Ophthalmology - Acute Red Eye Flashcards
What can be involved in presenting complaint?
Change in vision, redness, pain, discharge, double vision and change in appearance of eye
What can be included in past ocular history?
Previous similar episode
Previous surgery
Contact lens wear
Amblyopia - lazy eye
What can be included in past medical history?
CV risks - ischaemic optic neuropathies, retinal vein occlusion and CN palsies
Eczema/asthma/hay fever
Joints - uveitis, scleritis and episcleritis
Bowels - IBS - uveitis
Infection - uveitis
What is included in drug history?
Ethambutol and chloroquine
Tamsulosin - intraoperative floppy iris syndrome
Anticoagulants
What can be included in the social history?
Driver
Smoking - CV risk, age related macular degeneration , thyroid eye disease
Alcohol - nutritional optic neuropathies
Drug abuse
How is vision assessed in adults?
Snellen chard - best corrected acuity measured at 6m
Recorded as 6/60 - 6/6
Numerator is distance form chart and denominator is distance that is normal
What is used to assess vision in babies and toddlers?
Babies - preferential looking
Toddlers - matching Kay pictures
Older children - naming Kay pictures or Snellen chart
What is included in inspection of eye?
Facial asymmetry, rashes, lip position (ptosis, entropion, ectropion)
Globe position - proptosis and enophthalmos
Pupil symmetry
Lumps, bumps, redness and discharge
What is used for examination?
Slit lamp
Fundoscopy
Visual field exam
Eye movement and pupil exam
What are commonly encountered ophthalmic conditions?
Acute red eye - anterior segment
Loss of vision - posterior segment
Trauma
How is acute red eye examined?
Staining with fluorescein - outlines epithelial defects
What is the symptoms of infective conjunctivitis?
Gritty, red and discharge (purulent and watery)
What is the treatment for infective conjunctivitis?
Topical antibiotics - chloramphenicol/ fucidic acid
What are the symptoms of subconjunctival haemorrhage?
Red and painless
Treatment is reassurance - if BP high then do again after presentation
What are the symptoms and signs of allergic conjunctivitis?
Itchy, red, discharge, acute, lid swelling and conjunctival swelling (chemosis)
What is the treatment of allergic conjunctivitis?
Topical antihistamine
Avoid allergen
Mast cell stabilisers - sodium chromoglycate
What are the signs of symptoms of corneal ulcer?
Pain, red, photophobia, discharge, history of contacts, corneal defects with surrounding infiltrate and pus or cells in anterior chamber
What is the treatment of corneal ulcer?
Corneal scrape - MCS culture
Topical antibiotics
What are the symptoms and signs of corneal abrasion?
History of trauma, pain, red, watering, blurred vision and epithelial defect
What is the treatment for corneal abrasion?
Topical antibiotics
Analgesia
What are the symptoms and signs of acute anterior uveitis?
Pain, watering, photophobia, blurred vision/ floaters, red, keratic precipitates, cells in AC, hypopyon (white fluid in AC) and small irregular pupil
What is the treatment of acute anterior uveitis?
Topical steroids - prednisolone
Dilating drops - cyclopentolate
What are the signs and symptoms of scleritis?
Intense pain, redness, nodule which does not move over sclera and very tender
What is the treatment for scleritis?
Systemic steroids
What is the signs and symptoms of acute angle closure glaucoma?
Very painful, redness, blurred vision, nausea and vomiting, hazy cornea, fixed mid dilated pupil and hard eyeball
What is the treatment for acute angle closure glaucoma?
Lower IOP - carbonic anhydrase inhibitors, BB and prostaglandins
Constrict pupil - pilocarpine
Laser iridotomy
Describe orbital cellulitis
Infection of orbital tissues
Symptoms - very painful, red, blurred vision, diplopia, generally unwell, pyrexia proptosis and reduced eye movements
What is the treatment for orbital cellulitis?
Admit and IV antibiotics
CT scan
Drainage of pus
What are the signs and symptoms of endophthalmitis?
Is inflammation of internal eye tissues
Redness, blurred vision, pain and history or recent surgery
What is the treatment for endophthalmitis?
Admit and topical antibiotics
Vitreous tap
Intravitreal antibiotics
What is thyroid eye disease?
Inflammation of orbital fat and muscles
Can compress nerve
What are the signs and symptoms of thyroid eye disease?
Red, blurred vision, pain, diplopia, history of thyroid dysfunction, proptosis, lid retraction and reduced eye movement
What is the treatment for thyroid eye disease?
Topical lubrication
Systemic steroids
Orbital radiotherapy
Orbital decompression
