Red eye 1

Question 1

What are the different types of conjunctivitis ?

Answer 1

• Viral
• Bacterial
• Allergic
• Chlamydial

Question 2

What are the main causes of bacterial conjunctivitis in neonates ?

Answer 2

• Staph.aureus
• Neisseria gonorrhoea
• Chalmydial trachomatis

Question 3

What are the main bacterial causes of conjunctivitis in all other ages ?

Answer 3

• Staph.aureus
• Strep.pneumoniae
• H.infulenza

Question 4

What are the main causes of viral conjunctivitis ?

Answer 4

• Adenovirus
• Herpes simplex
• Herpes zoster

Question 5

What are the main signs/symptoms of conjunctivitis ?

Answer 5

• VISION UNAFFECTED
• Eye is red - diffuse more towards the gutter
• Discharge
• Discomfort/sore - gritty sensation
• Photophobia - mild
• May have follicles appear on conjunctiva

Question 6

What key symptom/sign would suggest bacterial conjunctivitis ?

Answer 6

• Purluent discharge
• Eyes may be ‘stuck together’ in the morning

Question 7

What type of discharge would suggest an allergic cause of conjunctivitis & what other additional features would suggest allergic cause ?

Answer 7

• Water discharge
• puffy eye (lids)
• itch is prominent
• history of atopy (often seen in the context of hayfever)
• • May be seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens)

Question 8

What features would suggestive viral conjunctivits rather than bacterial?

Answer 8

Serous discharge
Recent URTI
Preauricular lymph nodes

Question 9

What is the treatment of bacterial conjunctivitis ?

Answer 9

• 1st line = chloramphenicol
• 2nd line (or 1st if pregnant) = fusidic acid

Question 10

What would be the typical presentation of a chlamydial conjunctivitis ?

Answer 10

• Chronic history
• Unresponsive to treatment
• Young adult - sexually active
• Can cause scarring of the eyelids which leads to interning of the eyelashes (trachoma)

Question 11

What is the treatment of allergic conjunctivitis ?

Answer 11

• Mild = artificial tears + cool compress
• Moderate = mast cell stabiliser (sodium chromoglycate) +/- an antihistamine (cetirizine or loratidine)

Question 12

What additional advice should be given to someone with bacterial conjunctivitis ?

Answer 12

• Contact lens should not be worn during an episode of conjunctivitis
• Advice should be given not to share towels
• School exclusion is not necessary

Question 13

What is the treatment of chlamydial conjunctivitis ?

Answer 13

• 1st line = oxytetracycline
• 2nd line = oxytetracylcine + azithromycin if gential chlamydial infection

Question 14

What is blepharitis ?

Answer 14

Inflammation of the eyelids and appendages including skin, lashes and meibomian glands

Question 15

How is blepharitis classified ?

Answer 15

As anterior or posterior

• Anterior = lid margin is redder than the deeper part of the lid.
• Posterior = redness is in deeper part of the lid, lid margin often normal looking (meibomian gland disease)

Question 16

How can aanterior blepharitis be further classified ?

Answer 16

Seborrhoeic or staphylococcal

Question 17

What are the symptoms of blepharitis in general ?

Answer 17

​Symptoms usually bilateral

• Eyes have burning/itchy red margins
• Scales on the lashes
• Discomfort - grittiness, particularly of eyelid
• Redness of the eyelid
• Mild discharge - may be sticky in the morning

Question 18

What would point you to a diagnosis of seborrhoeic blepharitis ?

Answer 18

• Lid margins red
• Scales on lashes
• Lashes unaffected and no ulcers

Question 19

What would point you to a diagnosis of staphylococcal blepharitis ?

Answer 19

• Lid margin red
• Lashes affected - loss, ingrowing
• Ulcers of the lid margin

Question 20

What would point you to a diagnosis of meibomian gland disease blepharitis ?

Answer 20

• Lid margin and lashes unaffected
• Meibomian cysts (lumps under eyelid)
• Associated with acne rosacea

Question 21

What is the treatment of blepharitis ?

Answer 21

• 1st line = lid hygiene - daily bathing/ warm compress
• 2nd line = oral doxycycline