Opth- acute red eye diseases Flashcards
what is conjunctivitis
inflammation of the conjunctiva, most common cause of red eye
what is the most common cause of red eye
conjunctivitis
most common causative organism of conjunctivitis
adenovirus
causative organisms of viral conjunctivitis
adenovirus (most common)
herpes simplex
herpes zoster
what symptom is associated with adenoviral conjunctivitis
watery discharge
what symptoms are associated with herpes simplex conjunctivitis
cutaneous vesicles develop on the eyelids and on the skin around the eyes
what symptom is associated with herpes zoster conjunctivitis
shingles rash
is adenovirus conjunctivitis self limiting
yes
causative organisms of bacterial conjunctivitis
staph aureus
strep pneumonia
H influenza
is viral/bacterial conjunctivitis associated with morning crusting?
bacterial conjunctivitis
how does bacterial conjunctivitis present
bilateral spread within 48 hours
morning crusting
Copious mucopurulent yellow discharge
papillae
what is associated with palpable pre-auricular lymph nodes
viral conjunctivitis
what is chemosis
swelling of the conjuctiva
what is the first line medical management of bacterial conjunctivitis
topical broad spectrum antibiotic (usually chloramphenical)
what is episcleritis
inflammation of the episcleritis, the thin vascular sheet between the sclera and conjuctiva; less severe than scleritis
what is scleritis
full thickness inflammation of the scleritis; more serious than episcleritis
there is an associated systemic condition in around how many patients presenting with scleritis?
50%
other than systemic conditions, what can also be responsible for scleritis
surgery
infections
does episcleritis cause segmented/diffuse redness
segmented
what are the clinical features of scleritis
severe pain progressing over several days
pain with eye movement
photophobia
eye watering
reduced visual acuity
abnormal pupil reaction to light
tenderness to palpation of the eye
what is the medical management of sclerosis
oral NSAIDs
oral steroids and steroid sparing agents
what is keratitis
inflammation of the cornea
what is hypopyon
aggregation of inflammatory cells within the anterior chamber resulting in visible sediment in front of eye inferiorly
what are the symptoms of keratitis
photophobia
severe ocular pain and foreign body sensation
hypopyon
what is bacterial keratitis often associated with
other corneal pathologies or eye contact lens wear
what is the management of bacterial keratitis
hourly antibiotic drops
ofloxin- most gram negatives
gentamicin and cefuroxime- most gram positive and gram negative
what is herpetic keratitis aka
dendritic ulcer
causative organism of herpetic keratitis
herpes simplex virus (HSV)
who is Acanthamoeba keratitis most commonly seen in
contact lens wearers
list the different types of keratitis
bacterial keratitis
adenovirus keratitis
herpetic keratitis
fungal keratitis
acanthamoeba keratitis
what is the most common causative organism of bacterial keratitis
pseudomonas aeruginosa
what is Synechiae
small or irregular pupil due to adhesions pulling iris into abnormal shapes
what is anterior uveitis
inflammation in the anterior part of the uvea; the uvea involves the iris, choroid, and ciliary body
causes of anterior uveitis
autoimmune process- usually
infection
trauma
ischaemia
malignancy
autoimmune causes of anterior uveitis
Reiters syndrome
ankylosing spondylitis
ulcerative colitis
sarcoidosis
infective causes of anterior uveitis
TB
syphylis
herpes simplex, herpes zoster
what do cycloplegics do? what are examples of cycloplegics
dilates the pupil- helps relieve pain and photophobia of eye
eg atropine, cyclopentalote
what is acute angle-closure glaucoma
occurs when iris bulges forward and blocks the drainage of fluid from the eye, leading to a continual buildup of IOP
what is hyperopia
long-sightedness
risk factors of acute angle-closure glaucoma
hyperopia (long-sightedness)
age- increased age
ethnicity- asian
Pupillary dilatation- eg watching tv in dark room
symptoms of acute angle-closure glaucoma
eye pain- progresses rapidly
blurred vision- can progress to vision loss
systemically unwell- nausea and vomiting very common
haloes- coloured haloes around lights
investigations for acute angle-closure glaucoma
tonometry- assess for elevated IOP
gonioscopy
what is the immediate management of acute angle-closure glaucoma
combination of eye drops- parasympathomimetic, beta blocker, alpha 2 agonist
Intravenous acetazolamide
what is the definitive management of acute angle-closure glaucoma
bilateral laser peripheral iridotomy
clinical signs of acute angle-closure glaucoma
red eye- ciliary flush and hazy cornea
mid dilated or fixed pupil
Closed iridocorneal angleson gonioscopy
corneal oedema
what is ciliary flush
violet ring around the cornea caused by dilated blood vessels
what is cellulitis
bacterial infection of the lower dermis and subcutaneous tissue
what is preseptal cellulitis
infection of the eyelid and surrounding skin anterior to the orbital septum
cause of preseptal cellulitis
usually from a contiguous spread of infection from local facial or eyelid trauma eg insect bite
symptoms of preseptal cellulitis
redness of eyelid
swelling
tenderness
warmth
how is preseptal cellulitis managed
antibiotics
what is orbital cellulitis
infection of the orbital tissues posterior to orbital septum
causes of orbital cellulitis
direct extension from sinuses
extension from focal orbital infection
post-operative
causative organisms of orbital cellulitis
staphylococci
streptococci
coliforms
H.influenza
anaerobes
clinical features of orbital cellulitis
painful, especially on eye movements
proptosis
pyrexial
sight threatening
what is orbital cellulitis often associated with
paranasal sinusitis
what investigation is carried out to diagnose orbital cellulitis
CT scan
how is orbital cellulitis managed
broad spectrum antibiotics and monitor closely
sometimes access requires drainage
what is endopthalmitis
devastating infection inside of the eye that threatens sight
causes of endopthalmitis
post-operative or endogenous
most common causative organism of endopthalmitis
staph.epidermidis
clinical features of endopthalmitis
very red eye
very painful
decreasing vision
hypopyon
how to diagnose endopthalmitis
aqueous/vitreous for culture
how to manage endopthalmitis
Intravitreal amikacin/ceftazamide/vancomycin and topical antibiotics
red eye post-surgery suggests…
endopthalmitis
when does blepharitis usually occur
middle age- can occur at any age
what is blepharitis
term that encompasses various conditions which cause chronic inflammation of the eyelid margins
what is anterior blepharitis
inflammation of base of eyelashes
causes of anterior blepharitis (base of eyelashes)
bacterial- staphylococcal blepharitis
seborrhoeic dermatitis- less inflammation than staph but more oily
what is posterior blepharitis
inflammation of the meibomian glands
symptoms of blepharitis
burning, itching and/or crusting of eyelids
symptoms worse in mornings
bilateral
recurrent hordeolum (styes)
contact lens intolerance
what treatment should you avoid in herpetic keratitis
steroids
drooping eyelid ‘down and out’ which nerve palsy-
3rd nerve palsy- oculomotor nerve palsy
3rd nerve palsy- what should you be most worried about
PCA- posterior communicating arterial aneurysm
investigation for PCA
MRI
complications of blepharitis
stye (hordeolum)
chalazion
what time of day is blepharitis worse
mornings
what type of management is used for blepharitis
conservative management
what is a Meibomian cyst (chalazion)
sterile, chronic, inflammatory granuloma of the eyelid caused by a foreign body reaction to sebum within a meibomain gland
who are meiboamian cysts most common in
adults
risk factors for meiboamian cysts
pregnancy
blepahritis
seborrhoeic dermatitis
how do meiboamian cysts present
firm, painless, localised eyelid swelling that has developed slowly over several weeks
what is the conservative management advice for meiboamian cysts
warm compress for several weeks
what is hordeolum aka
stye
risk factors for styes
chronic blepharitis
acne rosacea
are styes painful/painless
painful
