Inflammations Flashcards
What is an inflammation?
An immune response to tissue damage Can be caused by -injury -irritation -infection
What is the purpose of inflammation?
To destroy harmful substances
What are the 4 cardinal signs of inflammation?
- rubor (redness)
- Calor (heat)
- Tumor (swelling)
- Dolor (pain)
- 5th sign of tissue dysfuction often added (scarring)
What are the steps of inflammation?
- Vasoconstriction: very brief
- Vasodilation (causes redness and heat, it increases the flow of cells to affected tissue)
- Increased permeability of blood vessels (causes swelling/ oedema and pain, allows cells to get to affected site and destroy harmful substances)
- Tissue repair and scarring
What are the signs and symptoms of episcleritis?
Symptoms -mild discomfort/ tenderness -Redness Signs -simple: -redness: sectoral (small localised area) or diffuse (rare); radial pattern maintained; bright red; blanches with phenylephrine -vasodilation
- Nodular:
- Nodule with surrounding injection
- top part of slit lamp beam displaced
- swelling
How do you manage episcleritis?
- Nothing: resolves in 1-2 weeks
- Reassurance
- cold compress (to reduce vasodilation)
- Artificial Tears
- Return if persists eg increased redness, increased pain, discharge, reduced vision
What is the best way to tell the difference between episcleritis and scleritis?
PAIN
-sceritis is much more painful than episcleritis
What are the symptoms of scleritis?
Symptoms
- Moderate/ sever pain (loss of sleep), aches on brows
- Pain feels like its inside their eyes
- redness
What are the all the different types of anterior scleritis you can get and describe the signs?
Non necrotising:
-diffuse: inflammation of segment or whole sclera, loss of radial pattern, benign
-Nodular: nodule within sclera cant be moved, some visual impairment depending on location
Necrotising:
-With inflammation: appearance of avascular tissue, scleral necrosis and visibility of underlying uvea (blue colour means the sclera is thinning)
-Without inflammation: no dense redness, yellow patch which develops into blue, common in women with rheumatoid arthritis, asymptomatic
What are the signs and symptoms of posterior scleritis?
- No redness
- pain
- reduced vision
- thickening of effected area (sometimes visible on volk/ ophthalmoscopy
Whats the management protocol for scleritis?
Emergency referal (same day) where they administer: topical steroids, systemic NSAIDs, Systemic steroids, systemic immunosupressive agents
What is anterior uveitis?
Swelling of the middle layer of the eye:
ie iris, cilliary body etc
What are the symptoms of anterior uveitis?
Pain- stabbing inside eye, patients feel they cant open their eyes
Photophobia (due to pupil restriction)
Redness pointing towards inflammation at limbus
Reduced vision
Normally one eye
What are the signs of anterior uveitus?
Vasodilation (circumlimbal flush)
Cilliary muscle spasm (affected pupil SMALLER)
Infiltration of white blood cells (aqueous cells seen in slit lamp investigation: white dots seen in anterior chamber)
-Hypopeon: white blood cells that sit at bottom of anterior chamber
-Keratic precipitates: WBCs sticking to endothelium of the cornea
Proteins leaking from iris blood vessels
-aqueous flare (hazy appearance)
Posterior synechaiae (result from small pupil, cells and protein)
What could result from anterior uveitis?
Secondary closed angle glaucoma: cells clogging trabecular meshwork, iris can stick to lens preventing aqeuous drainage
Iris bombe: iris bows foward due to white blood cells sticking to it
