Exam 1 - Painful red eye Flashcards
What are the five differential diagnoses for a painful red eye?
- Uveitis/iritis
- Keratitis
- Corneal abrasion
- Acute angle closure glaucoma
- Scleritis
Which of the five differentials for painful red eye requires an urgent referral to ophthalmology?
All of them except corneal abrasion
What is uveitis? Iritis?
Uveitis: inflammation of middle part of eye (choroid, ciliary body)
Iritis: “anterior uveitis”, inflammation of iris
Symptoms of uveitis
- Pain
- Photophobia
- Conjunctival hyperemia
- Pupil constriction
- Blurred vision
- May have epiphoria
Uveitis management
- Same day referral to ophthalmology
- Treated with corticosteroid eye drops and followed until resolved
Uveitis physical exam findings
- Restricted pupil
- Doesn’t react well
- Ciliary flush (red around iris)
What is keratitis?
Defect of the corneal epithelium - allows bacterial to penetrate the cornea
- Can be infectious or non-infectious
Keratitis risk factors
- Contact lens use
- Dry eyes
- Difficulty closing eye
Keratitis symptoms
- Redness
- Pain
- Photophobia
- Discharge
Keratitis diagnostic findings
Can be stained with fluoresein then visualised with wood slit lamp
Keratitis management and treatment
Same day referral to ophthamology
- Treatment depends on causative agent
What is herpes zoster ophthalmicus?
Vesicular lesions along trigeminal nerve dermatome –> subsequent development of conjunctivitis
What is the Hutchinson sign? When is this used?
Hutchinson sign: lesion seen at tip, side, or root of nose (to diagnose herpes zoster ophthalmicus)
- An absent sign does NOT rule out diagnosis
Herpes zoster ophthalmicus symptoms
- Red eye
- Foreign body sensation
- Tearing
- Blurred vision
- Photophobia
Herpes zoster ophthalmicus management (including prescription treatment)
Same day referral to ophthalmology
- Oral antivirals
- Possibly corticosteroids
Scleritis is more common in what patient populations?
Patients with autoimmune disorders (IBD, lupus, scleroderma)
Scleritis symptoms
- Severe eye pain
- Eye tenderness
- Blurred vision
- Inflamed sclera
- Tearing
- Photophobia
What is episcleritis?
Superficial inflammation of sclera (not painful, localized injection)
Does episcleritis require treatment? If so, what is used?
Usually self limiting and treatment not necessary
- Patient can use lubricating eye drops
If a patient has episcleritis, when should the provider refer out for emergent care?
If pain develops (can progress to scleritis)
Symptoms/physical exam findings for corneal abrasions
- Redness
- Tearing
- Severe pain
Use of fluorescein stain and Wood’s lamp
Corneal abrasion management (pharmacological therapy)
- Topical antibiotic ointment
- Lubricating drops as needed
Corneal abrasion: patient education
- Expected time course
- Symptoms to seek emergency care
Typically heals within 1-3 days; if not, refer to ophthalmology
Worrisome symptoms
- Purulent discharge
- Worsening eye pain
- Photophobia
What is acute angle closure glaucoma?
True ophthalmic emergency in which there is abrupt increased IOP
- Risk of vision loss –> refer to ER
Acute angle closure glaucoma symptoms
- Pain
- Redness
- Blurred vision, halos around lights
- Headache
- Nausea, vomiting
Acute angle closure glaucoma risk factors
- Age over 50 years
- Family history or history of AACG in the other eye
