Exam 1 - Painful red eye

Question 1

What are the five differential diagnoses for a painful red eye?

Answer 1

• Uveitis/iritis
• Keratitis
• Corneal abrasion
• Acute angle closure glaucoma
• Scleritis

Question 2

Which of the five differentials for painful red eye requires an urgent referral to ophthalmology?

Answer 2

All of them except corneal abrasion

Question 3

What is uveitis? Iritis?

Answer 3

Uveitis: inflammation of middle part of eye (choroid, ciliary body)

Iritis: “anterior uveitis”, inflammation of iris

Question 4

Symptoms of uveitis

Answer 4

• Pain
• Photophobia
• Conjunctival hyperemia
• Pupil constriction
• Blurred vision
• May have epiphoria

Question 5

Uveitis management

Answer 5

• Same day referral to ophthalmology
  
  • Treated with corticosteroid eye drops and followed until resolved

Question 6

Uveitis physical exam findings

Answer 6

• Restricted pupil
• Doesn’t react well
• Ciliary flush (red around iris)

Question 7

What is keratitis?

Answer 7

Defect of the corneal epithelium - allows bacterial to penetrate the cornea

• Can be infectious or non-infectious

Question 8

Keratitis risk factors

Answer 8

• Contact lens use
• Dry eyes
• Difficulty closing eye

Question 9

Keratitis symptoms

Answer 9

• Redness
• Pain
• Photophobia
• Discharge

Question 10

Keratitis diagnostic findings

Answer 10

Can be stained with fluoresein then visualised with wood slit lamp

Question 11

Keratitis management and treatment

Answer 11

Same day referral to ophthamology

• Treatment depends on causative agent

Question 12

What is herpes zoster ophthalmicus?

Answer 12

Vesicular lesions along trigeminal nerve dermatome –> subsequent development of conjunctivitis

Question 13

What is the Hutchinson sign? When is this used?

Answer 13

Hutchinson sign: lesion seen at tip, side, or root of nose (to diagnose herpes zoster ophthalmicus)

• An absent sign does NOT rule out diagnosis

Question 14

Herpes zoster ophthalmicus symptoms

Answer 14

• Red eye
• Foreign body sensation
• Tearing
• Blurred vision
• Photophobia

Question 15

Herpes zoster ophthalmicus management (including prescription treatment)

Answer 15

Same day referral to ophthalmology

• Oral antivirals
• Possibly corticosteroids

Question 16

Scleritis is more common in what patient populations?

Answer 16

Patients with autoimmune disorders (IBD, lupus, scleroderma)

Question 17

Scleritis symptoms

Answer 17

• Severe eye pain
• Eye tenderness
• Blurred vision
• Inflamed sclera
• Tearing
• Photophobia

Question 18

What is episcleritis?

Answer 18

Superficial inflammation of sclera (not painful, localized injection)

Question 19

Does episcleritis require treatment? If so, what is used?

Answer 19

Usually self limiting and treatment not necessary

• Patient can use lubricating eye drops

Question 20

If a patient has episcleritis, when should the provider refer out for emergent care?

Answer 20

If pain develops (can progress to scleritis)

Question 21

Symptoms/physical exam findings for corneal abrasions

Answer 21

• Redness
• Tearing
• Severe pain

Use of fluorescein stain and Wood’s lamp

Question 22

Corneal abrasion management (pharmacological therapy)

Answer 22

• Topical antibiotic ointment
• Lubricating drops as needed

Question 23

Corneal abrasion: patient education

• Expected time course
• Symptoms to seek emergency care

Answer 23

Typically heals within 1-3 days; if not, refer to ophthalmology

Worrisome symptoms

• Purulent discharge
• Worsening eye pain
• Photophobia

Question 24

What is acute angle closure glaucoma?

Answer 24

True ophthalmic emergency in which there is abrupt increased IOP

• Risk of vision loss –> refer to ER

Question 25

Acute angle closure glaucoma symptoms

Answer 25

• Pain
• Redness
• Blurred vision, halos around lights
• Headache
• Nausea, vomiting

Question 26

Acute angle closure glaucoma risk factors

Answer 26

• Age over 50 years
• Family history or history of AACG in the other eye