Eye inflammation Flashcards
Conjunctiva :Anatomy
Thin translucent membrane that covers the sclera of the eyes, except for the cornea
Conjunctivitis : Definition
- Conjunctivitis is inflammation of the conjunctiva
- Conjunctivitis may be bacterial, viral or allergic.
- It may be unilateral or bilateral.
Conjunctivitis : Clinical presentation
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
Conjunctivitis : Management
- Hygiene measures : Very contagious, avoid contact
- Chloromphenicol eye drops : Bacterial infection
- Neontal conjunctivitis : Urgent referral as it may be 2nd to Gonoccal infection
Anterior uveitis : Definition
- Inflammation of the anterior uvea. - anterior chamber of the eye
- The uvea consists of the iris, ciliary body and choroid.
* The choroid is the layer between the retina and the sclera.
Anterior uveitis : Pathophysiology
- Anterior uveitis involves inflammation in the anterior chamber of the eye.
- Inflammation is often 2nd to : autoimmune condition.
- The anterior chamber becomes infiltrated by neutrophils, lymphocytes and macrophages.
- Fluid collection containing inflammatory cells seen at the bottom of the anterior chamber on inspection.
Anterior uveitis : Risk factors
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
Anterior uveitis : Clinical presentation
- Painful red eye- typically a dull, aching pain
- Reduced visual acuity
- Photophobia - due to ciliary muscle spasm
- Excessive lacrimation - excess tear production
Anterior uveitis : Clinical signs on examination
- Ciliary flush - a ring of red spreading from the cornea outwards
-
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
Anterior uveitis : Management
- Urgent referral to ophthalmologist.
The usual first-line treatment involves:
1. Steroids (eye drops, oral or intravenous)
-
Sx relief :
* Cycloplegics : anti muscarinic eye drops which dilate pupil and reduce pain associated with ciliary spasm (e.g., atropine eye drops)
Episcleritis : Definition
Benign and self-limiting inflammation of the episclera
* The outermost layer of the sclera, just below the conjunctiva.
Episcleritis : Clinical features
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
Episcleritis : Management
- Differentiate Scleritis vs Episcleritis
- Phenylephrine eye drops : It will cause blanching of the episcleral vessels, causing the redness to disappear.
- Conservative management - self limiting, resolves in 1-2 weeks
Cornea : Anatomy
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
Corneal abrasion : Definition
**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
Corneal abrasion : Clinical presentation
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
Corneal abrasion : Management
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
Keratitis : Definition
Keratitis refers to inflammation of the cornea
-
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 - Bacteria infection : Staphylococcus or Pseudomonas
- Fungal infection : Candida
- Contact lens exposure induced acute red eye (CLARE)
- Exposure keratitis : 2nd to ectropion
Keratitis : Clinical features
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
Keratitis : Investigations for diagnosis
-
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
Keratitis : Management
- Urgent Ophthalmology referral
- Topical/Oral antiviral - acyclovir
- Corneal transplant : permanent scarring or visual loss
