Emergencies Flashcards
What is ciliary flush and what does it indicate?
Injection of the deep conjunctival vessels and episclera vessels surrounding the cornea
Ciliary flush is seen in iritis (inflammation in the anterior chamber) or acute glaucoma.
What is conjunctival hyperemia?
Engorgement of more superficial vessels
It is a non specific sign
(RED EYE)
What are the causes of red eye?
Pathology with lids= blepharitis, marginal keratitis, trichiasis, chalazion or stye, sub tarsal foreign body, dacrocystitis
Conjunctiva= bacterial conjunctivitis, gonococcal conjunctivitis, chlamydial, viral, allergic, subconjunctival haemorrhage, episcleritis, scleritis
Cornea= bacterial keratitis, herpetic keratitis, foreign body
Anterior chamber= anterior uveitis, iritis vs viritis
Acute angle closure
Trauma
Orbital vs pre septal cellulitis
What do you in blepharitis when there is meibomian gland disease and rosacea?
Doxycycline
What is the difference between a stye and chalazion?
Stye= bacterial infection of an oil gland of the eyelid
Chalazion= cyst due to blocked oil gland of the eye
What is blepharitis?
Inflammation of the eyelid
What is periorbital cellulitis?
Infection of the skin and soft tissue surrounding the orbit
What is the difference between episcleritis and scleritis?
Episcleritis= inflammation of the episclera
Associated with relatively mild pain and no vision changes
There will be a radial pattern of episcleral vessels and it is typically focal
Scleritis= inflammation of the sclera (ie: sclera proper)
This is more painful and can compromise vision
The distinction between episcleritis and scleritis relies on the severity of pain, acuity of onset time, whether engorged vessels can be moved with a light pressure from cotton bud, effect of topical anaesthetics.
What is a subconjunctival haemorrhage?
Painless rupture of a superficial vessel. It is usually idiopathic but can be triggered by valsalva maneuvers.
What is dry eyes?
A reduction in the normal tear film from either decreased production and/or increased evaporation which usually protect the sclera, conjunctiva and cornea
What is a corneal abrasion?
A scratch on the cornea secondary to trauma, this is seen with fluorescein staining.
What does the corneal abrasion present with?
Foreign body sensation
The cornea has lots of pain fibres and therefore patient will have moderate to severe eye pain
Best seen with topical fluorescein
What is keratitis?
Inflammation and/or infection of the cornea
Can present similarly to conjunctivitis however patients with keratitis will have a ciliary flush around the iris.
Again use fluorescein and slit lamp exam.
What would you see on slit lamp exam on keratitis?
Tiny granular infiltrates within the cornea, below the epithelium.
What are the symptoms of acute angle closure glaucoma?
Profound eye pain and reduced visual acuity.
What would you see on examination of acute angle closure glaucoma?
. Pupil is dilated and fixed
. Hazy cornea
What is anterior uveitis?
Inflammation of the iris +/- ciliary body
What would occur to the pupil in anterior uveitis?
It would be an irregular shape, suggesting inflammation in the anterior chamber.
What is hyphema (pronounced hi phema)
This is bleeding within the anterior chamber, it is often associated with trauma or inflammation
What is hypopyon?
A layering WBC rich exudate within the anterior chamber
It is often associated with keratitis or endophthalmitis
What are the most common aetiologies of red eye?
Dry eyes
Viral and allergic conjunctivitis
What are the etiologies of the eye which require emergency/urgent opthalmological referral?
Corneal abrasions
Foreign body
Keratitis
Scleritis
Anterior uveitis
Acute angle closure glaucoma
^ problems with the anterior chamber
What should you ask in an emergency hx of red eye?
The time course
How long have the symptoms been there, was it an abrupt or gradual onset?
Are the symptoms unilateral or bilateral
Is there pain? And if so what is the severity of the pain?
Is there loss of vision?
Is there photophobia?
Is there foreign body sensation?
If there discharge and if so what is it like
Is there eye trauma or relevant occupational hx?
Does the patient wear contact lenses?
PMH/SHX
When someone comes to eye casualty what should you do on examination?
Visual inspection of the external eye.
- pattern of hyperaemia
- presence of discharge
- pupil size and reactivity
- assesment for foreign body
- Assesment for hyphema or hypopyon
- +/- application of fluorescein
Assess visual acuity
Assess movement of extra ocular muscles
Slit lamp exam
IOP measurement if glaucoma is suspected
Dont dilate the pupils if suspecting acute glaucoma as this can worsen the condition
