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(2) Introductory ocular disease > Other causes of red eye > Flashcards

Other causes of red eye Flashcards

1
Q

Describe Pinguecula:

A

• Degenerated conjunctiva
- Break down of collagen fibres in conjunctival stroma
- Thinning of overlying epithelium

• Prevalence increases with age
- Seen in most Px > 70 years old

• UV light exposure catalyses development
- Countries with high sunlight levels
- Outdoor occupation
• Chronic eye irritation increases risks

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2
Q

Pinguecula: Symptoms

A

• Usually asymptomatic
• May notice yellow-white lump: concerned
• Can become inflamed
- Pingueculitis
- Irritation, foreign body sensation and localised redness

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3
Q

Pinguecula: Signs

A

• Yellow-white, raised lump on bulbar conjunctiva
•Resembles fatty deposit
• Usually bilateral
- Close to limbus, 3 + 9 O’clock position
- Nasal more common than temporal
- Although many patients develop both
• Pingueculitis- localised redness

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4
Q

Pinguecula: Management

A

• Benign - no specific treatment required
- Reassure
• Advice: UV protective measures

• Pingueculitis:
- cold compresses
- artificial tears/ocular lubricants

• Surgical removal possible, but rarely performed; cosmetic, severe, chronic irritation

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5
Q

Pterygium: Describe

A

• Fibrovascular growth
- Triangular-shaped, extends from bulbar conjunctiva
- Crosses limbus and invades cornea

• UV light exposure raises risk
- Countries with high sunlight levels
- Outdoor occupation

• Chronic dryness and irritation of ocular surface also increases risk
- Dust, wind

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6
Q

Pterygium: Symptoms

A

• Early, small pterygium asymptomatic
• At limbus: disrupts tear film, dryness/irritation
• Developed: cosmetic concern

• Advances across cornea:
- Warpage induces irregular astigmatism
- Visual impairment despite refractive correction
- Threatens visual axis

• Acute inflammatory episodes:
- Irritation/dryness
- Increased redness

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7
Q

Pterygium: Signs

A

• Fibrovascular tissue:
- Milky-cloudy white
- Translucent
- Network of fine blood vessels

• Apex orientated towards pupil
• Usually bilateral
• More commonly originate from nasal bulbar

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8
Q

Pterygium: Management

A

• Advice: UV protective measures
• Monitor progression, record size
- Acute Inflammatory Episodes: cold compresses, artificial tears/lubricants
- More severe: topical NSAIDS or steroids
• Surgical removal

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9
Q

Pterygium: Management
(Surgical removal indications)

A

•Proximity to visual axis
• Induced irregular astigmatism leading to visual impairment
• Chronic inflammation, unresponsive to treatment
• Cosmetically unacceptable
Routine referral to Ophthalmologist

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10
Q

Subconctival Haemorrhage: Describe

A

• Rupture of a fine blood vessel
• Blood leaks into space underneath conjunctiva
• Similar to bruise on skin
• Most are idiopathic

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11
Q

Subconctival Haemorrhage: Risk factors

A
  1. Raised pressure in venous due to coughing, straining, sneezing, vomiting
  2. Trauma
  3. Vascular disorders
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12
Q

Subconctival Haemorrhage: Symptoms

A

• Asymptomatic
• Px may notice red eye
• Dramatic=concerned
• Sometimes mild irritation
• Never painful

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13
Q

Subconctival Haemorrhage: Signs

A

• Typically unilateral
• Distinctive appearance- blood is fixed and immobile
• Edges of haemorrhage may appear fainter

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14
Q

Subconctival Haemorrhage: Management

A

• Reassure; self limiting 5-10 days
• Irritation:
- Cold compresses
- Artificial tears/ocular lubricants
- Recurrent can indicate systemic hypertension or blood clotting disorders
- Routine referral if recurrent

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15
Q

Describe Pre-septal cellulitis:

A

• Bacterial infection of tissue anterior to orbital septum
• No extension to more posterior orbital tissue
• Bacteria may spread from nearby site:
- Ocular (e.g. hordeolum, conjunctivitis)
- Trauma (e.g. tree branch, insect bite/sting)
• May be spread of more remote infection:
- Sinusitis (sinus infection)
- Middle ear infection

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16
Q

Pre-septal cellulitis: Symptoms

A

• Most common in children (<10 years old)
• Unilateral
• Swelling and redness of eyelids
• Tender eyelids
• Pyrexia (Fever; raised temperature)
• Malaise (general unwell feeling)

17
Q

Pre-septal cellulitis: Signs

A

• Erythema (redness) of skin surrounding eye
• Warm skin surrounding eye
• Tender ocular region
• Eyelid oedema (swelling)
- Increased weight of upper eyelid may cause posis
- Narrowed palpebral aperture

18
Q

Pre-septal cellulitis: scanning

A

• CT scan
- Useful to exclude orbital cellulitis

19
Q

Pre-septal cellulitis: Management

A

• Risk of mis-diagnosing orbital cellulitis as preseptal
• Preseptal can progress to orbital, particularly in children
• Emergency referral to Ophthalmologist (telephone call)
- CT Scan
- Systemic antibacterial drugs- oral tablets
- If severe, intravenous antibacterial drugs may be required

• IP Optoms can prescribe oral antibacterial drugs for adults if diagnosis is not in doubt

20
Q

Orbital cellulitis: Describe

A

• Bacterial infection of tissues posterior to orbital septum
• Sight-, and potentially life-, threatening
• Most common in children
- May develop from preseptal cellulitis
- Spread from adjacent sinusitis (particularly ethmoid)
- Dental abscess (bacterial mouth infection)
- Trauma (including ocular surgery)

21
Q

Orbital cellulitis: Symptoms

A

• Generally more severe than preseptal
• Sudden onset (more rapid than preseptal), unilateral
• Redness and swelling of peri-ocular tissues
• Malaise and pyrexia
• Impaired visual function

• Painful eye movements
• Diplopia
• Reduced/blurred vision

22
Q

Orbital cellulitis: Signs (early)

A

• Erythema (redness) and oedema (swelling) of eyelids
• Warm and tender eyelid skin
• Proptosis (eye bulges forward)

• Ocular motility:
- Restricted range of eye movements
- Diplopia and pain reported

23
Q

Orbital cellulitis: Signs (advanced)

A

Optic nerve compression
• Reduced VA
• Impaired colour vision
• Test each eye monocularly
• Investigate for red desaturation
•Pupils: RAPD in the affected eye …but no anisocoria

24
Q

Orbital cellulitis: Management

A

• Emergency referral to Ophthalmologist
- CT scan
- Hospital admission
- Antibacterial drugs (intra-venous)
- Surgery to drain fluid/pus in some cases

25
Q

Endophthalmitis: Describe

A

• Widespread inflammation involving up to the entire globe and surrounding tissues
• Typically caused by severe bacterial infection
• Route required for bacteria to penetrate deep into eye
- ocular surgery; contaminated instrument, ocular trauma, spread of infection

26
Q

Endophthalmitis: Symptoms

A

• Acute (within first week post-surgery)
• Chronic (one month post surgery
- 80% of cases develop 6 weeks after surgery

• Substantial variance in symptoms:
- Acute, PAINFUL, RED EYE
- Blurred vision, photophobia
- Chronic less severe

27
Q

Endophthalmitis: Signs

A

• Hyperaemia of lids + conj
• Hypopyon
- Accumulation of inflammatory cells in ant chamber
• Chemosis of lids + conj
• Hazy cornea
• Opacification of cornea
• Reduced VA

• Vitritis
- Inflammation extends to vitreous, hazy due to cells + flare

28
Q

Endophthalmitis: Management

A

• Emergency referral to Ophthalmologist

Intensive antibacterial therapy:
• Topical (eye-drops)
• Systemic (oral tablets)
• Intra-vitreal injections

(2) Introductory ocular disease (16 decks)

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