Module 3 - Red Eye

Question 1

Red Eye Differentials

Answer 1

• Bacterial/Viral/Allergic Conjunctivitis
• Corneal Abrasion
• Hordeolum/Chalazion
• Herpetic
• Glaucoma
• Iritis/Uveitis

Question 2

Treatment of Bacterial Conjunctivitis (Mild-Mod) *

Answer 2

(self hint macrolides)
- Azithromycin 1% 1gtt BID x 1 day THEN daily x 4 days
- Erythromycin 0.5% ointment 1/2in ribbon QID x 5 days
- Polymyxin B/TMP 10,000u/mg 1gtt QID x 5 days

Question 3

Treatment of Bacterial Conjunctivitis (Mod-Sev) *

Answer 3

(self hint fluoroquinolones)
- Ciprofloxacin 0.3% 1gtt QID x 7 days
- Levofloxacin 0.5% 1gtt QID x 7 days

• Multiple other fluoroquinolones
• Use fluoroquinolones for pseudomonas (contact wearing pts due risk of colonization)

Question 4

What not to use for Bacterial Conjunctivitis *

Answer 4

Aminoglycosides such as gentamycin + tobramycin are NOT recommended because they are corneal toxic and may delay healing and cause hyperemia

Question 5

Comparison of Conjunctivitis Chart *

Answer 5

Look at Notes

Question 6

Corneal Abrasion

Answer 6

• Usually history of trauma
• Tearing
• Foreign Body Sensation
• Photophobia
• Pain
• Use fluorescein stain: Cobalt blue light OR wood light
  
  • Abrasion of eye takes up stain

Question 7

Hordeolum Vs. Chalazion *

• Location
• Cause
• Symptoms
• Treatment

Answer 7

Location
- Hordeolum: near eyelash follicle
- Chalazion: above eyelash on lid or below (same)

Cause
- Hordeolum: BACTERIAL INFX of eyelash follicle or meibomian gland (staph aureus)
- Chalazion: BLOCKED meibomian gland

Symptoms
- Hordeolum: Tenderness like pimple but can cause swelling of lid with subsequent tearing
- Chalazion: Firm lump that does not hurt (grows slower than a hord)

Treatment
- Hordeolum: Most often will open on their own and drain but warm compress will speed process (Don’t Self Drain)
- Chalazion: Typically resolves in 1mo using warm compress lid mass but sometimes needs I+D

Question 8

Acute Angle-Closure Glaucoma *
Symptoms and PE

Answer 8

Symptoms
- Occular Pain
- N/V
- Blurred Vision
- HALO AROUND LIGHTS
- Severe photophobia

PE
- Redness of eye
- Dilated Pupil
- Cloudy Cornea
- More common in >50yo
- Associated with: Hyperemia (far sighted), Cataracts, Family hx, Trauma

Question 9

Medications that Induce Acute Angle-Closure Glaucoma

Answer 9

• Ace Inhibitors
• Adrenergic Agonist
• Anticholinergics
• Antihistamines
• Antidepressants (SSRI, Tricyclics)

Question 10

Iritis/Uveitis

Answer 10

• Star Pupil
• Pupil Constriction
• Watery Discharge
• Decreased vision: blurry
• Happens quickly
• Pain, Photophobia

Question 11

Immediate Eye Referrals *

Answer 11

• Decreased Vision
• Severe photophobia
• Halos
• Loss of red light reflex
• Full thickness penetrating injury
• Metallic foreign body
• Chemical Injury (prompt irrigation first)
• Elevated eye pressure (>30 tonometry)
• Severe occular pain

Question 12

• gonorrheal conjunctivitis

Answer 12

systemic
ceftriaxone 1g IM one dose
same day visit to optho

Question 13

• H Influenza conjunctivitis

Answer 13

systemic
augmentin PO

Question 14

• chlamydial conjunctivitis

Answer 14

azithromycin OR doxy PO

Question 15

23 yo sexually active, presents with 4 day history of bilateral eye exudates which she describes as copius. acuity 20/20, generalized conjunctival inflammation with sparing of the cornea. gram stain negative diplococci

Answer 15

gonorrhea
CEF and AZITHRO x 1 dose of each

study guide just says cef

Question 16

staph infection characterized by localized red swollen and acutely tender abscess of upper or lower eyelid

Answer 16

hordeolum