Painful, infected, inflamed eyes

Question 1

What is a hyphema and what is hypopyon?

Answer 1

hyphema = blood in anterior chamber

hypopyon = pus in anterior chamber

Question 2

In whom and how does hyphema present?

Answer 2

Mostly traumatic but can be seen in sickle cell and haemophilia

Painful eye with vision loss if the pupil is covered

Question 3

What causes hypopyon?

Answer 3

Becets and anterior uveitis

Question 4

What are the signs and symptoms of a blow out fracture?

Answer 4

• enophthalmous
• vertical diplopia
• inability to look up
• infra-orbital nerve damage causes loss of sensation to upper lip and gum

Question 5

Compare the signs and symptoms of bacterial vs viral conjunctivitis

Answer 5

both cause a red, gritty eye

bacterial: thick, purulent discharge, sticky eyes
viral: serous, watery discharge

Question 6

How is bacterial conjunctivitis managed?

Answer 6

delayed prescription of topical chloramphenicol

Question 7

What are the signs and symptoms of allergic conjunctivitis? What is seen on examination?

Answer 7

watery, red, lid oedema, itchy

O/E papillae can be seen on the underside of the lid and there may be some blepharitis

Question 8

How is allergic conjunctivitis managed?

Answer 8

topical or oral antihistamines

Question 9

What features in the history and examination would point towards ?gonococcal or chlamydia conjunctivitis?

Answer 9

• poor response to antibiotics
• sexual history

gonococcal = +++hyperpurulent discharge

chlamydia = lid follicles

Question 10

Which parts of the eye keep it moist and how?

Answer 10

Meibomian glands secrete lipids
Lacrimal glands secrete water and electrolytes
Goblet cells produce the mucins
Blinking spreads the tear film across the eye

Question 11

What are the symptoms of dry eyes?

Answer 11

gritty FB sensation and burning worse at the end of the day

Question 12

What are the causes of dry eyes?

Answer 12

meibomian gland dysfunction: blepharitis

reduced tear production: Sjogrens, age, antihistamines, b-blockers, SSRIs, diabetes

Reduced blink: Parkinsons, computer screens

Question 13

What is Schirmer’s test?

Answer 13

Filter paper is placed inside the lower eyelid and the person closes their eyes for 5 minutes and the distance the moisture has travelled is noted

Question 14

What is ectropian and what can cause it?

Answer 14

eversion of the lid margin

• age
• CN7 palsy

Question 15

What is entropian and what are the symptoms?

Answer 15

inversion of the lid margin causes a FB irritated sensation

Question 16

What is the name of the condition in which eyelashes are misdirected and in contact with the ocular surface?

Answer 16

Trichiasis

Question 17

Compare a chalazion and a stye

Answer 17

chalazion: inflammation of the Meibomian glands causes a hard tender red lump which just requires warm compresses and eyelid hygiene

Stye: infection of an eyelash follicle with staph aureus causing a tender swollen lid margin

Question 18

What is blepharitis?

Answer 18

Eyelid inflammation due to Meibomian gland dysfunction

Question 19

What are the symptoms of blepharitis and what is seen on examination?

Answer 19

red, watery, gritty eyes which are stuck together on waking up

O/E: eyelid is red and swollen with crusting and there is a tear film deficiency

Question 20

How is blepharitis managed?

Answer 20

• avoid mascara
• lid hygiene
• warm compresses
• may need chloramphenicol for any infections

Question 21

What is the uvea?

Answer 21

iris, choroid and ciliary body

Question 22

What conditions is uveitis associated with?

Answer 22

• ankylosing spondylitis
• IBD
• sarcoidosis
• reactive arthritis
• TB, syphilis, herpes, Lyme

Question 23

What are the symptoms of uveitis?

Answer 23

• eye pain worse on eye movement
• photophobia
• floaters
• watery
• reduced visual acuity

Question 24

What are the examination findings in uveitis?

Answer 24

• perilimbal injection (opposite to conjunctivitis)
• keratic precipitates
• small, fixed oval pupils
• reduced visual acuity

Question 25

How is uveitis managed?

Answer 25

- Topical steroids - Cycloplegic dilating agents eg cyclopentolate or atropine May need systemic immunosuppressants or DMARDs depending on cause

Question 26

What are the complications of uveitis?

Answer 26

- posterior synechia (adhesions) leading to pupil irregularity - recurrence - cataract - glaucoma due to steroid drops

Question 27

What is keratitis and what organisms can cause it?

Answer 27

Inflammation of the cornea - staph and strep - pseudomonas - aspergillus and candida

Question 28

What are the risk factors for keratitis?

Answer 28

- contact lens wearer - diabetic or immunosuppressed - dry eyes and blepharitis - topical corticosteroid use

Question 29

What are the symptoms of keratitis?

Answer 29

- painful - photophobia - FB sensation - blurred vision

Question 30

How is bacterial keratitis managed?

Answer 30

Topical quinolone | Cycloplegic agent for the pain

Question 31

What is herpetic keratitis and what key examination finding is seen?

Answer 31

herpes simplex travels along the trigeminal nerve to the ophthalmic division and then the corneal nerve Dendritic ulcers on fluorescein staining

Question 32

How is herpetic keratitis managed?

Answer 32

topical or oral aciclovir

Question 33

In whom is acanthamoeba keratitis seen? What is the key symptom and how is it managed?

Answer 33

Contact lens wearers presents with pain out of proportion to examination findings Manage: topical chlorhexidine

Question 34

Contact lens wearers are at particular risk of what sort of bacterial infection?

Answer 34

Pseudomonas

Question 35

What can cause a corneal abrasion?

Answer 35

FB Nail Contact lens Eyelash

Question 36

What are the signs and symptoms of a corneal abrasion?

Answer 36

- red - painful - watery - Sensation to blink - FB sensation

Question 37

What is seen on fluorescein staining with a corneal abrasion?

Answer 37

the yellow/orange stain collects in the abrasion so you see pooling of the dye

Question 38

How are corneal abrasions managed?

Answer 38

Topical chloramphenicol if infection risk Mostly supportive with analgesia and lubricating eye drops

Question 39

Compare the causes of preseptal cellulitis and orbital cellulitis

Answer 39

Pre-septal: small cut, URTI, bite Orbital: spread from sinuses, spread from dental sites

Question 40

What are the signs and symptoms of preseptal cellulitis?

Answer 40

- red, swollen, tender eyelid | - eyelid oedema

Question 41

What additional symptoms would make you suspect orbital cellulitis rather than preseptal?

Answer 41

- ophthalmoplegia - proptosis - reduced visual acuity and diplopia - systemically unwell

Question 42

How is preseptal cellulitis managed?

Answer 42

oral co-amoxiclav

Question 43

How is orbital cellulitis managed?

Answer 43

IV cefotaxime and flucloxacillin

Question 44

What are the complications of orbital cellulitis?

Answer 44

- meningitis - vision loss - retinal artery or vein occlusion - exposure keratopathy

Question 45

Where is the episclera located?

Answer 45

It is the outer layer of sclera which is located just under the conjunctiva

Question 46

What are the signs, symptoms and examination findings in episcleritis?

Answer 46

- no pain - wedge shaped red area +/- watery +/- photophobia

Question 47

How is episcleritis managed?

Answer 47

lubricants and NSAIDs if needed

Question 48

What is scleritis? What is it associated with?

Answer 48

inflammation of the full thickness of the sclera

Question 49

What are the signs and symptoms of scleritis?

Answer 49

- pain and pain on eye movement - photophobia - watery - blurred vision

Question 50

How is scleritis managed?

Answer 50

Topical or systemic NSAIDs and steroids May need immunosuppression if associated with RA, SLE, IBD, sarcoid