painful red eye Flashcards
chalazion (stye)
inflammation of the meiobiam gland
causes lumps in the eyelids
signs- eyelid swelling, redness, pain
mx: self limited. topical abx and surgical removal (if necessary)
opthalmic zoster (shingles)
painful condition caused by the herpes zoster infection
opthalmic nerve and trigeminal nerve can become affected
painful, blister like lesion
cornea, uvea inflammed
tx: anti viral meds, analgesia
dacryocystitis (inflammation of lacrimal sac)
secondary to obstruction of the lacrimal duct
tender, red, tense swelling at the medial canthus
mx: warm compress, oral abx, draining tear sac removl
orbital cellulitis
life-threatening infection of the soft tissues behind the orbital septum. more common in children
symptoms- fever, pain, visual impairment
signs- unilateral, tender, warm, red periorbital lid edema, proptosis, painful ophthalmoplegia, optic nerve dysfunction
ix: CT scan - thickened periocular tissues.
mx: admission and IV abx therapy
rhabdomyosarcoma
highly malignant orbital tumor of striated muscles in children
symptoms- unilateral eye pain
signs- reduced vision, progressive exopthlamos or proptosis. buldging / protrusin of the eye ball. red eye
mx: referral to an oncologist for exenteration, radiotherapy, chemo
conjunctivitis (bacterial)
inflammation fo the conjunctiva (mucous membrane which covers the white of the eye and inner surface of the eyelid)
bacterial- red sticky eyes, usually bilateral, red eyes with purulent discharge, no corneal or anterior chamber involvement. systemically well.
mx: regular hygine, minimise secretion build up topical abx 5 days
referral - if vision is affected. if no improvement after treatment after 2 days. or if worsens after treatment 5 days.
conjunctivitis (viral)
recent eye or URTI symptoms (kids) contagious.
symptoms- burning sensation, watery discharge (not purulent exudate). begins with one eye and can spread to the otehr. pre auricular lymphadenopathy.
red eye, watery. swollen conjunctiva.
mx: self resolving. cool compress, lubriants, abx drop if indicated.
allergic conjunctivitis
symptoms- itchy eyes, red and sore
signs- eyelid swelling, papillae (tiny elevation on the plpebral conjunctiva)
pmhx: atopy (asthma, eczema)
mx: remove allergens, topical anti histamines, cool compress
refer if not better in 3 days
episcleritis
- sectoral episcleritis
- diffuse episcleraitis
inflammation of episclera (outmost layer of the sclera)
symptoms: mild discomfort, tender, watery
signs: sectoral / diffuse redness
mx: topical steorids, self limiting
scleritis
inflammation of the sclera *!scleral necrosis
symptoms- eye pain that radiates to the head, wakes the patient up at night
signs- red eye, visible sclera nodules, necrotic patch
sclera may be disclolored and tender to palpation
pmhx: RA, vascular or connective tissue disease
mx: same day referral to opthalmologist
topical / systemic corticotherapy
keratitis
keratitis is corneal inflammation from various agents (virus, bacteria, fungi, parasite)
symptoms- sore, red eye *contact lens / trauma
viral keratitis
bacerial keratits
fungal keraitits
parasitic keratitis
mx: urgent referral to opthalmologist for corneal scrape and intensive topical abx / antiviral / antifungal tehrapy
keratoplasty (corneal graft) when cornea is perforated
uveitis
inflammation of the ‘uveal tract’ (ciliary body, choroid, iris)
symptoms- photophobia, red eye, sore eyes, vision can be affected
signs- anterior chamber appears cloudy
mx: mydriasis – intensive steroid therapy
glaucoma- acute angle closure glaucoma
sudden increase in IOP due to closed anterior chamber angle which prevents aqeuous drainage.
symptoms- painful eye with systemic symptoms including headache, nausea and vomiting
signs: red eye, tender, hard on palpation. cornea is hazy in appernace. anterior chamber is shallow wiht irregular semi dilated pupil
mx: same day referral. topical PILOCARPINE
pilocarpine is an aqeuous inhibitor and beta blocker- lower hte IOP. laser iridotomy / trabeculectomy
cataract extraction
blepharitis
Very common nonspecific generalized inflammation of the eyelids.
mx: Treat with daily lid hygiene, low dose
tetracyclines/doxycycline, lubrication as required with routine referral.
ectropion
lid turns outwards with exposure of the conjunctival sac. Eye may be sore and watery.
Routine referral and may require surgery
Entropion
Lids turning inwards and eyelashes may abrade cornea - check condition of cornea with fluorescein.
If corneal staining, tape the back eyelid away from the cornea and refer same day
trichiasis
ingrowing eyelashes - epilate when touching cornea,
lubricate with routine referral
Pterygium
A raised white/yellowish fleshy lesion at the limbus that may become
painful and red if inflamed.
Treatment: lubrication and sunglasses.
Routine ophthalmological referral for further management
corneal erosion
symptoms- trauma/foreign object in the eye, sore, watering
signs: red eye, watery
the corneal epithelium is not intact - does not stain with fluorescein
mx: check no foreign body, topical abx, can pad eye although this does not help to heal
see if pain or vision worsens,
herpes simplex keratitis
symptoms- sore red eye, not sticky
signs: abnormal corneal epithelium in dendrite pattern which stains with fluroescein
mx: !!!! avoid topical steroids. topical aciclovir.
opthalmology r/v following day
bacterial corneal infection
symptoms- red eye, sore, contact lens
signs: white area on cornea (peripheral / central)
mx: urgent referral to opthalmolgoist.
marginal keratitis
Symptoms: sore red eye, may be sticky, may or may not have blurry vision
Signs: white areas on the periphery of cornea which may be thinner than normal usually associated with blepharitis
Management: refer to ophthalmologist same day
hyphema
red eye, severe loss, trauma
non accidental injury in children
signs- eye has visible blood inside and cornea may also bestained. sore if raised IOP
mx: bed rest, eye pad . uregnt same day asssessment by opthalmologist
dry eyes
common chronic ocular condition which is often caused by, or coexists, with other ocular diseases
symptoms- gritty, sore, worse in the evening.
ix: poor tear film. fluorescein staining
mx; lubricants. preservative-free drops 4 per day. ointment on eyeball before sleep
refer if no improvement
