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MC > Red and tender eye > Flashcards

Red and tender eye Flashcards

1
Q

Acute conjunctivitis accounts for over ______ of all eye complaints seen in general practice

A

25%

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2
Q

A clear or mucous discharge indicates ______

A

viral or allergic conjunctivitis

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3
Q

______(inflammation of the cornea) is
one of the most common causes of an
uncomfortable red eye.

A

Keratitis

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4
Q

__________ often
presents painlessly as the neurotrophic effect
grossly diminishes sensation

A

Herpes simplex keratitis (dendritic ulcer)

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5
Q

DDx of red eye

A
  • trauma
  • foreign body, including IOFB
  • corneal ulcer
  • iritis (uveitis)
  • viral conjunctivitis (commonest type)
  • acute glaucoma
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6
Q

_______ generally has a gradual onset of redness, while a small foreign body will produce a very rapid hyperaemia

A

Conjunctivitis or uveitis

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7
Q

Photophobia occurs usually with _____ and _____

A

uveitis

and keratitis.

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8
Q

The wearing of contact lenses is very important as these are prone to cause infection or the _________ which resembles an acute ultraviolet (UV) burn.

A

‘overwear syndrome’,

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9
Q

Red eye red flags (urgent ophthalmic

referral)

A
  • Severe ocular pain
  • Severe orbital pain
  • Reduction of vision
  • Loss of vision
  • Diplopia
  • Dilated pupil
  • Abnormal corneal signs
  • Globe displacement
  • Endophthalmitis
  • Microbial keratitis ± contact lens use
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10
Q

The four essentials of the eye examination are:

A
  • testing and recording vision
  • meticulous inspection under magnification
  • testing the pupils
  • testing ocular tension
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11
Q

This is conjunctivitis in an infant less than 1 month old and is a notifiable disease

A

Neonatal conjunctivitis

ophthalmia neonatorum

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12
Q

Etilogy for neonatal conjunctivitis

A

Chlamydia trachomatis accounts for 50% or

more of cases

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13
Q

Dx of

A

The diagnosis is

confirmed by PCR tests on the conjunctival secretions

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14
Q

Tx of neonatal conjunctivitis

A

Treatment is with oral erythromycin for 21 days and local sulfacetamide eye drops.

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15
Q

___________, which
usually occurs within 1–2 days of delivery, requires vigorous treatment with intravenous cephalosporins or penicillin and local sulfacetamide drops

A

Neisseria gonorrhoeae conjunctivitis

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16
Q

______ is a chlamydial conjunctivitis that is

prevalent in outback areas and in the Indigenous population.

A

Trachoma

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17
Q

Recurrent and untreated Trachoma leads to

\

A

id scarring and inturned lashes (entropion) with

corneal ulceration and visual loss

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18
Q

Delayed development of the nasolacrimal duct occurs in about_______ of infants

A

6%

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19
Q

DDx for red eye in the elderly

A

In an elderly patient there is an increased possibility of acute glaucoma, uveitis and herpes zoster

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20
Q

________ should be considered in any patient over the age of 50 presenting with an acutely painful red eye.

A

Acute angle closure glaucoma

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21
Q

_____is defined as an episode of

conjunctival inflammation lasting less than 3 weeks.

A

Acute conjunctivitis

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22
Q

Acute conjunctivitis

Diffuse hyperaemia of____ and ______

A

tarsal or bulbar

conjunctivae

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23
Q

Typical features of bacterial conjunctivitis

A

Purulent discharge with sticking together of eyelashes in the morning is typical.

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24
Q

Organisms causing bact conj

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • N. gonorrhoeae (a hyperacute onset)
  • Pseudomonas aeruginosa
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25
Q

Tx of mild bacterial conjunctivitis

A

Mild cases may resolve with saline irrigation of the eyelids and conjunctiva but may last up to 14 days if untreated

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26
Q

Tx of moderate to severe conj

A

Chloramphenicol 0.5% eye drops, 1–2 hourly for 2 days, 1 decrease to 4 times a day for another 7 days

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27
Q

How to Tx Bacterial conj from diff organisms

Pseudomonas and other coliforms:

A

use topical gentamicin and tobramycin

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28
Q

How to Tx Bacterial conj from diff organisms

N. gonorrhoeae: _________

A

use appropriate systemic

antibiotics

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29
Q

Shows a brick red follicular

conjunctivitis with a stringy mucus discharge. What etiology of bacterial conjunctivitis?

A

Chlamydia trachomatis —may be sexually

transmitted

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30
Q

The most common cause of viral conjunctivitis is ________

A

adenovirus

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31
Q

This viral infection produces a follicular conjunctivitis.

A

Primary herpes simplex infection

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32
Q

How to dx Primary herpes simplex infection

A

Dendritic ulceration highlighted by fluorescein staining is diagnostic

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33
Q

Antiinfective for Primary herpes simplex infection

A

Aciclovir 3% ointment, 5 times a day for 14 days or for at least 3 days after healing

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34
Q

What is Atropine for in Mx of primary herpes simplex

A

prevent reflex spasm of the

pupil

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35
Q

Types of allergic conjunctivitis

A

• vernal (hay fever) conjunctivitis, and
• contact hypersensitivity reactions, e.g. reaction
to preservatives in drops

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36
Q

This is usually seasonal and related to pollen

exposure. There is usually associated rhinitis

A

Vernal (hay fever) conjunctivitis

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37
Q

Tx of Vernal (hay fever) conjunctivitis

A

1 Topical antihistamines/vasoconstrictors
2 Mast cell stabilisers, e.g. sodium cromoglycate
2% drops, 1–2 drops per eye 4 times daily or
ketotifen
3 Combination of 1 and 2
4 Topical steroids (severe cases

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38
Q

Tx of Contact hypersensitivity

A

Treat with naphazoline or phenylephrine.
• If not responding, refer for possible
corticosteroid therapy.

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39
Q

__________appears spontaneously, is a beefy red localised haemorrhage
with a definite posterior margin

A

Subconjunctival haemorrhage

40
Q

Cause of Subconjunctival haemorrhage

A

It is usually caused by a sudden

increase in intrathoracic pressure such as coughing and sneezing.

41
Q

Cause of Subconjunctival haemorrhage

T or F

It is not related to hypertension

A

T

42
Q

What is the Tx of Subconjunctival haemorrhage?

A

No local therapy is necessary

43
Q

The_________ is a vascular layer that lies just beneath the conjunctiva and adjacent to the sclera.

A

episclera

44
Q

Which is self-limiting, episcleritis or scleritis?

A

scleritis

45
Q

There are no significant associations with ______, which is usually idiopathic, but __________ may be associated
with connective tissue disease,

A

episcleritis

scleritis

46
Q

CTDs associated with scleritis?

A

rheumatoid arthritis and herpes zoster and rarely sarcoidosis and tuberculosis.

47
Q

Clinical features of episcleritis?

A 
no discharge
• no watering
• vision normal (usually)
• often sectorial
• usually self-limiting
48
Q

Tx of episcleritis?

A

Treat with topical or oral steroids

49
Q

Clinical features of scleritis?

A

Scleritis:
• painful loss of vision
• urgent referral

50
Q

The iris, ciliary body and the choroid form the ______ which is the vascular coat of the eyeball

A

uveal tract,

51
Q

________(acute iritis or iridocyclitis) is

inflammation of the iris and ciliary body and this is usually referred to as acute iritis

A

Anterior uveitis

52
Q

Causes of uveitis

A

Causes include autoimmune-related diseases such as the seronegative arthropathies (e.g. ankylosing spondylitis), SLE, IBD, sarcoidosis and some infections (e.g. toxoplasmosis and syphilis).

53
Q

MX of uveitis

A

Treatment includes pupil dilatation with
atropine drops and topical steroids to suppress inflammation. Systemic corticosteroids may be
necessary.

54
Q

Prognosis of anterior uveitis

A

The prognosis of anterior uveitis is good
if treatment and follow-up are maintained, but
recurrence is likely

55
Q

________(choroiditis) may involve the

retina and vitreous

A

Posterior uveitis

56
Q

______ should always be considered in a

patient over 50 years presenting with an acutely painful red eye

A

Acute glaucoma

57
Q

When does the attack of acute glaucoma happen?

A

The attack characteristically strikes in the evening when the pupil becomes
semidilated

58
Q

How to Tx acute glaucoma

A

treatment can be initiated with

acetazolamide (Diamox) 500 mg IV and pilocarpine 4% drops to constrict the pupil or pressure-lowering drops.

59
Q

_________ an acute abscess of a lash follicle or associated glands of the anterior lid margin, caused usually by S. aureus

A

Stye (external hordeolum

60
Q

Ddx for stye

A

A stye may be confused with a

chalazion, orbital cellulitis or dacryocystitis

61
Q

Tx of stye

A
  • Perform lash epilation to allow drainage of pus (incise with a size 11 blade if epilation does not work).
  • Use chloramphenicol ointment if the infection is spreading locally.
62
Q

Also known as internal hordeolum, this granuloma of the meibomian gland in the eyelid may become inflamed and present as a tender irritating lump in the lid.

A

Chalazion (meibomian cyst)

63
Q

DDx for Chalazion (meibomian cyst)

A

sebaceous gland carcinoma and

basal cell carcinoma.

64
Q

_______ is usually a staphylococcal microabscess of the gland and oral antistaphylococcal antibiotics (not topical) are recommended

A

Meibomianitis

65
Q

This common chronic condition is characterised by inflammation of the lid margins and is commonly associated with secondary ocular effects such as
styes, chalazia and conjunctival or corneal ulceration

A

Blepharitis

66
Q

Main types of blepharitis

A
  • seborrhoeic blepharitis
  • staphylococcal blepharitis
  • blepharitis associated with rosacea
67
Q

Mainstay of Tx in blepharitis

A

Eyelid hygiene is the mainstay of therapy

68
Q

For chronic blepharitis short-term use of a

_______

A 
corticosteroid ointment (e.g. hydrocortisone
0.5%) can be very effective
69
Q

________is infection of the lacrimal
sac secondary to obstruction of the nasolacrimal
duct at the junction of the lacrimal sac

A

Acute dacryocystitis

70
Q

Acute dacryocystitis

Inflammation is localised over the
_____

A

medial canthus.

71
Q

_______ is infection of the lacrimal gland

presenting as a tender swelling on the outer upper margin of the eyelid

A

Dacroadenitis

72
Q

Viral infection asstd withDacroadenitis

A

mumps

73
Q

Orbital cellulitis includes two basic types—

A

peri-orbital (or preseptal) and orbital (or postseptal) cellulitis

74
Q

cellulitis which is potentially blinding and life-threatening condition

A

orbital (or postseptal) cellulitis

75
Q

orbital or preorbital

restricted and painful eye movements

A

orbital cellulitis

76
Q

When to refer Herpes zoster ophthalmicus

A

Ocular problems
include conjunctivitis, uveitis, keratitis and
glaucoma

77
Q

Tx of HZO

A

oral anti-herpes virus agents

such as oral aciclovir 800 mg, 5 times daily for 10 days

78
Q

If sight at risk in HZO, what is the Tx

A

aciclovir 10 mg/kg IV slowly 8 hourly for 10 days

79
Q

Ideal time to give Acyclovir

A

provided this is

commenced within 3 days of the rash appearing

80
Q

________ is a yellowish elevated nodular growth on either side of the cornea in the area of the palpebral fissure

A

Pinguecula

81
Q

_______is a fleshy overgrowth of the
conjunctiva onto the nasal side of the cornea and usually occurs in adults living in dry, dusty, windy
areas

A

Pterygium

82
Q

Dx of corneal DO

A

Diagnosis is best performed with a slit lamp using a cobalt blue filter and flourescein staining

83
Q

________ presents as scattered small lesions on the cornea which stain with fluorescein if they are deep enough

A

Punctate keratopathy

84
Q

Think corneal abrasion if the eye is ______

A

‘watering’ and painful (e.g. caused by a large insect like a grasshopper or other foreign body)

85
Q

This is responsible for at least 1.5 million new cases of blindness every year in the developing world and for
significant morbidity in developed countries

A

Microbial keratitis

86
Q

Microbial keratitis

______is the most common
causative organism in contact lens wearers

A

Pseudomonas aeruginosa

87
Q

Microbial keratitis

_______ is associated with bathing or
washing in contaminated water

A

Acanthamoeba

88
Q

Problems with contact lenses

Infection is more likely to occur with ____

A

soft rather than hard lenses

89
Q

Problems with contact lenses

They should not be worn for sleeping
since this increases the risk of infection ________

A

10-fold.

90
Q

Hard lens trauma

This may cause corneal abrasions with irreversible endothelial changes or ptosis, especially with the
_________

A

older polymethyl-methacrylate-based lenses

91
Q

A common problem, usually presenting at night, is bilateral painful eyes caused by UV ________to both corneas some 5–10 hours previously

A

‘flash burns’

92
Q

What to do with penetrating eye injuries

A
  • X-ray
  • tetanus prophylaxis
  • transport by land
  • injection of anti-emetic
93
Q

This is an intra-ocular bacterial infection which

may complicate any penetrating injury including intra-ocular surgery

A

Endophthalmitis

94
Q

Endophthalmitis assoctated with pus in the anterior chamber

A

Pus may be seen in the anterior chamber

(hypopyon

95
Q

Never use corticosteroids in the presence of a_______

A

dendritic ulcer

96
Q

Beware of the contact lens _________, which is treated in a similar way to flash burns

A

‘overwear syndrome’

MC (90 decks)

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