Evaluation of the Red Eye - Holgren

Question 1

Identify this condition and describe the treatment:

pt reports - burning, gritty sensation that gets worse in the evenings

Answer 1

Dry Eyes

common with aging, F >M, often worse when reading

exposure: Bell’s palsy, Thyroid eye disease, scarred or malpositioned lids

may be associated with: rheumatological disorders, Stevens-Johnson, systemic meds

tx: artificial tears, lubricating ointment, punctal plug, Restasis, lid taping

Question 2

Identify this condition and describe the treatment:

red, swollen lids and skin

normal: vision, pupils, occular motility, conjunctiva

Answer 2

Anterior (preseptal) cellultis

cause: trauma, URI, sinusitis, otitis
tx: cool compresses, systemic antibiotics

hospitalize if a child < 3

Question 2

Identify this condition and describe the treatment:

spontaneous blood red eye, with normal vision, no pain and no discharge

Answer 2

Subconjunctival Hemorrhage

tx: resolves in 2-3 weeks on own

Question 2

Identify this condition and describe the treatment:

localized or diffuse redness, deep red, pain

pt: history of RA

Answer 2

Episcleritis/Scleritis

scleritis - deep red, pain, can be vision threatening

idiopathic may have rheumatologic/autoimmune associations

tx: refer to ophthalmologist

Question 4

Identify this condition and describe the treatment:

red eye, watery discharge, foreign body sensation, dendrite branching

Answer 4

Viral Keratitis

cause: Herpes Simplex Virus (type 1)
refer: STAT

Question 5

Identify this condition and describe the treatment:

thick, red lid margins with crusting, some loss of eye lashes

Answer 5

Blepharitis

staphylococcal, seborrheic (meibomian gland dysfunction)

tx: warm compress, lid hygiene, topical antibiotics ung (ointment), oral antibiotics

Question 5

Identify this condition and describe the treatment:

watery discharge with stringy mucus, itching

pt is an asthmatic

Answer 5

Allergic Conjunctivitis

ITENSE ITCHING

hx: allergy, ashtma, atopic/allergic disease
tx: topical antihistamines, mast cell stablizers

Question 6

Causes of this condition

hint: pt was born at 0730

Answer 6

Neonatal Conjunctivitis

Staph, strep, h.flu

N. gonorrhea - refer to ophthalmologist, systemic antibiotics and topical

Chlamydial - topical and oral erythromycin

Question 7

Identify this condition and describe the treatment:

pain, tearing, foriegn body sensation, photophobia, blurred vision

fluroscein exam:

Answer 7

Corneal Abrasion

tx: cycloplegic drops, oral analgesics with codiene; topical antibiotics; pressure patch 24 hours
refer: if not healed in 24-48 hours

Question 8

Identify this condition and describe the treatment:

red, painful decreased vision with purulent discharge

Answer 8

Bacterial Keratitis

refer STAT

Question 9

Identify this condition and describe the treatment:

pt was at work in a lab and got something in his eye

Answer 9

Chemical Injury

tx: immediate irrigation for 15 minutes, further irrigate until pH is normal

Alkali causes more damage

refer: STAT

Question 11

Identify this condition and describe treatment:

localized or diffuse lid cellulitis, tenderness

Answer 11

Hordeola/chalazia

inflammed lid glands due to obstructed orifces

tx: warm compress, topical antibiotic ung (ointment)

Question 12

Identify this condition and describe the treatment:

severe eye pain, blurred vision, halos around lights, nausea and vomiting

exam: mid-dilated pupil, redness, cloudy cornea, hard eye

Answer 12

Acute Glaucoma

cause: dim lights, drugs, emotional stress
refer: STAT

Question 14

Identify this condition and describe the treatment:

purulent discharge

Answer 14

Bacterial Conjunctivitis

cause: Staph, Steph, Hemophilus Influenzae
tx: warm compress, topical antibiotics, fluroquinolones

if Neisseria gonorrhea systemic antibiotics and hyperpurulent discharge

Question 15

Identify this condition and describe the treatment:

circumcorneal redness, pain, photophobia, decreased vision, small pupil

Answer 15

Iritis/Uveitis

idiopathic, infectious, sarcoidosis, autoimmune disorders, trauma

refer

Question 16

Identify this condition and describe the treatment:

watery, serous discharge, tender preauricular nodes

Answer 16

Viral Conjunctivitis

cause: Adenoviral, highly contagious
tx: no effective therapy (will clear in 1-2 weeks)
refer: pain, decreased vision, photophobia

Question 17

Identify this condition and describe the treatment:

swollen, red lids and conjuncitva; proptosis; impaired occular motility and painful movement; decreased vision; afferent pupillary defect; optic disc edema

Answer 17

Posterior (orbital) cellulitis

tx: hospitalization, CT scan, blood cultures IV antibiotic

often a fungal infection in immunocompromised

can lead to cavernous sinus thrombosis, meningitis

Question 18

Vision Threatening Red Eye Disorders

these need to be refered to ophthalmologist ASP!

Answer 18

orbital cellulitis

scleritis

chemical injuries

corneal infection

hyphema

iritis

acute glaucoma

Question 19

Identify this condition and describe the treatment:

inflamamtion and irritation

pt has job exposure to sun, wind and dust

Answer 19

Pinguecula (top photo)/Pterygium (bottom photo)

tx: artifical tears, topical NSAIDs
refer: severe inflammation, or if pterygium is actively growing

Question 20

Identify this condition and describe the treatment:

pt recieved a blow to the face, reports decreased vision and pain

Answer 20

Hyphema

blood in anterior chamber

refer STAT

Question 21

Identify this condition and describe the treatment:

tearing and discharge

Answer 21

Nasolacrimal Duct Obstruction

infected tear sac (Dacryocystitis)

Congenital tx: daily massage, antibiotics if infected, refer if no resolution 6-8 months

Aquired tx: systemic antibiotics if infected, refer if chronic