Infections of the eye Flashcards
What is scleritis
Inflammation of the full thickness of the sclera
Associated systemic conditions with scleritis
RA, SLE, IBD, sarcoidosis and granulomatosis with polyangitis
What % of scleritis affects both eyes
50% of cases of bilateral
Presentation of scleritis
Severe pain, pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation to the eye
Management of scleritis
Look for underlying condition, NSAIDs, steroids and immunosuppression
What is episcleritis
Benign and self-limiting inflammation of the sclera
Where is the episclera located
Situated just underneath the conjunctiva, outmost layer of sclera
What is episcleritis associated with
Not infection usually, mainly RA and IBD
Presentation of episcleritis
Acute onset of unilateral symptoms
Mild pain
Segmental redness
Foreign body sensation
Dilated episcleral vessels,
Watering of eye, no discharge
Management of episcleritis
Self limiting and will recover in 1-4 weeks, in mild cases no treatment is necessary. Lubricating eye can help, cold compresses, analgesia
What parts of the eye does anterior uveitis involve
Iris and anterior chamber
What parts of the eye does intermediate uveitis involve
Peripheral retina and vitreous
What parts of eye does posterior uveitis involve
Choroid and retina
Associations with acute anterior uveitis
HLA B27 related conditions such as ankylosing spondylitis, IBD, reactive arthritis
Associations with chronic anterior uveitis
Sarcoidosis, syphilis, Lyme disease, TB, herpes, JIA
Presentation of anterior uveitis
Unilateral symptoms that start spontaneously without a history of trauma or precipitating events. May occur with flare of an associated disease such as reactive arthritis
Symptoms of anterior uveitis
Dull, aching, painful
Red, ciliary flush
Reduced visual acuity
Floaters and flashes
Miosis
Photophobia
Excessive tear production
Posterior synechiae
Hypopyon
Management of anterior uveitis
Steroids, cycloplegic-mydriatic medications such as cyclopentolate or atropine eye drops, DMARDS and TNF inhibitors.
Treatment options of severe cases of anterior uveitis
laser therapy, cryotherapy or surgery
What does cyclopegic mean
Paralysing the ciliary muscles
What does mydriatic mean
Dilating the pupils
What types of medications are cyclopentolate and atropine
Antimuscarinic
What is the role of antimuscarinic
Medications that blocks to the action of the iris sphincter muscles and ciliary body. These dilate the pupil and reduce pain associated with ciliary spasm by stopping the action of the ciliary body.
Types of posterior uveitis
Retinitis, vasculitis and neuroretinitis
What is ciliary flush
Ring of red spreading from the cornea outwards
What causes an abnormally shaped pupil
Posterior synechiae (adhesions) which pull the iris
What is a hypopyon
Collection of white blood cells in the anterior chamber seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level
Where is the conjunctival layer
Thin layer of tissue that covers to inside of the eyelids and the sclera of the eye
Three main types of conjunctivitis
Bacterial, viral, allergic
Presentation of conjunctivitis
Unilateral or bilateral, red eyes, bloodshot, itchy or gritty sensation, discharge from eye
Bacterial conjunctivitis symptoms
Purulent discharge and inflamed conjunctiva, typically worse in morning.
Symptoms of viral conjunctivitis
Clear discharge, associated with other symptoms of viral infection, tender preauricular lymph nodes
Management of bacterial conjunctivitis
Usually gets better on its own, but hloramphenicol and fuscific acid can be used for eye drops
What can neonatal conjunctivitis infection be related to
Gonococcal infection
Symptoms of allergic conjunctivitis
Swelling of conjunctival sac and eyelid with watery discharge and itch. After contact with allergens
Management of allergic conjunctivitis
Oral or topical antihistamines. Topical mast-cell stabilisers can be used in patients with chronic seasonal symptoms
What is keratitis
Inflammation of the cornea
Causes of keratitis
Viral - herpes simplex.
Bacterial - pseudomonas or staphylococcus.
Fungal - candida or aspergillus.
Contact lens acute red eye (CLARE). Exposure to keratitis
What is the most common cause of keratitis
Herpes simplex keratitis
What is stromal keratitis
When the inflammation reaches the layer between the epithelium and endothelium (stroma).
Complications of stromal keratitis
Stromal necrosis, vascularisation, scarring, corneal blindness
Which layer does herpes keratitis usually affect
Any part of the eye but mostly epithelial layer of cornea
Presentation of keratitis
Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced visual acuity
Diagnosis of keratitis
Fluorescein staining will show a dendritic corneal ulcer. Slit-lamp exam is required for diagnosis. Corneal swabs or scrapings to isolate the virus
Management of keratitis
Aciclovir topical or oral, ganciclovir eye gel, topical steroids may be used alongside. Corneal transplant
