Disease Profiles: Acute Red Eye Flashcards
Describe the clinical presentation of endopthalmitis
Very painful
Decreasing vision
Very red eye
Define scleritis
Full thickness inflammation of the sclera
Describe the management of chlyamydial conjunctivitis
Topical oxytetracycline
Adults may need oral azithromycin for genital chlamydia infection
Need contact tracing
Describe the clinical presentation of episcleritis
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
What causes endopthalmitis?
Can be post-surgical or endogenous
Often caused by conjunctival commensal bacteria, most common causative organism is Staph. epidermidis
Describe the clinical features of acanthamoeba keratitis
Most often seen in contact lens wearers
Often extremely painful
Can be diagnosed late
Describe the management of anterior uveitis
Topical steroids
Mydriatics
Investigate for systemic associations if recurrent or chronic
Describe the management of preseptal cellulitis
Antibiotics (can be outpatient if orbital cellulitis definitively excluded)
Define preseptal cellulitis
Infection of the eyelid and surrouding skin anterior to the orbital septum
Describe the clinical presentation of a stye
An acute-onset painful, localized swelling (papule or furuncle) near the eyelid margin that develops over several days
Usually unilateral but can be bilateral
Describe the management of endopthalmitis
Intravitreal amikacin/ceftazidime/vancomycin and topical antibiotics
Define anterior uveitis
Inflammation in the anterior part of the uvea; the uvea involves the iris, ciliary body and choroid
Name the two types of anterior blepharitis
Bacteria, usually staphylococci
Seborrhoeic dermatitis
What is anterior blepharitis?
Refers to inflammation of the base of the eyelashes (located on the anterior margin of the eyelid)
Which type of keratitis is this picture demonstrating?
Herpetic keratitis (dendritic ulcer)
What are the most common causative organisms of bacterial conjunctivitis in a neonate?
Staph. aureus
Neisseria gonnorhoeae
Chlamydia trachomatis
Describe the clinincal presentation of allergic conjunctivitis
Watery, itchy eyes
Bilateral and symmetrical ocular involvement with global injection and chemosis
What is an external stye?
Appears on the eyelid margin, caused by infection of an eyelash follicle or associated gland
Name three autoimmune causes of anterior uveitis
Reiter’s, HLA B27-related diseases, sarcoidosis
Describe the clinical presentation of anterior uveitis
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
Describe the clinical presentation of blepharitis
Burning, itching and/or crusting of the eyelids
Symptoms are worse in the mornings
Both eyes are affected
Recurrent hordeolum
Contact lens intolerance
How would you differentiate between anterior and posterior blepharitis?
Anterior blepharitis - lid margin redder than deeper part of lid
Posterior blepharitis - redness is in deeper part of lid, lid margin often looks normal
What causes scleritis?
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
Name a form of malignancy which can cause anterior uveitits
Leukaemia
What causes herpetic keratitis (dendritic ulcer)?
Herpes simplex virus (HSV)
Define orbital cellulitis
Infection of the orbital tissues posterior to orbital septum
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
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)
Describe the clinical presentation of orbital cellulitis
Painful, especially on eye movements
Proptosis
Often associated with paranasal sinusitis
Pyrexial
Sight threatening
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
Describe the management of orbital cellulitis
Broad spectrum antibiotics and monitor closely
Sometimes an abscess will require drainage
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
Define blepharitis
Common chronic inflammatory condition affecting the margin of the eyelids
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
Why should you not treat herpetic keratitis with steroids?
Can cause corneal melt and perforation of the cornea
How would you investigate endopthalmitis?
Aqueous/vitreous for culture
Define conjunctivitis
Inflammation of the conjunctiva
How would you investigate orbital cellulitis?
CT scan to identify orbital abscesses
If any suggestion of muscle restriction or optic nerve dysfunction - CT scan
What are the most common causative organisms of bacterial conjunctivitis in most age groups?
Staph. aureus
Step. pneumoniae
Hamophilus influenzae (especially in children)
What is an internal stye?
Occurs on the conjunctival surface of the eyelid, caused by infection of a Meibomian gland
Describe the examination findings in anterior uveitis
Circumcorneal red eye
Ciliary injection
Keratic precipitates
Hypopyon
Synechiae
Cells and flare in the anterior chamber
What is posterior blepharitis?
Inflammation of the meibomian glands (often called meibomian gland dysfunction)
Define stye (hordeolum)
Acute localized infection or inflammation of the eyelid margin, usually caused by staphylococcal infection
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
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
Describe the management of acanthamoeba keratitis
Anti-amoebic drops
What usually causes preseptal cellulitis?
Contiguous spread of infection from local facial or eyelid trauma e.g. insect bites
Describe the clinical presentation of acute angle-closure glaucoma
Severe pain and nausea
Circumcorneal injection
Cornea cloudy (oedematous)
Pupil mid-dilated
Eye stony hard
Describe the management of scleritis
Oral NSAIDs
Oral steroids + steroid sparing agents
Name 3 causative organisms of viral conjunctivitis
Adenovirus, herpes simplex, herpes zoster
Name three infective causes of anterior uveitis
TB, syphilis, herpes simplex/zoster
Describe the management of herpetic keratitis
Treated with topical antiviral (ganciclovir)
Describe the clinical presentation of preseptal cellulitis
Tenderness, warmth, swelling, redness of the eyelid
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
What is a hypopyon?
Aggregation of inflammatory cells within the anterior chamber resulting in visible ‘sediment’ in front of the eye inferiorly
Describe the management of bacterial conjunctivitis
Topical chloramphenical
Swab and culture if unresponsive - fusidic acid for Staph. aureus, gentamicin for most gram negatives
Describe the management of episcleritis
Self limiting - lubricants and cold compresses, topical NSAIDs, mild steroids
Define cellulitis
Bacterial infection of the lower dermis and subcutaneous tissue
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
Define episcleritis
Inflammation of the episclera, the thin vascular sheet which lies between the conjunctiva and sclera
Describe the management of fungal keratitis
Topical antifungals
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
Define keratitis
Inflammation of the cornea
Describe the clinical features of adenoviral keratitis
Bilateral
Usually follows URTI/conjunctivitis
May affect vision
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
Describe the clinical presentation of keratitis
Photophobia
Severe ocular pain and associated foreign body sensation
Hypopyon
Name two complications of blepharitis
Stye (hordeolum), chalazion
Define endopthalmitis
Devastating infection inside of the eye that threatens sight
Describe the management of adenoviral keratitis
Can require steroids to speed up recovery if becomes chronic
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
Over 50% of patients with herpes simplex conjunctivitis will develop a ______ _______
Dendritic ulcer
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
Chlyamydial conjunctivitis can cause ______ scarring if not treated
Subtarsal scarring
How would you manage viral conjunctivitis caused by herpes simplex or herpes zoster?
Antivirals e.g. ganciclovir
What is the most common cause of conjunctivitis?
Viral aetiology, most commonly adenovirus
Which age group most commonly develops blepharitis?
Middle-age
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
What causes orbital cellulitis?
Direct extension from sinus
Extension from focal orbital infection
Post-operative
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
Name two risk factors for the development of a stye
Chronic blepharitis and acne rosacea
How would you manage viral conjunctivitis caused by adenovirus (watery discharge)?
Lubrication, cold compress (self-limiting)
What typically causes allergic conjunctivitis?
Most cases seasonal as a result of pollen allergy, can occur due to allergens e.g. animal dander
