Eye 3: Red eye

Question 1

subconjunctival hemorrhage

Answer 1

-diffuse or localized area of blood under conjunctiva
-asymptomatic
-no pain
-pressure within the vessels -> hemorrhage
-idiopathic
-trauma, chronic cough, sneezing aspirin, HTN
-resolves within 10-14 days (self limited)
-warm compress
-resolves like a bruise

Question 2

uvea

Answer 2

-part of eye consisting of:
-iris, choroid of eye, ciliary body

Question 3

choroid of eye

Answer 3

-thin vascular middle layer of eye that is situated between sclera (white of the eye) and the retina

Question 4

ciliary body

Answer 4

-body of tissue that connects iris with choroid includes a group of muscles which act on lens of eye to change it shape

Question 5

acute conjunctivitis

Answer 5

-extremely common
-discharge- moderate to copious
-vision- no effect
-mild pain
-conjunctival injection- diffuse
-cornea- clear
-pupil size- normal
-pupillary light response normal
-intraocular pressure normal
-smear- causative organisms

Question 6

acute anterior uveitis (iritis)

Answer 6

-incidence- common
-no discharge
-vision often blurred
-pain- moderate
-conjunctival injection- mainly circumcorneal
-cornea usually clear
-pupil size small
-pupillary light response poor
-intraocular pressure usually normal may be elevated

Question 7

acute angle-closure glaucoma

Answer 7

-incidence is uncommon
-discharge- none
-vision- markedly blurred
-pain is severe
-conjunctival injection- mainly circumcorneal
-cloudy cornea
-pupil size moderately dilated
-pupillary light response - none
-intraocular pressure markedly elevated

Question 8

corneal trauma or infection

Answer 8

-incidence- common
-discharge- watery or purulent
-vision- usually blurred
-pain- moderate to severe
-conjunctival injection- mainly circumcorneal
-cornea- clarity change related to cause
-pupil size- normal or small
-pupillary light response- normal
-intraocular pressure- normal

Question 9

conjunctivitis

Answer 9

-conjunctiva helps keep eyelid and eye moist
-conjunctival inflammation
-pink eye
-most common non traumatic eye infection in children and adults
-cellular infiltrate and exudate
-highly contagious
-no age or race or sex predilection
-conjunctivitis of the newborn- term used by WHO for any conjunctivitis with discharge occurring during the first 28 days of life

Question 10

hyperacute purulent conjunctivitis

Answer 10

-ophthalmia neonatorum was the term used to describe hyperacute purulent conjunctivitis
-usually caused by gonococci- first 10 days of life
-in this instance- transmission is vertical

Question 11

causes of conjunctivitis

Answer 11

-infection- virus, bacteria, STIs, fungal, parasitic
-irritating substances- chemical, smoke etc.
-keratoconjunctivitis sicca- dryness
-allergens

Question 12

conjunctivitis differential diagnosis

Answer 12

-corneal abrasion
-acute angle glaucoma
-herpes zoster- ophthalmic branch of trigeminal
-iritis and uveitis
-scleritis
-episcleritis

Question 13

conjunctivitis signs and symptoms

Answer 13

-Redness
-↑tears
-Discharge
-Thick yellow discharge - crusts over the eyelashes, especially after sleep (bacteria)
-Green or white
-Itchy eyes (allergies)
-Burning eyes (chemicals and irritants)
-Blurred vision (normal acuity)
-Photophobia

Question 14

viral conjunctivitis

Answer 14

-frequent hx of viral syndrome
-STD- herpes simplex virus or fever blister elicited (NO STERIODS)
-can aid in dx of condition
-any individual with follicular conjunctivitis (follicle inflammation) or preauricular adenopathy (lymph node in front of ear) with or without kertitis should be questioned about the possibility of STIs**
-high risk individuals should be treated empirically for chlamydia (treat gonococcal infection if suspected at same time)

Question 15

HSV infection treatment

Answer 15

-(eg,ganciclovir0.15% gel) and/or systemic (eg, oralacyclovir,valacyclovir) antivirals is recommended
-no specific treatment for contagious viral conjunctivitis.
-Artificial tears and cold compresses may help reduce discomfort.
-use of topical antibiotics and steroids in the acute infection is discouraged
-Frequent hand and linen hygiene is encouraged to minimize spread.

Question 16

3 major agents associated with conjunctivitis

Answer 16

-1. follicular conjunctivitis
-2. pre-auricular adenopathy
-3. superficial keratitis
-adenovirus
-chlamydia
-herpes simplex

Question 17

viral conjunctivitis

Answer 17

-clear, watery discharge
-scanty exudate
-pruritus common
-occasionally severe photophobia and FB sensation
-pharyngitis, fever, malaise and preauricular adenopathy -> pharyngoconjunctival fever
-epidemic keratoconjunctivitis (EKC)- caused by adenovirus
-complication- visual loss
-cold compresses and sulfonamide therapy (secondary infection prevention)

Question 18

bacterial conjunctivitis

Answer 18

-copious purulent discharge
-acute onset
-minimal pain
-occasional pruritus*
-no blurring of vision
-staphylococcal and streptococcal species
-self limiting
-lasts 10-14 days
-sulfacetamide ointment
-clean medial to lateral

Question 19

chlamydial conjunctivitis

Answer 19

-chronic onset
-minimal pain level
-occasional pruritis
-can lead to scarring
-can be severe enough to cause lid derangement and ingrown eyelashes
-STD history- identify andg treat sexual partners
-trachoma is more chronic- insidious form -> major cause of blindness worldwide!
-rx- single dose therapy with oral azithromycin
-treat gonorrhea at same time -IM 1 gram ceftriaxone

Question 20

gonococcal conjunctivitis

Answer 20

-neonate- purulent bacterial conjunctivitis -> neisseria gonorrhea
-ophthalmologic emergency - can cause blindness
-can be invasive and lead to rapid corneal perforation -> IV antibiotics
-have to open the eye to view
-IM 1 gram ceftriaxone
-treat chlamydia at same time azithromycin

Question 21

allergic conjunctivitis

Answer 21

-acute or subacute onset
-seasonal
-no pain
-pruritis
-tearing
-redness
-stringy discharge
-occasional photophobia and visual loss from discharge (not from damage)
-hyperemia and edema (chemosis)
-large cobblestone papillae** if chronic
-mild to moderate

Question 22

allergic conjunctivitis treatment

Answer 22

-numerous topical antimicrobial agents can be used
-broad spectrum antibiotics
-antimicrobials and symptomatic therapy recommended for all pts initially
-supportive- artificial tears (non preservatives) help discomfort of keratitis and photophobia // cold compresses help swelling and discomfort in lids
-antimicrobial drops- helps prevent secondary bacterial infection-> every 2 hours
-topical histamine H1 receptor blocker
-systemic antihistamines
-topical corticosteroids
-ointment used at night or every 4-6 hours throughout the day
-CAUTION:
-exclude herpes simplex infection
-best to reserve use by ophthalmologist

Question 23

allergic conjunctivitis caution

Answer 23

• S/E of steroid therapy
  -cataracts
  -glaucoma
  -exacerbation of herpes simplex

Question 24

work up conjuncitivitis

Answer 24

-generally not needed
-dx on hx and physical exam
-swabs taken if no improvement in 48-72 hrs
-take swabs in all and immunosuppressed or when N. gonorrhoeae is suspected
-swabs taken from lower conjunctival fornix
-gram stain and Giemsa stain

Question 25

dry eye syndrome

Answer 25

-poor quality tears:
-meibomian gland disease, acne rosacea
-lid related
-vitamin A deficiency
-poor quantity:
-kerato-conjunctivitis Sicca (KCS) (sjogrens syndrome and rheumatoid arthritis)
-lacrimal disease (sarcoidosis)
-paralytic (VII CN palsy)

Question 26

episcleritis

Answer 26

-superficial to sclera *
-idiopathic
-collagen vascular disorder (RA)
-asymptomatic, mild pain
-self limiting or topical treatment

Question 27

scleritis

Answer 27

-deep*
-idiopathic
-collagen vascular disease (RA, ankylosing spondylitis (AS), SLE, Wegener, PAN)
-zoster
-sarcoidosis
-dull, deep pain wakes pt at night
-systemic treatment with NSAID or prednisone if severe

Question 28

shingles

Answer 28

-hutchinson sign- along eye dermatome
-vesicles
-high dose oral acyclovir (800 mg 5x a day)

Question 29

uveitis

Answer 29

-anterior- acute recurrent and chronic
-posterior- vitritis, retinal vasculitis, retinitis- choroidits
-choroiditis
-panuveitis- anterior and posterior

Question 30

anterior uveitis (iritis)

Answer 30

-photophobia
-ciliary body and iris inflammation
-red eye
-decreased vision
-idiopathic- commonest
-associated to systemic disease:
-seronegative arthropathies- AS, IBD, psoriatic arthritis, Reiter’s
-autoimmune- sarcoidosis, Behcet’s
-infection- shingles, toxoplasmosis, TB, syphilis, HIV

Question 31

glaucoma

Answer 31

-group of eye disease- 2nd most common cause of vision loss in US
-halo/glare
-can occur at any age but is 6 times more common in people > 60 years
-common feature of all forms is damage to optic nerve
-raised intraocular pressure (IOP) is most important risk factor
-glaucoma should be suspected in pt with visual field defect, abnormal optic disk on fundoscopy, or elevated IOP
-normal IOP- low or normal tension glaucoma
-conversely with elevated IOP may have no optic neuropathy(rare)

Question 32

open angle/chronic glaucoma

Answer 32

-IOP > approx 21 mm Hg or more
-enlargement of optic cup
-repeatable field loss
-older pts and asymptomatic
-women > men
-hyperopia commonly enountered
-treatment:
-beta blockers (timolol)
-alpha-2 adrenergic agonist brimonidine (alphagan)
-prostaglandin agonists (latanoprost)

Question 33

acute angle-closure glaucoma signs and symptoms

Answer 33

-dangerous
-ocular, facial pain
-pain, headache (migraine differential), nausea, vomiting, abdominal pain
-unilateral blurring of vision
-redness, photophobia
-reduced vision
-haloes around lights
-edematous or steamy cornea
-increased IOP
-acuity often to 20/80 or >
-circumlimbal injection
-fixed, mid dilated pupil
-shallow anterior chamber

Question 34

acute angle-closure glaucoma treatment

Answer 34

-accurate dx and prompt intervention
-lower IOP quickly
-carbonic anhydrase inhibitor (acetazolamide)
-beta blocker (timolol)
-pilocarpine
-prednisolone acetate
-iridotomy

Question 35

injected

Answer 35

-red

Question 36

dacryocystitis

Answer 36

-inflammation/infection of lacrimal system

Question 37

lacrymaladenoitis

Answer 37

inflammation/infection of lacrimal gland