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OP3104- AOC- YR 3 > Ocular Events- Red eye > Flashcards

Ocular Events- Red eye Flashcards

1
Q

What structures of the eye go red?

A
  1. Episclera
  2. Sclera
  3. Limbus
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2
Q

3 causes of red eye

A
  1. Infection
  2. Inflammation
  3. Trauma
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3
Q

Are inflammation and infection associated together?

A

Always get inflammation with infection.
However, signs of inflammation do not always indicate infection.

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4
Q

5 signs of infection and inflammation, what is the additional 6th sign for infection?

A

Inflammation & Infection: Pain, redness, loss of function, heat, swelling.
Additional sign of infection: Pus

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5
Q

3 signs of an urgent eye problem?

A
  1. Pain
  2. Photophobia
  3. Reduced vision
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6
Q

True or false- cancer lesions are painless and do not affect vision generally?

A

True

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7
Q

Inflammatory conditions- how does the name give the hint

A

Usually ends with -itis or inflammatory

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8
Q

True or false- inflammation in one form of your body can cause inflammation in other parts of your body?

A

True

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9
Q

What assessements need to be carried out for inflammation and infection?

A
  1. VA
  2. General check of px’s eye and adnexa
  3. Anterior eye check with slit lamp
  4. Fluorescein exam
  5. Pupils
  6. IOP
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10
Q

Are red eye conditions infectious?

A

Yes

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11
Q

The following signs and symptoms relate to?
Signs: Watery discharge, conjunctival hyperemia, swelling of conjunctiva, follicles, petechial subconjunctival hemorrhages.
Symptoms: Red watery eyes, itchy, starts unilateral and can become bilateral, flu like symptoms.

A

Viral Conjunctivitis

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12
Q

Management of viral conjunctivitis.
What to do if px complains of itchy eyes?

A

Lubrication + Hygiene+ px sholdn’t share towels.
For itchy eyes anti-histamines are given

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13
Q

What causes acute allergic conjunctivitis?

A

Happens due to direct contact- pollen grass animal fur.

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14
Q

Clinical features of acute allergic conjunctivitis?

A
  1. Sudden eyelid swelling.
  2. Lid oedema + erythema
  3. Conjunctival hyperemia and chemosis
  4. Watery discharge
  5. No papillae
  6. No cornea involvement
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15
Q

Management of acute allergic conjunctivitis?

A

Reassure px, resolves spontaneously in a few hours, cold compress, advise px to not rub eyes.

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16
Q

what do this signs suggest?
Red itchy eye, watering, mid- moderate lid oedema, conjunctival chemosis, papillae, cornea univolved?

A

Seasonal allergic conjunctivitis

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17
Q

Seasonal allergic conjunctivitis Management?

A

Identify and manage allergen, cold compress, advise against lid rubbing

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18
Q

Pharamacological treatment for Seasonal allergic conjunctivitis

A
  1. Tropical mast stabilizers
  2. Tropical antihistamines + mast cell stabilisers
  3. Oral histamines
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19
Q

Seasonal vs acute allergic conjunctivitis

A

Seasonal: No papillae
Acute: papillae

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20
Q

Vernal keratoconjunctivitis presents in?

A

Young children (<10)
Usually seasonal but can present all year round

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21
Q

Veral keratoconjunctivitis clinical features?

A
  1. FB sensation/ itching/ burning
  2. Mucoid discharge
  3. Blurred vision
  4. Pain
  5. Photophobia
  6. Bilateral but asymmetrical
  7. Conjunctival chemosis + hyperemia
  8. Cobble- stone papillae
  9. Tranta’s dot at limbus
  10. Punctate epithelial keratopathy
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22
Q

Management of vernal keratoconjunctivitis?

A

Avoid triggers, cold compress, tropic mast cell stabilizers if mild, severe = ophthalmology

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23
Q

Cause of bacterial conjunctivitis?

A

Bacteria

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24
Q

Symptoms of bacterial conjunctivitis?

A
  1. Redness
  2. Burning/ gritty sensation
  3. Crusting of lids
  4. Intermittent blur
  5. usually bilateral
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25
Q

Signs of bacterial conjunctivitis?

A
  1. Lid crusting
  2. Purent/ mucopurulent discharge
  3. redness- worse at fonixes
  4. no corneal involvement
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26
Q

Management of bacterial conjunctivis?

A

Self ressolves (7-10 days), lid hygine, remove crusts with saline, CL not to be worn, chloramophenoecol speeds recovery

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27
Q

This are clinical features of?
1. Lasts more then 2 weeks
2. Unilteral or can be bilateral but assymetrical
3. Lid oedema +/- ptosis
4. Gritty sensation
5. Conjunctival hyperaemia + chemosis
6. Large follicles (Starts as papillae)
7. (Superior) epithelial keratitis
8. Marginal defects
9. Superior pannus

A

Chlamydial conjunctivitis

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28
Q

Chlamydial conjuncitivis management?

A

Ocular lubrication, refered urgently to opthalmology or GUM
Swabs taken before starting treatment - may have other STDs
Sexual patners need to be contacted

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29
Q

Gonococcal conjunctivitis clinical features?

A
  1. Severe purulent discharge- starts within 24 hrs
  2. Lid swelling and chemosis
  3. Marginal ulceration of cornea that progresses rapidly
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30
Q

Gonococcal conjunctivitis management?

A

Ocular lubrication, urgent referal to opthalmology or GUM

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31
Q

Pre- orbital Cellulitis clinical features?

A
  1. Swollen and tenderness of lids.
  2. Eyelids redness
  3. Ptosis
  4. No proptosis
  5. Pyrexia
  6. Normal VA
  7. Pupils normal
  8. OM Normal
  9. CV normal
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32
Q

Pre- orbital Cellulitis management

A

Adults- systematic antibiotics
Children- same day referral to ophthalmology or A&E.

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33
Q

Hordeolum clinical features?

A
  1. Tender eye lumps
  2. Epiphora
  3. Localized redness of eyes and lids (Redness near blockage)
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34
Q

Hordeolum management?

A
  1. Resolves spontaneously
  2. Warm compress
  3. Surgery- rare
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35
Q

External hordeollum is associated with?

A

Acute infection of gland of zeiss or moll

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36
Q

Internal hordeollum is associated with?

A

Acute bacterial infection of meibomian gland

37
Q

Chalazion clinical features?

A
  1. Painless, well defined ocular lump.
  2. Single or multiple
  3. May be recurrent
  4. Can rupture through skin
38
Q

Chalazion management?

A

Resolves in 6 months with massage and compresses.
Large Chalazion- surgically removed.
Associated with blepharitis- if treated, chalazion reduced.

39
Q

Diffused non-necrotizing anterior scleritis classification?

A
  1. Anterior- 90% (diffused & nodular)
  2. Posterior- 10% (with or without inflammation)- emergency
40
Q

Episcleritis clinical features?

A
  1. Typically unilateral, 25% bilateral
  2. VA unaffected
  3. No AC inflammation
  4. Mild ache/ burning sensation
  5. Sometimes tender
  6. Occasionally watery
  7. Hyperemia from dilated vessels in episcleral
  8. Redness improves with vasodilators
41
Q

Management of episcleritis?

A
  1. Self- limiting (7-10 days)
  2. Cold compress
  3. No NSAIDs- if px has bowel conditions
42
Q

Difference between episcleritis and scleritis?

A

Episcleritis: Does don’t blanch with 2.5% phenylephrine. Vision is blurry, eyes feel tender, severe pain, cells and flare in AC, Hyperemia both superficial and deep episcleral vessels.
Scleritis: VA unaffected, No AC inflammation, mild ache and burning sensation, sometimes tend, hyperemia from dilated vessels (hence red around nodule), watering, redness improves with vasodilators

43
Q

Endophthalmitis happens ?

A

Post operative- related to px hygine

44
Q

Clinical features of endopthalmitis?

A
  1. Vision loss
  2. Pain
  3. Conjunctival chemosis and hyperemia
  4. Photophobia
  5. Corneal haze
  6. Pupil reflex sluggish & absent
  7. Cells and flare in AC
  8. Fibrinous exudates and/ or hypopyon if severe
  9. May have uveitis
45
Q

Management of endopthalmitis?

A

Same day referal to HES
Antibiotics and steroids

46
Q

Anterior uveitis clinical features?

A
  1. Circumcorneal hyperemia
  2. Keratic precipitate
  3. Aqueous cells and flares
  4. Hypopyon/ fibrin
  5. IOP may be affected
47
Q

Posterior synechiae in anterior uveitis?

A

Yes

48
Q

Management of anterior uveitis?

A

Tropical steroids, and if iris spasm= tropical cycloplegia

49
Q

How is vision lost in acute angle glaucoma?

A

Rapid, progressive loss of vision in one eye

50
Q

Do patients with acute angle closure glaucoma have pain?

A

Yes, ocular are periocular pain

51
Q

Clinical features of acute angle closure glaucoma?

A
  1. Rapid progressive loss of vision in one eye
  2. Ocular and periorbital pain
  3. Nausea and vomiting
  4. Ciliary flush
  5. Fixed, semi dilated pupils
  6. Corneal oedema
  7. Shallow AC
  8. High IOP (40+)
  9. Optic disc oedematous and hyperaemic
52
Q

Management of acute angle closure glaucoma?

A
  1. Acetazolamide (Diamox)
  2. Laser peripheral iridotomy
  3. Lens removal + IOL (once pressures are contolled)
53
Q

Microbial keratitis clinical signs and it is associated with?

A

Clinical signs: Lid oedema, epiphora, purulent discharge, central corneal lesion, stromal oedema with folds in descement’s membrane, anterior chamber activity

54
Q

Microbial keratitis management?

A
  1. Stop CLs wear
  2. > 1mm lesion= same day referral
  3. Tropical antibiotics
  4. Possible oral antibiotics
  5. Cycloplegic
55
Q

Acanthamoeba keratitis clinical features?

A
  1. Pain
  2. Vision loss
  3. Epiphora
  4. Photophobia
  5. Early signs: Subepithelial infiltrates, pseudodendrites, radial keratoneuritis.
    Later signs: Central ring, stromal thinning, stromal inflammation, AC cells and flare, hypopyon.
56
Q

Management of Acanthamoeba Keratitis?

A

Emergence

57
Q

Herpes Simplex Keratitis is usually monocular or binocular?

A

Monocular

58
Q

Herpes Simplex Keratitis first occurrence?

A

Pain that reduces with time.

59
Q

What ulcer is seen with Herpes Simplex Keratitis?

A

Dendritic epithelial ulcer

60
Q

Management of Herpes Simplex Keratitis?

A

Antiviral therapy : Acyclovir

61
Q

What is Herpes Zoster Opthalmicus look like?

A

Ocular lesion occurs after skin rash

62
Q

Hutchinson sign is present in what condition?

A

Herpes Zoster Opthalmicus

63
Q

Herpes Zoster Opthalmicus has what type of discharge?

A

Mucopurulent

64
Q

Herpes Zoster Opthalmicus does it reduce corneal sensation?

A

Yes

65
Q

Herpes Zoster Opthalmicus management?

A
  1. Managed with GP is lesion is mild and only affects epithelium
  2. Most need referral to HES.
  3. Systemic antivirals
  4. Tropical steroids.
66
Q

What is seen in CLPU?

A
  1. Moderate redness and watering
  2. Mild FB sensation
  3. Mild photophobia
  4. Peripheral stromal infiltrates
  5. Anterior chamber is quite/ not inflammed
  6. No lid oedema
67
Q

CLPU management?

A
  1. Stop CLs wear temporarily
    - Symptoms resolve in 1-2 days. infiltrates resolve in 2-3 weeks
    ocular lubrication used for symptomatic relief.
68
Q

Marginal Keratitis is associated with?

A

Blepharitis and upper respiratory tract infection

69
Q

Clinical features of Marginal Keratitis?

A
  1. Ocular discomfort
  2. Photophobia
  3. Stromal infiltrate with overlying endothelial loss
  4. Stains with fluorescein
  5. Can be single or multiple
  6. Hyperemia or adjacent conjunctivitis.
70
Q

Marginal Keratitis management?

A
  1. Lid hygiene
  2. Ocular lubrication
  3. Systemic analgesia
  4. Self-limiting but chloramphenicol and steroids help reduce inflammation
71
Q

Traumatic mydriasis and hyphemia caused by blunt force trauma presents with what symptoms?

A
  1. Blurred vision in affected eye
  2. Pain in affected eye
  3. Photophobia in affected eye
  4. Px usually hit by something
72
Q

Signs of Traumatic mydriasis and hyphemia

A
  1. Conjunctival hyperemia
  2. Cloudy anterior chamber
  3. IOP normal
  4. Minimum pupil reaction
73
Q

In px with Traumatic mydriasis and hyphemia, mydriasis and hyphemia suggest ?

A

Internal damage has occured

74
Q

Traumatic mydriasis and hyphemia management

A

Same day referral to HES

75
Q

3 types of trauma?

A
  1. Mechanical
  2. Chemical
  3. UV
76
Q

Clinical features of corneal abrasions?

A
  1. Sudden onset pain
  2. Blurred vision
  3. Photophobia
  4. Lacrimation
  5. Conjunctival hyperemia
  6. Corneal epithelial defect - stains with fluorescein
77
Q

Corneal abrasion management?

A
  1. Must evert lids to check for FB
  2. Ocular lubrication
  3. May need to use tropical anesthetic to help with examination
  4. Cycloplegia if large abrasion
  5. Simple can be managed by optom, complex needs referral
78
Q

How to manage loose FB ?

A

Irrigate with saline

79
Q

What must be done before removing FB?

A

Check VA before and after

80
Q

Subconjunctival hemorrhage clinical features ?

A
  1. Usually asymptomatic, might have mild ache
  2. Red area on eye
  3. Localized or diffused redness
  4. Usually uniocular
  5. No discharge
81
Q

Subconjunctival hemorrhage management?

A
  1. Self limiting
  2. Resolves in 2 weeks depending on size
82
Q

Recurrent Subconjunctival hemorrhage suggests?

A

Clotting issue/ undiagnosed hypertension, GP referral required.

83
Q

Signs of chemical burns?

A
  1. Immediate redness and watering
  2. Conjunctival chemosis and hyperemia
  3. Limbal and conjunctival blanching
  4. Burns to eyelids and surrounding skin
  5. Corneal epithelial defect
  6. Corneal oedema
  7. Raised IOP
84
Q

Symptoms of chemical burns

A
  1. Pain
  2. Severe chemical trauma may cause pain due to nerve damage
85
Q

Which chemical causes more damage - acid or alkaline?

A

Alkalis- they penetrate more than acids making them more destructive.

86
Q

Management of chemical burns?

A
  1. Irrigate fir 5 mins- done immediately even if referring.
  2. Need to evert lids to check for particals
  3. Refer to A&E
87
Q

Photokeratitis is also known as?

A

Arc Eye or snow blindness

88
Q

Photokeratitis cause?

A

Overexposure of UV light such as welding, sun lamps, skiing without googles

89
Q

Photokeratitis management?

A

Symptoms go away in 24-48 hrs, lubricating drops and cold compress. need to discuss with patient how this can be avoided.

OP3104- AOC- YR 3 (8 decks)

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