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Ophthalmology for Finals > Painful, infected, inflamed eyes > Flashcards

Painful, infected, inflamed eyes Flashcards

1
Q

What is a hyphema and what is hypopyon?

A

hyphema = blood in anterior chamber

hypopyon = pus in anterior chamber

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2
Q

In whom and how does hyphema present?

A

Mostly traumatic but can be seen in sickle cell and haemophilia

Painful eye with vision loss if the pupil is covered

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3
Q

What causes hypopyon?

A

Becets and anterior uveitis

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4
Q

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

A
  • enophthalmous
  • vertical diplopia
  • inability to look up
  • infra-orbital nerve damage causes loss of sensation to upper lip and gum
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5
Q

Compare the signs and symptoms of bacterial vs viral conjunctivitis

A

both cause a red, gritty eye

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

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6
Q

How is bacterial conjunctivitis managed?

A

delayed prescription of topical chloramphenicol

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7
Q

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

A

watery, red, lid oedema, itchy

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

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8
Q

How is allergic conjunctivitis managed?

A

topical or oral antihistamines

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9
Q

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

A
  • poor response to antibiotics
  • sexual history

gonococcal = +++hyperpurulent discharge

chlamydia = lid follicles

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10
Q

Which parts of the eye keep it moist and how?

A

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

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11
Q

What are the symptoms of dry eyes?

A

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

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12
Q

What are the causes of dry eyes?

A

meibomian gland dysfunction: blepharitis

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

Reduced blink: Parkinsons, computer screens

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13
Q

What is Schirmer’s test?

A

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

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14
Q

What is ectropian and what can cause it?

A

eversion of the lid margin

  • age
  • CN7 palsy
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15
Q

What is entropian and what are the symptoms?

A

inversion of the lid margin causes a FB irritated sensation

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16
Q

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

A

Trichiasis

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17
Q

Compare a chalazion and a stye

A

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

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18
Q

What is blepharitis?

A

Eyelid inflammation due to Meibomian gland dysfunction

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19
Q

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

A

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

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20
Q

How is blepharitis managed?

A
  • avoid mascara
  • lid hygiene
  • warm compresses
  • may need chloramphenicol for any infections
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21
Q

What is the uvea?

A

iris, choroid and ciliary body

22
Q

What conditions is uveitis associated with?

A
  • ankylosing spondylitis
  • IBD
  • sarcoidosis
  • reactive arthritis
  • TB, syphilis, herpes, Lyme
23
Q

What are the symptoms of uveitis?

A
  • eye pain worse on eye movement
  • photophobia
  • floaters
  • watery
  • reduced visual acuity
24
Q

What are the examination findings in uveitis?

A
  • perilimbal injection (opposite to conjunctivitis)
  • keratic precipitates
  • small, fixed oval pupils
  • reduced visual acuity
25
Q

How is uveitis managed?

A
  • Topical steroids
  • Cycloplegic dilating agents eg cyclopentolate or atropine

May need systemic immunosuppressants or DMARDs depending on cause

26
Q

What are the complications of uveitis?

A
  • posterior synechia (adhesions) leading to pupil irregularity
  • recurrence
  • cataract
  • glaucoma due to steroid drops
27
Q

What is keratitis and what organisms can cause it?

A

Inflammation of the cornea

  • staph and strep
  • pseudomonas
  • aspergillus and candida
28
Q

What are the risk factors for keratitis?

A
  • contact lens wearer
  • diabetic or immunosuppressed
  • dry eyes and blepharitis
  • topical corticosteroid use
29
Q

What are the symptoms of keratitis?

A
  • painful
  • photophobia
  • FB sensation
  • blurred vision
30
Q

How is bacterial keratitis managed?

A

Topical quinolone

Cycloplegic agent for the pain

31
Q

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

A

herpes simplex travels along the trigeminal nerve to the ophthalmic division and then the corneal nerve

Dendritic ulcers on fluorescein staining

32
Q

How is herpetic keratitis managed?

A

topical or oral aciclovir

33
Q

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

A

Contact lens wearers presents with pain out of proportion to examination findings

Manage: topical chlorhexidine

34
Q

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

A

Pseudomonas

35
Q

What can cause a corneal abrasion?

A

FB
Nail
Contact lens
Eyelash

36
Q

What are the signs and symptoms of a corneal abrasion?

A
  • red
  • painful
  • watery
  • Sensation to blink
  • FB sensation
37
Q

What is seen on fluorescein staining with a corneal abrasion?

A

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

38
Q

How are corneal abrasions managed?

A

Topical chloramphenicol if infection risk

Mostly supportive with analgesia and lubricating eye drops

39
Q

Compare the causes of preseptal cellulitis and orbital cellulitis

A

Pre-septal: small cut, URTI, bite

Orbital: spread from sinuses, spread from dental sites

40
Q

What are the signs and symptoms of preseptal cellulitis?

A
  • red, swollen, tender eyelid

- eyelid oedema

41
Q

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

A
  • ophthalmoplegia
  • proptosis
  • reduced visual acuity and diplopia
  • systemically unwell
42
Q

How is preseptal cellulitis managed?

A

oral co-amoxiclav

43
Q

How is orbital cellulitis managed?

A

IV cefotaxime and flucloxacillin

44
Q

What are the complications of orbital cellulitis?

A
  • meningitis
  • vision loss
  • retinal artery or vein occlusion
  • exposure keratopathy
45
Q

Where is the episclera located?

A

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

46
Q

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

A
  • no pain
  • wedge shaped red area

+/- watery
+/- photophobia

47
Q

How is episcleritis managed?

A

lubricants and NSAIDs if needed

48
Q

What is scleritis? What is it associated with?

A

inflammation of the full thickness of the sclera

49
Q

What are the signs and symptoms of scleritis?

A
  • pain and pain on eye movement
  • photophobia
  • watery
  • blurred vision
50
Q

How is scleritis managed?

A

Topical or systemic NSAIDs and steroids

May need immunosuppression if associated with RA, SLE, IBD, sarcoid

Ophthalmology for Finals (8 decks)

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