Red and tender eye Flashcards
Acute conjunctivitis accounts for over ______ of all eye complaints seen in general practice
25%
A clear or mucous discharge indicates ______
viral or allergic conjunctivitis
______(inflammation of the cornea) is
one of the most common causes of an
uncomfortable red eye.
Keratitis
__________ often
presents painlessly as the neurotrophic effect
grossly diminishes sensation
Herpes simplex keratitis (dendritic ulcer)
DDx of red eye
- trauma
- foreign body, including IOFB
- corneal ulcer
- iritis (uveitis)
- viral conjunctivitis (commonest type)
- acute glaucoma
_______ generally has a gradual onset of redness, while a small foreign body will produce a very rapid hyperaemia
Conjunctivitis or uveitis
Photophobia occurs usually with _____ and _____
uveitis
and keratitis.
The wearing of contact lenses is very important as these are prone to cause infection or the _________ which resembles an acute ultraviolet (UV) burn.
‘overwear syndrome’,
Red eye red flags (urgent ophthalmic
referral)
- 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
The four essentials of the eye examination are:
- testing and recording vision
- meticulous inspection under magnification
- testing the pupils
- testing ocular tension
This is conjunctivitis in an infant less than 1 month old and is a notifiable disease
Neonatal conjunctivitis
ophthalmia neonatorum
Etilogy for neonatal conjunctivitis
Chlamydia trachomatis accounts for 50% or
more of cases
Dx of
The diagnosis is
confirmed by PCR tests on the conjunctival secretions
Tx of neonatal conjunctivitis
Treatment is with oral erythromycin for 21 days and local sulfacetamide eye drops.
___________, which
usually occurs within 1–2 days of delivery, requires vigorous treatment with intravenous cephalosporins or penicillin and local sulfacetamide drops
Neisseria gonorrhoeae conjunctivitis
______ is a chlamydial conjunctivitis that is
prevalent in outback areas and in the Indigenous population.
Trachoma
Recurrent and untreated Trachoma leads to
\
id scarring and inturned lashes (entropion) with
corneal ulceration and visual loss
Delayed development of the nasolacrimal duct occurs in about_______ of infants
6%
DDx for red eye in the elderly
In an elderly patient there is an increased possibility of acute glaucoma, uveitis and herpes zoster
________ should be considered in any patient over the age of 50 presenting with an acutely painful red eye.
Acute angle closure glaucoma
_____is defined as an episode of
conjunctival inflammation lasting less than 3 weeks.
Acute conjunctivitis
Acute conjunctivitis
Diffuse hyperaemia of____ and ______
tarsal or bulbar
conjunctivae
Typical features of bacterial conjunctivitis
Purulent discharge with sticking together of eyelashes in the morning is typical.
Organisms causing bact conj
- Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus
- Streptococcus pyogenes
- N. gonorrhoeae (a hyperacute onset)
- Pseudomonas aeruginosa
Tx of mild bacterial conjunctivitis
Mild cases may resolve with saline irrigation of the eyelids and conjunctiva but may last up to 14 days if untreated
Tx of moderate to severe conj
Chloramphenicol 0.5% eye drops, 1–2 hourly for 2 days, 1 decrease to 4 times a day for another 7 days
How to Tx Bacterial conj from diff organisms
Pseudomonas and other coliforms:
use topical gentamicin and tobramycin
How to Tx Bacterial conj from diff organisms
N. gonorrhoeae: _________
use appropriate systemic
antibiotics
Shows a brick red follicular
conjunctivitis with a stringy mucus discharge. What etiology of bacterial conjunctivitis?
Chlamydia trachomatis —may be sexually
transmitted
The most common cause of viral conjunctivitis is ________
adenovirus
This viral infection produces a follicular conjunctivitis.
Primary herpes simplex infection
How to dx Primary herpes simplex infection
Dendritic ulceration highlighted by fluorescein staining is diagnostic
Antiinfective for Primary herpes simplex infection
Aciclovir 3% ointment, 5 times a day for 14 days or for at least 3 days after healing
What is Atropine for in Mx of primary herpes simplex
prevent reflex spasm of the
pupil
Types of allergic conjunctivitis
• vernal (hay fever) conjunctivitis, and
• contact hypersensitivity reactions, e.g. reaction
to preservatives in drops
This is usually seasonal and related to pollen
exposure. There is usually associated rhinitis
Vernal (hay fever) conjunctivitis
Tx of Vernal (hay fever) conjunctivitis
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
Tx of Contact hypersensitivity
Treat with naphazoline or phenylephrine.
• If not responding, refer for possible
corticosteroid therapy.
__________appears spontaneously, is a beefy red localised haemorrhage
with a definite posterior margin
Subconjunctival haemorrhage
Cause of Subconjunctival haemorrhage
It is usually caused by a sudden
increase in intrathoracic pressure such as coughing and sneezing.
Cause of Subconjunctival haemorrhage
T or F
It is not related to hypertension
T
What is the Tx of Subconjunctival haemorrhage?
No local therapy is necessary
The_________ is a vascular layer that lies just beneath the conjunctiva and adjacent to the sclera.
episclera
Which is self-limiting, episcleritis or scleritis?
scleritis
There are no significant associations with ______, which is usually idiopathic, but __________ may be associated
with connective tissue disease,
episcleritis
scleritis
CTDs associated with scleritis?
rheumatoid arthritis and herpes zoster and rarely sarcoidosis and tuberculosis.
Clinical features of episcleritis?
no discharge • no watering • vision normal (usually) • often sectorial • usually self-limiting
Tx of episcleritis?
Treat with topical or oral steroids
Clinical features of scleritis?
Scleritis:
• painful loss of vision
• urgent referral
The iris, ciliary body and the choroid form the ______ which is the vascular coat of the eyeball
uveal tract,
________(acute iritis or iridocyclitis) is
inflammation of the iris and ciliary body and this is usually referred to as acute iritis
Anterior uveitis
Causes of uveitis
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).
MX of uveitis
Treatment includes pupil dilatation with
atropine drops and topical steroids to suppress inflammation. Systemic corticosteroids may be
necessary.
Prognosis of anterior uveitis
The prognosis of anterior uveitis is good
if treatment and follow-up are maintained, but
recurrence is likely
________(choroiditis) may involve the
retina and vitreous
Posterior uveitis
______ should always be considered in a
patient over 50 years presenting with an acutely painful red eye
Acute glaucoma
When does the attack of acute glaucoma happen?
The attack characteristically strikes in the evening when the pupil becomes
semidilated
How to Tx acute glaucoma
treatment can be initiated with
acetazolamide (Diamox) 500 mg IV and pilocarpine 4% drops to constrict the pupil or pressure-lowering drops.
_________ an acute abscess of a lash follicle or associated glands of the anterior lid margin, caused usually by S. aureus
Stye (external hordeolum
Ddx for stye
A stye may be confused with a
chalazion, orbital cellulitis or dacryocystitis
Tx of stye
- 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.
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.
Chalazion (meibomian cyst)
DDx for Chalazion (meibomian cyst)
sebaceous gland carcinoma and
basal cell carcinoma.
_______ is usually a staphylococcal microabscess of the gland and oral antistaphylococcal antibiotics (not topical) are recommended
Meibomianitis
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
Blepharitis
Main types of blepharitis
- seborrhoeic blepharitis
- staphylococcal blepharitis
- blepharitis associated with rosacea
Mainstay of Tx in blepharitis
Eyelid hygiene is the mainstay of therapy
For chronic blepharitis short-term use of a
_______
corticosteroid ointment (e.g. hydrocortisone 0.5%) can be very effective
________is infection of the lacrimal
sac secondary to obstruction of the nasolacrimal
duct at the junction of the lacrimal sac
Acute dacryocystitis
Acute dacryocystitis
Inflammation is localised over the
_____
medial canthus.
_______ is infection of the lacrimal gland
presenting as a tender swelling on the outer upper margin of the eyelid
Dacroadenitis
Viral infection asstd withDacroadenitis
mumps
Orbital cellulitis includes two basic types—
peri-orbital (or preseptal) and orbital (or postseptal) cellulitis
cellulitis which is potentially blinding and life-threatening condition
orbital (or postseptal) cellulitis
orbital or preorbital
restricted and painful eye movements
orbital cellulitis
When to refer Herpes zoster ophthalmicus
Ocular problems
include conjunctivitis, uveitis, keratitis and
glaucoma
Tx of HZO
oral anti-herpes virus agents
such as oral aciclovir 800 mg, 5 times daily for 10 days
If sight at risk in HZO, what is the Tx
aciclovir 10 mg/kg IV slowly 8 hourly for 10 days
Ideal time to give Acyclovir
provided this is
commenced within 3 days of the rash appearing
________ is a yellowish elevated nodular growth on either side of the cornea in the area of the palpebral fissure
Pinguecula
_______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
Pterygium
Dx of corneal DO
Diagnosis is best performed with a slit lamp using a cobalt blue filter and flourescein staining
________ presents as scattered small lesions on the cornea which stain with fluorescein if they are deep enough
Punctate keratopathy
Think corneal abrasion if the eye is ______
‘watering’ and painful (e.g. caused by a large insect like a grasshopper or other foreign body)
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
Microbial keratitis
Microbial keratitis
______is the most common
causative organism in contact lens wearers
Pseudomonas aeruginosa
Microbial keratitis
_______ is associated with bathing or
washing in contaminated water
Acanthamoeba
Problems with contact lenses
Infection is more likely to occur with ____
soft rather than hard lenses
Problems with contact lenses
They should not be worn for sleeping
since this increases the risk of infection ________
10-fold.
Hard lens trauma
This may cause corneal abrasions with irreversible endothelial changes or ptosis, especially with the
_________
older polymethyl-methacrylate-based lenses
A common problem, usually presenting at night, is bilateral painful eyes caused by UV ________to both corneas some 5–10 hours previously
‘flash burns’
What to do with penetrating eye injuries
- X-ray
- tetanus prophylaxis
- transport by land
- injection of anti-emetic
This is an intra-ocular bacterial infection which
may complicate any penetrating injury including intra-ocular surgery
Endophthalmitis
Endophthalmitis assoctated with pus in the anterior chamber
Pus may be seen in the anterior chamber
(hypopyon
Never use corticosteroids in the presence of a_______
dendritic ulcer
Beware of the contact lens _________, which is treated in a similar way to flash burns
‘overwear syndrome’
