OPTH Lec04 Flashcards
What causes red eyes?
innocuous trivial disorders cause engorgement of the suferfical visible blood vessels of the conjunctiva, episclera, or sclera; can be a threat to sight and can be a warning sign for mortality. Can reflect inflammation of the cornea, iris, ciliary body, and ocular adnexa
What are some DDx for red eye?
1) Acute angle closure glaucoma (serious) 2) Irisitis 3) Iridocyclitis 4) Uveitis 5) Herpes simplex keratitis 6) Conjunctivits 7) Episcleritis 8) Scleritis 9) Adrenal Disease 10) Spontaneous Subconjunctival hemorrhage 11) Pterygium 12) Kertoconjunctivitis Sicca 13) Abrasions and foreign bodies 14) Abnormalities of lid function
What is this?
Red eye caused by acute angle closure
What is this?
Viral Conjunctivits
What is this?
Red eye caused by bacterial conjunctivits
What is this?
Scleritis
What is adrenal disease?
Not serious; affects the eyelids (stye and belpharitis), lacrimal apparatus including dacryocytitis, and orbit. Can be caused by basal cell carinoma, squamous cell carcinoma, molluscum contagiosum, thyroid disease and vascular lesions.
What is scleritis?
Localized or diffus scleral inflammation. uncommon, deep boring pain, sclera will be protracted and and indicator of collagen vascular degeneration. SERIOUS!
What is episcleritis?
Uncommon sectorial inflammation of the episclera between the conjunctiva and the sclera. Some pain, no discharge, not serious
What is conjunctivits?
Hyperemia of the conjunctival blood vessels; very common and not serious; can be viral, allergic, bacterial toxic, or system
What types of effects on the eye can Herpes Simplex have?
Can cause herpes simplex keratitis - common and serious corneal inflammation that can lead to scarring and other sequelae
What is uveitis?
Inflammation of the uveal tract (iris, ciliary body, choroid
What is a Spontaneous subconjunctival hemorrhage?
Common, not serious. Find blood in the potential space between the conjunctiva and the sclera caused by increase in ocular venous pressure, coughing, sneezing, vomiting or vigorous ey rubbing. If this is recurrent - worry that could be a bleeding disorder.
What is this?
Subconjunctival hemorrhage
What is pterygium?
Will start as pinguecula (yellow deposits on the conjunctiva next to the limbus). Solar elastotic degeneration of the conjunctiva, advances over the cornea. Treat medically or surgically.
What is this?
Pterygium
What is Keratoconjnctivitis Sicca
Dry eyes due to lacrimal insufficiency associated with systemic disease (Sjorgren’s Syndrome - dry eyes, dry mouth; rheumatoid arthritis) usually not serious
What are the long term complications fo abrasions and foreign bodies?
Can result in focal irritative hyeremia
What are abnormalitis of lid function?
Bell’s palsy, thyroid ophthalmopathy, ectropion, entropion, and other lid lesions to the red eye
What is this?
Corneal Abrasion
How do you diagnose a red eye?
1) History - onset, duration, exacerbations, exposure, bilateral or unilateral, contacts, current illness, previous medical history, meds, seasonal allery history 2) Check visual acuity 3) Inspection - try to determine is subconjunctival hemorrhage, conjunctival hyperemia, ciliary flush or combined 3) Detect dischareg (profuse, scant, purulent, mucopurulent, or serous?) 4) Chek for corneal opacities, keratic percipitates, cornela edema, corneal scarring (leukoma) and irregular corneal light reflex 5) Check for scarring with fluorescein 6) Estimate anterir chamber depth, look for hyphema or hypopion 7) Check pupils 8) If elevated IOP is suspected and can use tonometry - use it 9) Palpate to detect a hard eye 10) Look for porptosis, lid malfunction or any limitationg o eye movement
What is this?
Proptosis - forward displacement of the eye from behind the eyelids
What are the signs of a red eye?
Hyperemia - nonspecific Discharge
What can discharge from the eye indicate?
1) purulent = bacterial 2) mucopurulent = bacteria, viral or mixed 3) serous (watery, clear, or yellow-tinged) = viral cause 4) Scant white stinge discharge = allergy or dry eyes (kertitis sicca) 5) Oily discharge with greasy lids = blepharitis; if have focal telangiestasia of lid margin = Acne Rosaceabacterial 6) profuse purulence - must rule out serious infection such as Neisseria gonorrhea 7) Lymphadenopathy - preauricular is common in viral conjunctivitis, possible in severa bacterial conjunctivitis and present in chronic granulomatous conjunctivitis
What are the dangers signs of red eye?
1) Reduced VA 2)Ciliary Flush 3) Corneal Opacity 4) Epithelial disruption 5) Fluorescein stain 6) Pupil 7) Elevated IOP 8) Proptosis 9) Itching 10) Exudation 11) Blurred Vision 12) Severe pain 13) Photophobia 14) Colored haloes
What can reduced VA mean for someone with red eye?
serious degeneration; this should NEVER occur in simple conjunctivitis
What is ciliary flush?
Injection of deep conjunctival and episcleral vessels overlying the ciliary region near the limbus. Can be the best in sunlight. Will appear violaceous, usually not seen with simple conjunctivitis
What would corneal opacity in a red eye indicate?
Best seen with a penlight or ophthalmoscop set on plus lense. Maybe KPs, cornela edema, ulcers, or leukoma
What would epithelial disruption look like?
Conjunctival or corneal; look at the light reflex in different positions. Looking for distortions or irregularities.
What can be pupililary signs in a red eye indicate?
1) Iritis will cause miosis on the affected side and photophobia in both eyes. 2) Chronic or previous iritis may cause synechiae, or adhesions between the iris and lens. 3) Acute NAG usuallyhas a fixed oval; id dilated pupil, with a shallow anterior chamber. ALWAYS compare with the unaffected eye. Conjunctivitis does not affect the pupil
What would elevated IOP be a danger sign for?
Acute angle closure glaucoma. Rarely irisitis due to trabeculitis NEVER found in conjunctivitis alone
What would proptosis look like and what do they indicate?
Proptosis is a forward displacement of the globe. Mid cases can be see by standing behind he patient and observing the corneas.
What would sudden onset of proptosis indicate?
Serious orbital or cavernous sinus disease.
What is proptosis an indicator of in children?
Orbital cellulitis, rhabdomyosarcoma or neuroblastoma
What is proptosis an indicator of in adults?
Thyroid related immune orbitopathy or tumors
What is itching a danger sign for?
Usually nonspecific; indicates allergies
What is exudation a danger sign of?
Exudation is “mattering” (sandman, lids stuck together, etc) and indicated conjunctival irritation; this is nonspecific
What would blurred vision indicate in conjunctivitis?
blepharitis, dry eyes - will clear with blinking
What would severe pain with red eye be a danger sign for?
keratitis, corneal ulcer, scleritis (deep boring pain ins common), iritis, acute glaucoma.
What would you be concerned about with someone with a red eye and photophobia?
Patients with conjunctivitis complain of photophobia
What does photophobia observed with bright illumination on the contralateral side indicate?
ocular degeneration such as iritis
What would you be concerned about with someone who is complaining of colored halos?
cornea edema, causes acute NAG
Red eye, URI, and fever would suggest what?
adenovirus type 3 and 7 (will cause pharyngoconjunctival fever)
Red eye and allergy would suggest what?
seasonal rhinitis and hay fever
Red eye and erythema multiforme is an indicator of what?
Stevens-Johnson Syndrome - allergy mediated response to sulfa meds. Can result in scarring and blindness.
When should a referral be made for a red eye?
If there is no improvement after several days of treatment
What should you do if your patient is complaining of hyperpurulent conjunctivitis with copious discharge?
Culture and refer
What is blepharitis?
Inflammation of the eyelid; chronic degeneration with frequent relapses. Caused by Staphylococci
What is the treatment for blepharitis?
Treat staphylococci with antibiotic. Treat scalp seborrhea with antidandruff shampoo. Cleanse the lids with warm watr and dilute baby shampoo.
What are the two types of styes?
1) Hordeolum - acute inflammation of the glands or hair follicales of the lid. Can be external or internal. 2) Chalazion - chronic inflammation of the meibomian glands, may follow a hordeolum, a non tender bulge
How do you treat a stye?
Hot compress and antibiotic ointment.Incision ad curettage if not resolving. If the lesion is persistne or recurrent may be cancer.
How do you treat conjunctivitis?
Antibiotics, ointments (for children), hot compresses for bacterial, cool for allergic. Viral conjunctivitis has no specific treatment, just avoid spreading it.
What should never be prescribed for analgesia?
Topical Anesthetics
What should topical anesthetics never be prescribed for anagesia?
because they inhibit growth and healing of corneal epithelium and they may produce an allergic reaction.
What is a side effect of corneal anesthesia?
It eliminates the blink reflex and will expose the cornea to dehydraion, injury and infection
Do you treat conjunctivitis with steroids?
NO!!!! - There is NO place for steroids in the treatment of red eye! Avoid antibiotic - steroid conbinations (ie blephamide, AK-cide, Ocul-, Trol-)
What are the side effects of steroids?
1) Exacerbations of hepatic and fungal keratitis. Eye may feel better while it melts away and perforates 2) Can cause catarcts 3) Can increase the intraocular pressure and cause secondary glaucoma
