Eye inflammation

Question 2

Conjunctiva :Anatomy

Answer 2

Thin translucent membrane that covers the sclera of the eyes, except for the cornea

Question 3

Conjunctivitis : Definition

Answer 3

• Conjunctivitis is inflammation of the conjunctiva
• Conjunctivitis may be bacterial, viral or allergic.
• It may be unilateral or bilateral.

Question 4

Conjunctivitis : Clinical presentation

Answer 4

Conjunctivitis presents with:

• Red, bloodshot eye
  No pain or visual issues
• Itchy or gritty sensation
• Discharge :
  1. Bacterial conjunctivitis : Purulent discharge
  2. Viral conjunctivitis : Clear discharge
  -Assoc with sx of viral infection : dry cough, sore throat, blocked nose etc

Question 5

Conjunctivitis : Management

Answer 5

1. Hygiene measures : Very contagious, avoid contact
2. Chloromphenicol eye drops : Bacterial infection
3. Neontal conjunctivitis : Urgent referral as it may be 2nd to Gonoccal infection

Question 6

Anterior uveitis : Definition

Answer 6

1. Inflammation of the anterior uvea. - anterior chamber of the eye
2. The uvea consists of the iris, ciliary body and choroid.
   * The choroid is the layer between the retina and the sclera.

Question 7

Anterior uveitis : Pathophysiology

Answer 7

1. Anterior uveitis involves inflammation in the anterior chamber of the eye.
2. Inflammation is often 2nd to : autoimmune condition.
3. The anterior chamber becomes infiltrated by neutrophils, lymphocytes and macrophages.
4. Fluid collection containing inflammatory cells seen at the bottom of the anterior chamber on inspection.

Question 8

Anterior uveitis : Risk factors

Answer 8

Anterior uveitis may be associated with underlying an autoimmune condition, particularly:
* Seronegative spondyloarthropathies (e.g., ankylosing spondylitis, psoriatic arthritis and reactive arthritis)
* Inflammatory bowel disease*
* Sarcoidosis
* Behçet’s disease

Question 9

Anterior uveitis : Clinical presentation

Answer 9

• Painful red eye- typically a dull, aching pain
• Reduced visual acuity
• Photophobia - due to ciliary muscle spasm
• Excessive lacrimation - excess tear production

Question 10

Anterior uveitis : Clinical signs on examination

Answer 10

1. Ciliary flush - a ring of red spreading from the cornea outwards
2. Pupil changes
   * Miosis
   a constricted pupil due to sphincter muscle contraction

• Abnormally shaped pupil
  due to adhesions pulling the iris into abnormal shapes
• Fluid accumulation in lower anterior chamber
  Inflammatory cells collected as a white fluid in the anterior chamber

Question 11

Anterior uveitis : Management

Answer 11

• Urgent referral to ophthalmologist.

The usual first-line treatment involves:
1. Steroids (eye drops, oral or intravenous)

2. Sx relief :
   * Cycloplegics : anti muscarinic eye drops which dilate pupil and reduce pain associated with ciliary spasm (e.g., atropine eye drops)

Question 12

Episcleritis : Definition

Answer 12

Benign and self-limiting inflammation of the episclera
* The outermost layer of the sclera, just below the conjunctiva.

Question 13

Episcleritis : Clinical features

Answer 13

Acute-onset unilateral features:
* Localised or diffuse redness (often a patch of redness in the lateral sclera)

• No pain (or mild pain)
• Dilated episcleral vessels
  No photophobia or discharge and normal visual acuity

Question 14

Episcleritis : Management

Answer 14

1. Differentiate Scleritis vs Episcleritis

• Phenylephrine eye drops : It will cause blanching of the episcleral vessels, causing the redness to disappear.

2. Conservative management - self limiting, resolves in 1-2 weeks

Question 15

Cornea : Anatomy

Answer 15

Transparent, dome-shaped front surface of the eye

• Covers the iris and the pupil.
  It plays a crucial role in the eye’s ability to focus light

Question 16

Corneal abrasion : Definition

Answer 16

**Corneal abrasions are scratches or damage to the cornea. **

• They cause a red, painful eye and photophobia.
• Caused by trauma : Foreign body, Entropian , contact lenses

Question 17

Corneal abrasion : Clinical presentation

Answer 17

There is often a history of trauma, followed by:

• Painful red eye, ‘gritty’ sensation of a foreign body
• Photophobia
• Epiphora (excessive tear production)
• Blurred vision

Question 18

Corneal abrasion : Management

Answer 18

Diagnosis :
1. Fluorescein stain : orange dye which collects in abrasions and highlights them when viewed under cobalt blue light

Management :
2. Conservative management - analgesia, eye drops

Question 19

Keratitis : Definition

Answer 19

Keratitis refers to inflammation of the cornea

Answer 20

1. Viral infection :
   * Herpes simplex virus} most common cause of kertitis
   * Herpes simplex keratitis : inflammation of epithelial layer of the cornea
   * Recurrent HSV keratitis : latent virus in the trigmeninal ganglion which allows it to persistent in the body
   * Can reactivate and lead to recurrent episodes of keratitis
2. Bacteria infection : Staphylococcus or Pseudomonas
3. Fungal infection : Candida
4. Contact lens exposure induced acute red eye (CLARE)
5. Exposure keratitis : 2nd to ectropion

Question 21

Keratitis : Clinical features

Answer 21

1 . Primary infection
* Mild symptoms : Blepharoconjunctivitis - inflammation of the eyelid margins and conjunctiva

2 . Recurrent infection 2nd to HSV Keratitis
* Painful, red eye
* Fluid filled blisters (Vesicles) and Watery discharge
* Photophobia, Reduced visual acuity

Question 22

Keratitis : Investigations for diagnosis

Answer 22

1. Slit lamp examination
   * Flurescein staining : Dendritic corneal ulcer
   * Branching’ ulcer similar to dendritic cells/trees

Caused by : recurrent HSV replication in corneal epithelium causes immune mediated damage, leading to ulcers

Question 23

Keratitis : Management

Answer 23

1. Urgent Ophthalmology referral
2. Topical/Oral antiviral - acyclovir
3. Corneal transplant : permanent scarring or visual loss