Ophthalmology - Red Eyes (Conjunctivitis, Abrasions, Ulcers and Shingles) Flashcards
Give a differential for a painless red eye
- Conjunctivitis
- Episcleritis
- Subconjunctival haemorrhage
Give a differential for a painful red eye
- Glaucoma
- Anterior uveitis
- Scleritis
- Corneal abrasions/ulceration
- Keratitis
- Foreign body
- Traumatic/chemical injury
What are the three types of conjunctivitis? How to these present?
-Bacterial: initially 1 eye then spreads to both, purulent discharged and inflamed conjunctiva. Usually worse in morning due to excess gunk in eye. Associated with staph, chlamydia and gonococcus
-Viral conjunctivitis: common, usually clear serous discharge, associated other sx of URTI (sore throat/blocked nose), may have pre-auricular LN tenderness
*Both of these are highly contagious
-Allergic conjunctivitis: caused by contact with allergens/atop (look for signs of atopy), causes swelling of conjunctival sac and eye lid with significant water discharge and itch
Other symptoms
- Red, bloodshot eyes
- Itchy or gritty sensation
What is the management for the 3 types of conjunctivitis?
-Conjunctivitis usually self resolves without treatment after 1-2 weeks.
-Avoid sharing towels, rubbing eyes and contact lenses
-Clean eyes with cool boiled water and cotton wool.
-Bacterial conjunctivitis: can used chloramphenicol/fusidic acid but will self resolve
-Viral: hygiene measures
-Allergic: antihistamines (topical or systemic) or mast-cell stabiliser if very serious
*School exclusion is not necessary
What is a corneal abrasion? Name some causes
-Scratches or damage to the cornea
Causes
- Contact lenses (suspect pseudomonas in these patients)
- Foreign bodies
- Finger nails
- Eyelashes
- Entropion (inward turning eyelid)
How to patients with a corneal abrasion present?
- Hx of contact lenses or foreign body
- Painful red eye
- Foreign body sensation
- Watering eye
- Blurring of vision
- Photophobia
How do you diagnose and manage a corneal abrasion?
Diagnosis
- Florescein stain applied - will collect in the abrasions or ulcers and highlight them
- Slip lamp examination
Management
-Simple analgesia
-Lubricating eye drops -
Prophylactic choloramphenicol (antibiotic eye drops)
-Bring patient back after 1 week to check healing (uncomplicated abrasions heal after 2-3 days)
*If suspect sight threatening cause of red eyes or major abrasion: same day ophthalmology appointment
What is Keratitis? Name the most important causes of keratitis (6)
Inflammation of the cornea
Causes
- Viral infection: herpes simplex (most common)
- Bacterial infection: pseudomonas and staph
- Funal infection: candida or aspergillus
- Contact lens acute red eye (CLARE)
- Exposure keratitis: inadequate eyelid coverage (eg ectropion)
- Amoebic infection: acanthamoebic keratitis
Which part of the eye does herpes keratitis most commonly affect?
- Can cause inflammation to ay part of the eye but most commonly affects the epithelial layer of the cornea
- Can also affect the stroma (between epithelium and endothelium, called stromal keratitis) and this is associated with stromal necrosis, scarring, vascularisation and corneal blindness.
What is the PC of someone with keratits?
- Painful red eye
- Photophobia
- Vesicles around the eye
- Foreign body sensation
- Watering eye
- Sometimes get reduced visual acuity
What investigations would you perform on someone with keratitis?
- Staining with fluorescing: will show the borders of ulcers
- Slit lamp examination
- Corneal swabs/scrappings to identify organism
How would you manage a patient with keratitis?
Patients should be referred for ophthalmology assessment ASAP
Secondary care treatment
- Aciclovir (topical)
- Ganciclovir gel
- Topical steroids: maybe used alongside antivirals to treat stromal keratitis
*Corneal transplant may be required if there is scarring caused by stroma kertitis
What is ophthalmic shingles/Herpes zoster ophthalmicus? Name 2 important features
-Reactivation of varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve
Features
- Vesicular rash around the eye (may nor may not involve the actual eye)
- Hutchinson’s sign: rash on tip or side of nose which indicates nasociliary involvement and is strong risk factor for ocular involvement (must refer to ophthalmology ASAP)
How should you manage ophthalmic shingles
-Occular involvement requires urgent ophthalmology review
-Start ora antiviral (aciclovir) within 72h and take for 7-10 days
-If patient is immunocompromised/severe infection: IV antivirals
*Topical antiviral not given but can used topical steroids to treat secondary inflammation of the eye
Name some complications of herpes ophthalmicus
- Ocular: keratitis, episcleritis, anterior uveitis
- Ptosis
- Post-herpetic neuralgia
