A

Aggregation of inflammatory cells within the anterior chamber resulting in visible ‘sediment’ in front of the eye inferiorly

56
Q

Describe the management of bacterial conjunctivitis

A

Topical chloramphenical

Swab and culture if unresponsive - fusidic acid for Staph. aureus, gentamicin for most gram negatives

57
Q

Describe the management of episcleritis

A

Self limiting - lubricants and cold compresses, topical NSAIDs, mild steroids

58
Q

Define cellulitis

A

Bacterial infection of the lower dermis and subcutaneous tissue

59
Q

What causes anterior uveitis?

A

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
Q

Define episcleritis

A

Inflammation of the episclera, the thin vascular sheet which lies between the conjunctiva and sclera

61
Q

Describe the management of fungal keratitis

A

Topical antifungals

62
Q

What causes episcleritis?

A

Usually idiopathic, if no clear cause will be self-limiting

Can be caused by underlying systemic disease e.g. IBD, rheumatoid arthritis, sarcoidosis

63
Q

Define keratitis

A

Inflammation of the cornea

64
Q

Describe the clinical features of adenoviral keratitis

A

Bilateral

Usually follows URTI/conjunctivitis

May affect vision

65
Q

Describe the clinical presentation of scleritis

A

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
Q

Describe the clinical presentation of keratitis

A

Photophobia

Severe ocular pain and associated foreign body sensation

Hypopyon

67
Q

Name two complications of blepharitis

A

Stye (hordeolum), chalazion

68
Q

Define endopthalmitis

A

Devastating infection inside of the eye that threatens sight

69
Q

Describe the management of adenoviral keratitis

A

Can require steroids to speed up recovery if becomes chronic

70
Q

Describe the management of a stye

A

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
Q

Over 50% of patients with herpes simplex conjunctivitis will develop a ______ _______

A

Dendritic ulcer

72
Q

How can you differentiate between staphylococcal blepharitis and seborrhoeic blepharitis?

A

Seborrhoeic blepharitis is characterized by less inflammation than staphylococcal blepharitis; however, it causes more excess oil or greasy scaling

73
Q

Chlyamydial conjunctivitis can cause ______ scarring if not treated

A

Subtarsal scarring

74
Q

How would you manage viral conjunctivitis caused by herpes simplex or herpes zoster?

A

Antivirals e.g. ganciclovir

75
Q

What is the most common cause of conjunctivitis?

A

Viral aetiology, most commonly adenovirus

76
Q

Which age group most commonly develops blepharitis?

A

Middle-age

77
Q

Describe the management of bacterial keratitis

A

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
Q

What causes orbital cellulitis?

A

Direct extension from sinus

Extension from focal orbital infection

Post-operative

79
Q

Describe the clinical features of fungal keratitis

A

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
Q

Name two risk factors for the development of a stye

A

Chronic blepharitis and acne rosacea

81
Q

How would you manage viral conjunctivitis caused by adenovirus (watery discharge)?

A

Lubrication, cold compress (self-limiting)

82
Q

What typically causes allergic conjunctivitis?

A

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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