Ophthalmology Overview - Red Eye Flashcards
What are the 2 most common presenting symptoms in ophthalmology? How do we approach these?
9 Causes of Unilateral Red Eye and 4 Causes of Bilateral Red eye?
Differentials for Vision Loss:
- Sudden & Painless? (6)
- Sudden & Painful? (3)
- Gradual & Anterior Segment? (3)
- Gradual & Posterior Segment? (4)
Unilateral Red Eye - Corneal Foreign Body or Abrasion
- Treatment?
Treatment
- Local anaesthetic.
- Try removing with cotton bud but 25G needle or burr usually necessary because of rust ring.
- Chlorsig ointment QID.
- Review 1-2/7.
What is Recurrent Corneal Erosion Syndrome?
Recurrent Corneal Erosion (RCE) syndrome is a common, recurrent condition caused by abnormal epithelial adhesion to the underlying basal lamina. The spontaneous breakdown of the corneal epithelium can lead to the sudden onset of ocular pain, blurred vision, tearing, and photophobia, typically upon awakening.
What is a Hyphema? Treatment?
Hyphema is the collection of blood in the anterior chamber of the eye. The most common cause of hyphema is blunt trauma, though spontaneous hyphemas can occur in the setting of sickle cell disease or other increased bleeding states. Hyphemas are graded based on the degree of blood obscuring the cornea.
Treatment
- Elevated bed rest.
- Topical steroids +/- antihypertensives.
- Risk of rebleed in 1-2 weeks.
Management of a Penetrating Eye Injury - FAST?
Blowout Fracture of the Orbit
- 4 clinical features?
- 4 treatment?
Blowout Fracture of the Orbit
- Traumatic mydriasis.
- Restricted EOM (superior/inferior).
- Enophthalmos.
- Numb cheek/gum (infraorbital nerve).
Treatment
- Check no globe rupture.
- Urgent CT scan.
- Broad-spectrum antibiotics.
- Maxillofacial referral.
7 ways to differentiate between Preseptal vs Orbital Cellulitis?
Treatment for Orbital Cellulitis? 4 complications?
Orbital Cellulitis - Treatment
- Urgent CT scan, admission, broad-spectrum IV antibiotics.
- ENT referral for drainage of sinuses/orbital abscess.
- Can cause blindness, cavernous sinus thrombosis, brain abscess, death.
Preseptal Cellulitis - Where is the infection? Treatment?
Preseptal Cellulitis
- Confined to skin and subcutaneous tissues of eyelids.
- Tarsal plates and orbital septa form a barrier.
- Treatment: Oral antibiotics but watch for clinical deterioration.
What is this?
Causes? Treatment?
Subconjunctival Haemorrhage
- Spontaneous, cough, sneeze.
- Treatment
- Check BP.
- Reassurance, lubricants.
- Spontaneous resolution in 1-2 weeks.
- If recurrent: clotting studies and FBP.
- Beware base of skull fracture in trauma.
What is a Pinguecula?
Pinguecula is an abnormal growth of tissue on the conjunctiva, the clear membrane that covers the white of the eye. A pinguecula is a yellowish raised growth on the conjunctiva typically adjacent to the border where the colored part of the eye meets the white part of the eye.
What is a Pterygium?
- Definition?
- Also known as?
- Epidemiology?
- Aetiology?
- 3 Clinical Features?
Pterygium is a growth of fleshy tissue (has blood vessels) that may start as a pinguecula.
What is a Pterygium?
- 3 Differential Diagnoses?
- Management?
- Complications?
- Prognosis?
Treatment
- Lubricants, topical NSAIDs + steroids.
- Wrap-around sunglasses.
- Excision.
Complications
- Recurrence after surgical removal
- Visual impairment
- Reduced ocular motility
Prognosis
- Good
- Recurrence after surgical removal indicates a high risk of recurrence after subsequent procedures.
What is Episcleritis? 3 Types? Treatment?
Episcleritis is an acute unilateral or bilateral inflammation of the episclera, the thin layer of tissue between the conjunctiva and sclera.
- Usually no systemic association.
- Self-limiting but may last for months.
Treatment
- Lubricants.
- Oral NSAIDs.
- Low dose topical steroids (rarely).
What is Scleritis?
- Definition?
- Epidmiology?
- Aetiology?
Scleritis
- 6 Clinical features?
- Diagnostics?
- Severe boring pain (keeps patient up at night).
- Violaceous (bluish-red) hue.
- Look for a CTD eg. RA, SLE, IBD, Wegener’s.
Scleritis?
- Treatment?
- Prognosis?
Treatment
- Systemic steroids + immunosuppression.
Episcleritis vs Scleritis
- Frequency?
- Pain severity?
- Clinical features?
- Prognosis?
- Associated conditions?
- Management?
How are Corneal Ulcers classified?
What is Herpes Simplex Keratitis?
- 7 Clinical features?
- 4 Corneal epithelial changes that can occur?
- A leading cause of corneal blindness worldwide. Unilateral red eye (rarely bilateral).
- Primary infection causes a blepharoconjunctivitis. Remains latent in the trigeminal ganglion.
- Upon reactivation, 2/3 develop corneal epithelial changes:
1. Punctate epithelial erosions.
2. Dendritic ulcers.
3. Geographic ulcers.
4. Metaherpetic (trophic) ulcer.
Herpes simplex keratitis
- Diagnostics?
- 3 types of ulcers?
- Treatment?
- 5 complications?
Treatment: Dendritic and geographic ulcers
- Debridement + Zovirax ointment 5x/d for 1-2 weeks.
- NO STEROIDS.
Metaherpetic (neurotrophic) ulcer
- Preservative-free lubricants.
- Bandage contact lens.
- Lid closure (tarsorraphy, botox).
Complications
- Immune keratitis, corneal scarring, uveitis, glaucoma, retinal necrosis.
What is this? What is Hutchinson sign?
Herpes Zoster Ophthalmicus
- Primary infection = “chickenpox.”
- Reactivation = “shingles.”
- Involvement of ophthalmic division of trigeminal nerve causes “Herpes zoster ophthalmicus.”
- Hutchinson sign – ocular involvement likely if nasociliary nerve involved (lesions at tip of nose).
Herpes Zoster Ophthalmicus
- 5 Complications?
- Treatment?
Complications
1. Corneal pseudodendrites
2. Immune keratitis.
3. Uveitis.
4. Glaucoma.
5. Chorioretinitis.
Bacterial and Fungal Keratitis
- 3 risk factors?
- 3 Bacterial organisms?
- 3 Fungal organisms?
Bacterial and Fungal Keratitis
- Treatment?
What is Marginal Keratitis?
Treatment?
Marginal keratitis is an inflammatory disease of the peripheral cornea, characterized by peripheral stromal infiltrates which are often associated with epithelium break down and ulceration.
- Not all ulcers are caused by infection.
- Immune reaction to bacterial antigen.
- Commonly associated with blepharitis.
- Treatment: Topical antibiotic + steroid. and Treat blepharitis.
What is Iritis?
- Also known as?
- Affected part of eye?
- Common aetiologies?
- Clinical features?
- 5 Associated conditions?
Clinical Features
- Photophobia, redness, discomfort, reduced vision.
- 50% idiopathic.
Associations
1. HLA-B27 (ankylosing spondylitis, IBD, psoriasis, Reiter’s).
2. Sarcoidosis.
3. CTD (Wegener’s, polyarteritis nodosa).
4. Juvenile idiopathic arthritis (JIA).
5. Fuchs’ heterochromic iridocyclitis (FHIC).
Iritis
- Diagnostics?
- Complications?
- Treatment?
Iritis - Treatment
- Intensive topical steroids + Atropine 1%.
- Treat systemic condition.
5 Clinical Features of Iritis seen on slit lamp?
Is Iritis painful?
- Uveitis is often associated with HLA-B27 syndromes, such as Crohn disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, and reactive arthritis.
- Posterior uveitis does not manifest with pain (unlike painful anterior uveitis), because the choroid is not innervated by sensory nerves.
Acute Angle Closure Glaucoma
- 4 clinical features?
- Hazy cornea.
- Mid-dilated pupil.
- Very high IOP (feels rock-hard).
- Nausea + vomiting.
Acute Angle Closure Glaucoma - Treatment?
What is Endophthalmitis?
- Aetiology?
Endophthalmitis is a rare, potentially sight-threatening inflammation of the vitreous humor (vitritis) that may be infectious (bacterial/fungal infection) or noninfectious (sterile).
- Infection inside the eye.
Causes
- Exogenous = Surgery (usually recent but may be distant)/Trauma.
- Endogenous = Haematogenous spread (usually fungal).
Treatment
- Intravitreal antibiotics +/- vitrectomy.
Endophthalmitis - Treatment?
Bacterial Conjunctivitis
- Clinical Features?
- Treatment?
Bacterial Conjunctivitis - Clinical Features
- Usually bilateral.
- Thick, mucopurulent discharge.
Treatment
- Reassurance.
- Lid hygiene.
- Chlorsig drops/ointment.
Viral Conjunctivitis
- Clinical Features?
- Treatment?
Viral Conjunctivitis - Clinical Features
- Bilateral but asymmetric (can be unilateral).
- “Pink eye” with watery/mucoid discharge.
- Tender preauricular lymphadenopathy.
- Severe adenoviral disease
- Haemorrhagic conjunctivitis with lid ecchymoses, pseudomembrane, subepithelial infiltrates and symblepharon.
Treatment (mostly supportive)
- Strict personal hygiene (highly infectious).
- Cool compresses and lubricants.
- Peel pseudomembranes.
- Topical steroids if severe inflammation or vision affected.
Allergic Conjunctivitis
- 4 Main Types?
6 Clinical features of Allergic Conjunctivitis seen on slit lamp?
Allergic Conjunctivitis - Treatment? (6)
**What is Blepharitis? **
- Definition?
- Aetiology?
- Classification?
Blepharitis
- Clinical features?
Blepharitis
- Diagnostics?
- Treatment?
- Complications?
Blepharitis/Dry eyes: Extremely common and often coexist. Treatment
A) Blepharitis
- Regular lid scrubs eg. baby shampoo, bicarbonate of soda, Sterilid.
- Warm compresses, lid massage.
B) Dry eyes
- Regular lubrication (preservative-free).
- Environmental modifications.
- Topical steroids (to treat inflammatory component), punctal plugs/cautery.
What is Ultraviolet Keratitis (Arc Eyes)/Photokeratitis?
- Definition
- Aetiology?
- Pathophysiology?
Ultraviolet Keratitis
- Clinical Features?
- Diagnostics?
- Treatment?
- Complications?
