ENT Flashcards
Causes of a painless red eye
Conjunctivitis
Episcleritis
Subconjunctival haemorrhage
Causes of a painful red eye
Glaucoma Anterior uveitis Scleritis Corneal abrasion or ulceration Keratitis Foreign body Traumatic or chemical body
Red flags for a red eye
Impaired vision
Pain/photophobia
Lack of ocular discharge
Define conjunctivitis
Inflammation and redness of the conjunctiva -> covers the inside of eyelids and sclera
Symptoms of conjunctivitis
Red eyes Unilateral or bilateral Vision unaffected Bloodshot Itchy or gritty sensation Discharge from the eye Does NOT cause pain, photophobia or reduced visual acuity
Symptoms of bacterial conjunctivitis
Purulent discharge -> pus
Eyes may be stuck together in morning
Highly contagious
Starts in one eye and spreads to other
Causative organisms for bacterial conjunctivitis
Staph
Strep
Haemophilus
Neisseria
Symptoms of viral conjunctivitis
Clear discharge (serous) Dry cough Sore throat Blocked nose Preauricular lymph nodes (in front of the ears) Recent URTI
Common cause of viral conjunctivitis
Adenovirus
Features of allergic conjunctivitis
Most frequent Watery and serous discharge Itch Caused by contact with allergens Type 1 hypersensitivity Antihistamines (oral or topical) used to reduce symptoms
Treatment for conjunctivitis
Reassurance (resolves after 1-2 weeks) + hygiene
Treatment for bacterial conjunctivitis
Chloramphenicol
Fuscidic acid
Features of chlamydial conjunctivitis
Trachoma is on the leading causes of blindness in the world
What is ophthalmia neonatorum
Conjunctivitis in the first three weeks of life
Purulent discharge
Causes of ophthalmia neonatorum
Chlamydia
Herpes simplex
Gonorrhoea
Staph/strep
Tests for ophthalmia neonatorum
Swab and microscopy
Treatment for ophthalmia neonatorum
Chlamydia - erythromycin/azithromycin
Gonorrhoea - cefotaxime and chloramphenicol
Define episcleritis
Thin vascular layer between sclera and conjunctiva
Common in young women
Symptoms of episcleritis
Acute onset Unilateral (bilateral in 30%) Typically not painful Segmental redness Dilated episcleral vessels Watering of eye NO discharge Visual acuity is normal
What is episcleritis associated with
Rheumatoid arthritis
Rheumatic fever
SLE
PAN
Treatment for episcleritis
Self-limiting and will recover in 1-4 weeks
Artificial tears
Topical or systemic NSAIDs (e.g. naproxen)
Define subconjunctival haemorrhage
Small blood vessel within the conjunctiva ruptures and releases blood into the space between the sclera and the conjunctiva
They often appear after episodes of strenuous activity such as heavy coughing, weight lifting or straining when constipated
Causes of subconjunctival haemorrhage
Hypertension
Bleeding disorders (e.g. thrombocytopenia)
Whooping cough
Medications (warfarin, NOAC’s, antiplatelets)
Trauma
Symptoms of subconjunctival haemorrhage
Sudden onset
Painless - does not affect vision
Bright red covering white
Management of subconjunctival haemorrhage
Resolves spontaneously - 2 weeks
Define scleritis
Inflammation of the full thickness of the sclera
More serious than epscleritis
What is the most severe type of scleritis
Necrotising scleritis
Causes visual impairment, can lead to perforation of sclera
Associated conditions with scleritis
Rheumatoid arthritis SLE IBD Sarcoidosis Granulomatosis with polyangiitis
Symptoms of scleritis
Constant, severe dull ache Severe pain Pain with eye movement Photophobia Eye watering -> no discharge Reduced visual acuity Headache Abnormal pupil reaction to light Tenderness to palpation of the eye
Management of scleritis
Urgent referral within 24 hours
Oral NSAIDs
Oral high dose prednisolone
Treat underlying condition - methotrexate for RA
Define anterior uveitis
Inflammation in the anterior uvea which comprises of the iris and ciliary body
Causes of anterior uveitis
Ankylosing spondylitis IBD Reactive arthritis Sarcoidosis Syphilis Lyme disease TB Herpes simplex Behcet's disease
Symptoms of anterior uveitis
Unilateral
Dull, aching painful red eye
Ciliary flush (ring of red spreading from cornea outwards)
Reduced visual acuity - blurred visual
Photophobia
Pain on movement
Lacrimation
Floaters and flashes
Sphincter muscle contraction causing miosis (constricted pupil)
Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
Ask about in a history for anterior uveitis
Headaches Mouth ulcers (Behcet's) Joint problems Chest and skin disease GU symptoms
Investigations for anterior uveitis
Slit lamp with dilated pupil to visualise inflammatory cells
Fundus fluorescein and indocyanide green-angiography
Treatment for anterior uveitis
Urgent same day referral to ophthalmologist
Topical prednisolone
Cyclopentolate or atropine (to dilate pupil)
DMARDs and TNF inhibitors for immunosuppression
Laser therapy/surgery (vitrectomy) in severe cases
Define keratitis
Inflammation of the cornea
Breakdown of the epithelium = corneal ulcer
Causes of keratitis
Viral - herpes simplex
Bacterial - psuedomonas or staph
Fungal infection with candida or aspergillus
Contact lens acute red eye (CLARE)
Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropian)
Symptoms of herpes simplex keratitis
Painful red eye Photophobia Vesicles around the eye Watery discharge Foreign body sensation Reduced visual acuity
Investigations for herpes simplex keratitis
Staining with fluorescein - shows dendritic corneal ulcer
Slit lamp examination
Corneal swabs or scrapings
Management for herpes simplex keratitis
Aciclovir (topical or oral)
Symptoms of bacterial keratitis
Painful red eye
Loss of vision
Hazy cornea with central abscess
Management of bacterial keratitis
Requires specialist
Intense antibiotics
Define corneal abrasions
Scratches or damage to the cornea
Causes of corneal abrasions
Contact lenses - may have psuedomonas infection Foreign bodies Finger nails Eyelashes Entropion (inward turning eyelid)
Symptoms of corneal abrasions
History of contact lenses/foreign body Painful red eye Foreign body sensation Watering eye Blurring vision Photophobia
Diagnosis of corneal abrasions
Staining with fluorescein -> yellow/orange colour
Slit lamp examination in more severe cases
Management of corneal abrasions
Same day referral Analgesia - paracetamol Lubricating eye drops Antibiotic eye drops - chloramphenicol Cyclophentolate eye drops - dilate pupil - improves photophobia
Usually heals over 2-3 days
Bacterial causes of corneal ulcers
Pseudomonas
Fungal causes of corneal ulcers
Candida
Aspergillus
Protozoal causes of corneal ulcers
Acanthamoeba
Vasculitic cause of corneal ulcers
Rheumatoid arthritis
Management of corneal ulcers
Refer
Chloramphenicol drops (gram +ve)
Ofloxacin (gram -ve)
Cause of herpes simplex corneal ulcers
Keratitis manifestation
Symptoms of herpes simplex corneal ulcers
Pain
Photophobia
Watering
Diagnosis of herpes simplex corneal ulcers
Slit lamp - fluorescein -> look for dendritic ulcers
Treatment for herpes simplex corneal ulcers
Aciclovir
