Painful, infected, inflamed eyes Flashcards
What is a hyphema and what is hypopyon?
hyphema = blood in anterior chamber
hypopyon = pus in anterior chamber
In whom and how does hyphema present?
Mostly traumatic but can be seen in sickle cell and haemophilia
Painful eye with vision loss if the pupil is covered
What causes hypopyon?
Becets and anterior uveitis
What are the signs and symptoms of a blow out fracture?
- enophthalmous
- vertical diplopia
- inability to look up
- infra-orbital nerve damage causes loss of sensation to upper lip and gum
Compare the signs and symptoms of bacterial vs viral conjunctivitis
both cause a red, gritty eye
bacterial: thick, purulent discharge, sticky eyes
viral: serous, watery discharge
How is bacterial conjunctivitis managed?
delayed prescription of topical chloramphenicol
What are the signs and symptoms of allergic conjunctivitis? What is seen on examination?
watery, red, lid oedema, itchy
O/E papillae can be seen on the underside of the lid and there may be some blepharitis
How is allergic conjunctivitis managed?
topical or oral antihistamines
What features in the history and examination would point towards ?gonococcal or chlamydia conjunctivitis?
- poor response to antibiotics
- sexual history
gonococcal = +++hyperpurulent discharge
chlamydia = lid follicles
Which parts of the eye keep it moist and how?
Meibomian glands secrete lipids
Lacrimal glands secrete water and electrolytes
Goblet cells produce the mucins
Blinking spreads the tear film across the eye
What are the symptoms of dry eyes?
gritty FB sensation and burning worse at the end of the day
What are the causes of dry eyes?
meibomian gland dysfunction: blepharitis
reduced tear production: Sjogrens, age, antihistamines, b-blockers, SSRIs, diabetes
Reduced blink: Parkinsons, computer screens
What is Schirmer’s test?
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
What is ectropian and what can cause it?
eversion of the lid margin
- age
- CN7 palsy
What is entropian and what are the symptoms?
inversion of the lid margin causes a FB irritated sensation
What is the name of the condition in which eyelashes are misdirected and in contact with the ocular surface?
Trichiasis
Compare a chalazion and a stye
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
What is blepharitis?
Eyelid inflammation due to Meibomian gland dysfunction
What are the symptoms of blepharitis and what is seen on examination?
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
How is blepharitis managed?
- avoid mascara
- lid hygiene
- warm compresses
- may need chloramphenicol for any infections
What is the uvea?
iris, choroid and ciliary body
What conditions is uveitis associated with?
- ankylosing spondylitis
- IBD
- sarcoidosis
- reactive arthritis
- TB, syphilis, herpes, Lyme
What are the symptoms of uveitis?
- eye pain worse on eye movement
- photophobia
- floaters
- watery
- reduced visual acuity
What are the examination findings in uveitis?
- perilimbal injection (opposite to conjunctivitis)
- keratic precipitates
- small, fixed oval pupils
- reduced visual acuity
How is uveitis managed?
- Topical steroids
- Cycloplegic dilating agents eg cyclopentolate or atropine
May need systemic immunosuppressants or DMARDs depending on cause
What are the complications of uveitis?
- posterior synechia (adhesions) leading to pupil irregularity
- recurrence
- cataract
- glaucoma due to steroid drops
What is keratitis and what organisms can cause it?
Inflammation of the cornea
- staph and strep
- pseudomonas
- aspergillus and candida
What are the risk factors for keratitis?
- contact lens wearer
- diabetic or immunosuppressed
- dry eyes and blepharitis
- topical corticosteroid use
What are the symptoms of keratitis?
- painful
- photophobia
- FB sensation
- blurred vision
How is bacterial keratitis managed?
Topical quinolone
Cycloplegic agent for the pain
What is herpetic keratitis and what key examination finding is seen?
herpes simplex travels along the trigeminal nerve to the ophthalmic division and then the corneal nerve
Dendritic ulcers on fluorescein staining
How is herpetic keratitis managed?
topical or oral aciclovir
In whom is acanthamoeba keratitis seen? What is the key symptom and how is it managed?
Contact lens wearers presents with pain out of proportion to examination findings
Manage: topical chlorhexidine
Contact lens wearers are at particular risk of what sort of bacterial infection?
Pseudomonas
What can cause a corneal abrasion?
FB
Nail
Contact lens
Eyelash
What are the signs and symptoms of a corneal abrasion?
- red
- painful
- watery
- Sensation to blink
- FB sensation
What is seen on fluorescein staining with a corneal abrasion?
the yellow/orange stain collects in the abrasion so you see pooling of the dye
How are corneal abrasions managed?
Topical chloramphenicol if infection risk
Mostly supportive with analgesia and lubricating eye drops
Compare the causes of preseptal cellulitis and orbital cellulitis
Pre-septal: small cut, URTI, bite
Orbital: spread from sinuses, spread from dental sites
What are the signs and symptoms of preseptal cellulitis?
- red, swollen, tender eyelid
- eyelid oedema
What additional symptoms would make you suspect orbital cellulitis rather than preseptal?
- ophthalmoplegia
- proptosis
- reduced visual acuity and diplopia
- systemically unwell
How is preseptal cellulitis managed?
oral co-amoxiclav
How is orbital cellulitis managed?
IV cefotaxime and flucloxacillin
What are the complications of orbital cellulitis?
- meningitis
- vision loss
- retinal artery or vein occlusion
- exposure keratopathy
Where is the episclera located?
It is the outer layer of sclera which is located just under the conjunctiva
What are the signs, symptoms and examination findings in episcleritis?
- no pain
- wedge shaped red area
+/- watery
+/- photophobia
How is episcleritis managed?
lubricants and NSAIDs if needed
What is scleritis? What is it associated with?
inflammation of the full thickness of the sclera
What are the signs and symptoms of scleritis?
- pain and pain on eye movement
- photophobia
- watery
- blurred vision
How is scleritis managed?
Topical or systemic NSAIDs and steroids
May need immunosuppression if associated with RA, SLE, IBD, sarcoid
