OPTH - Red eyes Flashcards
What can give you red eyes & cause function threatening problem?
- Endogenous Endophthalmitis
- Viral Retinitis
- Scleritis
- Panuveitis
- Retinal Vasculitis
What is an important thing to ask in Hx of red eye?
Unilateral or Bilateral?
The 3 components to clinical examination of eyes
- Always test and record visual acuity +/- visual fields etc
- Always test and record pupil reactions
- Always test and record intra-ocular pressure
Describe ectropion
- O/E
- Hx
- Rx
- EVERSION of the right lower eyelid.
- “My right eye is red and it waters a lot”.
- Rx: Ocular lubricants. Consider surgical repair if lid position does not improve over next 3 months.
Describe entropion
- O/E
- Hx
- Rx
- INVERSION of the right lower eyelid
- “My right eye is red and feels very irritated”
- Rx: Requires Surgical Repair to prevent lashes rubbing on ocular surface
Describe Blepharitis
- O/E
- Hx
- Rx
- crust formation around lashes and associated inflammation
- “My eyes have been red and itchy for a few weeks”
- Rx: Daily Routine of Lid Margin Hygiene (e.g. warm face washer, mechanical removal of lid debris, avoid make up, topical ABx in refractory cases)
Describe Chalazion
- O/E
- Hx
- Rx
- Swelling located above the eyelash margin.
- “Is it a stye, Doc?”
- Rx: Often self-resolving. Incision and curette for refractory cases
Chalazia differ from styes (hordeola) in that they are subacute and usually painless nodules.
unlike a stye, chalazia are usually situated inside the lid rather than on the lid margin
Describe Periorbital (Preseptal) Cellulitis
- O/E
- Hx
- common causative oragnisms
- Rx
- Red, hot, oedematous, tender skin over eyelid, clear conjunctiva
- RVA 6/6, LVA 6/6 PEARL Normal IOP
- “My eye has been painful, red and swollen over the past 2-3 days.”
- Causative agents: Staph aureus, Strep pyogenes. From skin, sinuses/meibomian glands
- Rx: Oral antibiotics (e.g. Augmentin Duo Forte). Greater risk of progression to orbital cellulitis in children warrants more aggressive treatment
Describe orbital (Postseptal) Cellulitis
- O/E
- Hx
- common causative oragnisms
- Rx
O/E
- Red, hot, oedematous, tender skin over eyelids
- Conjunctival chemosis
- Proptosis may be present Difficult to assess due to lid swelling
Hx
- Onset over a few days
- Painful red eye +/- diplopia and visual impairment
- Systemic symptoms – fever, nausea, malaise
Causative agents:
- Staph aureus, Strep pyogenes, H. influenzae
- most spread from sinuses
Rx:
- CT orbits/brain to confirm diagnosis
- Swab purulent discharge (if present)
- Admission to hospital
- IV antibiotics
- ENT review
- May need surgical drainage (if abscess has formed).
Describe Dry eyes
- O/E
- Hx
- Rx
- “My eyes are often red and sore. Sometimes they become very watery!”
What is Sjögrens Syndrome?
a chronic autoimmune disease in which the body’s white blood cells destroy the exocrine glands, specifically the salivary and lacrimal glands, that produce saliva and tears, respectively.
Present with xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes), which takes place in association with lymphocytic infiltration of the glands
Ix of conjunctivitis + its underlying cause
Conjunctival Swab •MCS – Microscopy, Culture and Sensitivities •Adenovirus PCR •HSV – Herpes Simplex PCR •Varicella Zoster PCR •RSV – Respiratory Syncytial Virus PCR
Describe pterygium
- Hx
- O/E
- Rx
- “My eye has been red for years, especially after I have been out in the sun. I think it’s getting worse, Doc.”
- Triangular membrane on ocular surface arising from medial canthal region
- Rx: surgical removal if:
1. threat to vision
2. symptom relief`
3. cosmetic reasons
Describe subconjunctival haemorrhage
- Hx
- O/E
- Rx
- # 1 – “I was injured in an accident”
- # 2 – “I have had a cough recently and have been on antibiotics. I also happen to take warfarin tablets”
- very red
- Common. Usually non-serious, however may suggest serious pathology in some clinical contexts (i.e. Base of Skull fracture, supra-therapeutic warfarin dosage).
- Rx: Self resolving.
What is chemosis?
swelling (or edema) of the conjunctiva
