Ophthalmology: Red eye Flashcards
What are the 3 causes of PAINLESS red eye?
Superficial to deep:
Conjunctivits
Episcleritis
Subconjunctival haemorrhage
Patient presents with an red, itchy eye. They deny pain but state that their eyes are sticky in the mornings What is the likely diagnosis? What would it be without the discharge
Bacterial conjunctivitis
Without discharge either viral or allergic
What are common bacterial agents in conjunctivitis? What 2 STI-related organisms can cause it?
Common
Staph aureus
Strep. Pneumoniae
H.influenzae
Sexually transmitted
Chlamydia trachomatis
Neisseria Gonorrhoea
What is the treatment for conjunctivitis?
Usually self resolves within 2 weeks
Bacterial: Chloramphenicol (fusidic acid if pregnant)
Viral: Good hygiene measures
Allergic: antihistamines 1st line, mast cell stabilisers 2nd line
Patient presents with a red eye. They have a red patch on the white of the eye (as below). They have a background of haemophilia and believe the red eye occurred following a coughing bout. What is the likely diagnosis?
Subconjunctival haemorrhage
Associated with high pressure states and increased bleeding
What is the treatment for a subconjunctival haemorrhage?
Self limiting
Address any hypertension or bleeding problems
Patient presents with a bloody patch on their eye which is not painful. They state that their eye has been watery and they struggle with looking at lights. On examination, the bloody patch moves with gentle pressure. What is the likely diagnosis? How is it treated?
Episcleritis
Self resolves in a month
Can give systemic NSAIDs or steroid drops if severe
What are the 5 causes of PAINFUL,red eye?
Glaucoma (open and closed)
Anterior uveitis
Scleritis
Corneal abrasion
Keratitis
Trauma/chemical injury
What symptoms and signs distinguish closed from open angle glaucoma?
Closed // Open
Symptoms:
Severe pain / / intermittent
Signs:
Closed has dilated pupil, hazy cornea and firm eyeball but open does not
What are the investigations and management of open angle glaucoma?
Investigations
Tonometry to assess pressure
Fundoscopy to assess cupping
Management
1st line: Lantaprost (PGE analogue) to increase flow
+ timolol/dorzolamide to reduce humour
Trabeculotomy if fails
What is the initial and further management of closed angle glaucoma?
Initial
Lie on back
Pilocarpine (2% blue, 4% brown) to contract iris
Acetazolimide to reduce humour production
Secondary
Further pilocarpine and acetazolimide
Laser iridotomy if fails
What are the visual changes seen in glaucoma?
Blurred vision
Halos around lights
Patient presents with a red eye with photophobia and halos around lights. On examination, there is a ring around the iris, the pupil is small and fixed. you also note a pus-like substance in the iris. What is the potential diagnosis? How do you manage?
Anterior uveitis
Reduce inflammation with steroids and DMARDs
Use cyclopentate/atropine to dilate pupil
How do you distinguish keratitis from corneal abrasion?
Fluorescin stain: Shows dendritic ulcer in keratitis but not in corneal abrasions
Slit lamp confirms
+ corneal scraping/swab for analysis
What is the treatment for corneal abrasion?
Analgesia and eye drops
Chloramphenicol
Review after 1 week
