Ophthalmology: "The red eye"

Question 1

what is conjunctivitis?

Answer 1

nflammation of the conjunctiva.

The conjunctiva is a thin layer of tissue that covers to inside of the eyelids and the sclera of the eye.

There are three main types:

Question 2

how does conjunctivitis present?

Answer 2

Unilateral or bilateral
Red eyes
Bloodshot
Itchy or gritty sensation
Discharge from the eye

Question 3

how can you differentiate from a bacterial/viral/allergic conjunctivitis?

Answer 3

bacterial:

• purulent discharge
• typically worse in the morning
• starts in one eye and spreads to another

viral:

• clear discharge
• associated with other viral symptoms e.g. cough/sore throat/blocked nose
• may find tender lymph nodes

allergic:
- swelling

Question 4

does conjunctivitis cause pain?

Answer 4

no

Question 5

which conditions present as a painful red eye?

Answer 5

Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury

Question 6

which conditions present as a painless red eye?

Answer 6

Conjunctivitis

Episcleritis

Subconjunctival Haemorrhage

Question 7

how do you manage bacterial conjunctivitis?

Answer 7

If bacterial conjunctivitis is suspected then antibiotic eye drops can be considered, however bear in mind it will often get better without treatment. Chloramphenicol and fuscidic acid eye drops are both options.

Question 8

how do you manage allergic conjunctivitis?

Answer 8

Antihistamines (oral or topical) can be used to reduce symptoms.

Question 9

what is Episcleritis?

Answer 9

self limiting inflammation of the episclera (the outermost layer of the sclera)

• common in young-middle aged adults
• not usually caused by infection
• associated with inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease.

Question 10

how does Episcleritis present?

Answer 10

• Typically not painful
• Segmental redness
• Foreign body sensation
• Dilated episcleral vessels
• Watering of eye
• No discharge

Question 11

what is scleritis?

Answer 11

inflammation of the full thickness of the sclera. This is more serious than episcleritis.

• not usually caused by infection.
• There is an associated systemic condition in around 50% of patients presenting with scleritis.

Question 12

how does scleritis present?

Answer 12

acute onset of symptoms - 50% of cases are bilateral:

Severe pain
Pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation of the eye

Question 13

what does the management of scleritis involve?

Answer 13

• Consider an underlying systemic condition
• NSAIDS (topical / systemic)
• Steroids (topical / systemic)
• Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)

Question 14

what is meant by a retinal detachment?

Answer 14

retina separates from the choroid underneath

This is usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid

Question 15

what are some risk factors for a retinal detachment?

Answer 15

• Posterior vitreous detachment
• Diabetic retinopathy
• Trauma to the eye
• Retinal malignancy
• Older age
• Family history

Question 16

how does a retinal detachment present?

Answer 16

Peripheral vision loss. This is often sudden and like a shadow coming across the vision.

Blurred or distorted vision

Flashes and floaters

nb: painless