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YEAR 4 OPTHAM > Red eye > Flashcards

Red eye Flashcards

1
Q

What are the features of scleritis?

A

Red eye

Pain ( unlike episcleritis) deep boring pain (wake up at night)

Photophobia

watery eye

gradual decrease in vision

unilateral or bilateral

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2
Q

Who gets scleritis ?

A

Common in middle aged women

Immune - Rheumatoid arthritis

Connective tissue diseases e.g. granulomatosis with polyangigit, SLE, relapsing polychondritis

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3
Q

Is scleritis serious?

A

Yes !
vision- threatening

emergency

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4
Q

Management of scleritis?

A

Urgent opthalmology referral for systemic corticosteroids

Treat:
underlying condition
NSAIDS
corticosteroids
immunosuppression

(certain forms can lead to globe perforation and reduced visual acuity - if suspect shield eye and avoid palpation)

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5
Q

Investigations for scleritis?

A

assumed underlying cause until proven otherwise

e.g.
FBC + imflamm markers

RA / syphillis screen

urine dip - blood / protein

B-scan ultrasonography of globe

Xray - chest/ sacroiliac joint

MRI / CT sinuses and orbit

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6
Q

What investigations for a patient with scleritis with no previously diagnosed systemic disease?

A

rule out systemic vasculitis

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7
Q

complications of scleritis?

A

Scleral thinning
retinal detachment
increased ocular pressure
uveitis
cataract
ischaemia of anterior segment of the globe

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8
Q

What is cilliary flush? Where is it seen?

A

injection of deep conjunctival vessels and episcleral vessels surrounding cornea.

seen in:
Iritis (inflammation of anterior chamber aka anterior uveitis)
Acute glaucoma

Don’t get in simple conjunctivitis

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9
Q

What is conjunctival hyperemia?

A

engorgement of superior vessels

  • non specific sign
  • inflammatory sign
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10
Q

What are common causes of Bacterial conjunctivitis?

A

Staph aureus

Staph epidermis

Strep pneumoniae

Haemophilus influenzae

Direct contact with infected secretions (be careful!)

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11
Q

What are the symptoms of Bacterial Conjunctivitis?

A

subacute onset

Redness

Grittiness

Burning

mucopurulent discharge

often bilateral

relative NEGATIVE finding: NO photophobia

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12
Q

What signs do you get in bacterial conjunctivitis?

A

Crusty lids

conjunctival hyperaemia

mid papillary reaction

oedematous lids and conjunctiva

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13
Q

What investigations for bacterial conjunctivitis?

A

If diagnosis uncertain : swab

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14
Q

What treatment for bacterial conjunctivitis?

A

Topical antibiotics usually effective in 2-7 days

Chloramphenicol or fusidic acid = 1st line

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15
Q

What is chlamydial conjunctivitis ?

A

Chlamydia trachomatis serotypes D to K

see in sexually active adults / adolescents
+/- genital infection

Chronic with a mild keratitis

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16
Q

What are the symptoms / signs of chlamydial conjunctivitis?

A

Foreign body sensation / itchy/ irritated

Stuck together in morning

purulent discharge (bacterial)

follicles

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17
Q

What investigations would you do for chlamydial conjunctivitis?

A

Swab / smear

Direct monoclonal fluorescent antibody microscopy

PCR

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18
Q

What is the management for chlamydial conjunctivitis?

A

Treat:
topical tetracycline / oral doxycycline / azithromycin

Contact tracing

GUM referral

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19
Q

What is the aetiology of viral conjunctivitis?

A

Often: adenovirus type 3,4,7

  • (PCF) pharyncgoconjunctival fever
  • Adenovirus types 8 +9 - epidemic keratoconjunctivitis
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20
Q

What are the symptoms of viral conjunctivitis?

A

Acute onset

bilateral

watery discharge

Foreign body sensation

History of URTI

Relevant negatives: NO photophobi a

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21
Q

The hyperaemic conjunctiva in viral conjunctivitis can be associated with … ?

i.e. what other signs do you get in viral conjunctivitis

A

Follices

Haemorrhages

inflammatory membranes

Lymphadenopathy ( esp preauricular)

Keratitis on 80% with EKC and 30% with PCF

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22
Q

What is treatment of viral conjunctivitis?

A

self resolving up to 2 weeks

Advice to isolate (v contagious like bacterial)

Topical steroids if keratitis to stop risk of scarring

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23
Q

What are the RF associated with allergic conjunctivitis?

A

3/4 have atopy

2/3 FHX of atopy

24
Q

What are the symptoms + signs of allergic conjunctivitis?

A

itchy ++
bilateral
Watery discharge

Chemosis (oedema)

Papillae (‘cobblestone’ in chronic cases)

25
Q

What investigations for allergic conjunctivitis?

A

Exclude infection (viral NOT itchy)

allergy skin patch testing

tear IgE levels

26
Q

What is the treatment for allergic conjunctivitis?

A

cold compress

remove trigger allergen

NSAIDs

oral antihistamines or topical (olapatanol)

Mast cell stabilisers (sodium cromoglycate)

topical corticosteroids

immunosuppressants (cyclosporin) for steroid resistant cases

27
Q

Investigations for viral conjunctivitis?

A

Rapid adenovirus assay

PCR

28
Q

Prostaglandin analogues side effects in opthalmology?

A

increased eyelash length, iris pigmentation and periocular pigmentation

29
Q

What are the features of a spontaneous subconjunctival haemorrhage ?

A

Painless red eye w/o discharge

Visual acuity not affected

conjunctival vessels masked

30
Q

What is the treatment for a spontaneous subconjunctival haemorrhage ?

A

No specific treatment

Lubricants

self resolves 10 -14 days

31
Q

If a pt is getting recurrent spontaneous subconjunctival haemorrhages, what investigations should you do?

A

Do:

FBC
Clotting studies

32
Q

What sinister cause could be behind a spontaeneous subconjunctival haemorrhage you must exclude?

A

Base of skull fracture

33
Q

What is episcleritis?
Common causes?

A

Episcleritis is describes the acute onset of inflammation in the episclera of one or both eyes.

The majority of cases are idiopathic

associated conditions include:
inflammatory bowel disease
rheumatoid arthritis

34
Q

What are the features of episcleritis?

A

asymptomatic common

mild tearing / irritation

tender to touch

vessels blanch with phenylephrine

35
Q

What is the treatment for episcleritis?

A

Self limiting (months)

If doesn’t resolve:
lubricants
NSAIDS (froben po 100 mg tablets)
Low dose steroid (predsol)

36
Q

What is Pterygium?

A

fibrovascular growth from the conjunctiva over the cornea

37
Q

What is treatment for Pterygium?

A

Excision of pterygium

Cover defect with a conjunctival autograft or amniotic membrane

Adjuvant mitomycin - reduce reoccurence

38
Q

What are the features of a corneal abrasion / foreign body?

A

Severe pain (esp when blink)

Watering +++

39
Q

If able what should you do when a pt presents with a FB in cornea and how?

A

Remove FB with cotton bud under topical anaesthetic

40
Q

When should you refer a pt with a corneal abrasion

A

if the abrasion crosses the visual axis

41
Q

what treatment for a corneal abrasion / FB ?

A

Chloramphenicol ointment

cyclopentolate

double pad

42
Q

When do you need to exclude intraocular FB ?

A

if the history suggests high impact activity when happened e.g. hammering / grinding without protective eye wear - exclude intraoculaur FB

43
Q

What are the common causes of bacterial keratitis?

A

Staph aureus
Strep pyogenes
Strep pneumoniae
Pseudomonas erruginosa

44
Q

What pt factors / RF for getting bacterial keratitis?

A

contact lenses- extended wear of soft ones (less likely with hard contact lenses)

Corneal disease e.g. neurotrophic keratopathy

45
Q

What are the symptoms /signs of bacterial keratitis?

A

Ocular pain
watering / discharge
FB sensation
Decreased vision
Photophobia

SIGNS:
Corneal lesion (ulcer)
Corneal oedema
hypopyon

46
Q

What is hypopyon ?

A

accumulation of leukocytes in the anterior chamber due to severe intraocular inflammation

47
Q

What investigations for bacterial keratitis ?

A

Culture :
Blood agar: most fungi and bacteria except Neisseria

Chocolate agar: Neisseria and Moraxella

Sabourand agar: fungi

48
Q

What is the treatment for bacterial keratitis?

A

Ofloxacin
initially : Hourly
Then : 2 hourly (when awake)

Cyclopentolate tds

Steroids when cultures become sterile / improving (7-10 days after starting treatment)

49
Q

What is herpes simplex keratitis?

A

Reactivation of latent herpes simplex virus type 1

Migrates down branch of trigeminal nerve to cornea

50
Q

What would be in Hx of Herpes simplex keratitis?

A

Cold sores
run down
stress

51
Q

Symptoms / signs of a pt with herpes simplex keratitis?

A

Tearing

light sensitivity

pain

hyperaemia

Corneal sensation reduced

dendritic ulcer

geographic amoeboid ulcer esp if incorrect use of steroid

52
Q

Treatment for herpes simplex keratitis

A

Topical aciclovir ointment - 5 x day for 10-14 days

Cyclopentolate

topical steroids -minimise scaring

53
Q

How does herpes zoster in the eyes present ?

A

Crusting and ulceration of skin innervated by 1st division of trigeminal nerve

Hutchinson’s sign - lesion to top of nose = increased chance of ocular invovlement

54
Q

Treatment for herpes zoster in eye?

A

Oral aciclovir w/in 48 hrs of onset of vesicles 800 mg 5x day for 7 days

will have no effect if later

Aciclovir ointment within 5/7 days of onset of vesicles

55
Q

ocular complications of herpes zoster in the eye?

A

Conjunctivitis

uveitis

keratitis

scleritis

optic neuritis

56
Q

Differentials for conjunctivitis and distinguishing features?

A
  • Dry eyes – presents with dryness, burning, a feeling of something in the eye
  • Corneal abrasion – severe pain, photophobia, watering of the eye
  • Uveitis – eye pain, blurred vision, photophobia, floaters, redness
  • Glaucoma – severe eye pain, nausea, vomiting, blurred vision, halos around lights
57
Q

Common signs and symptoms of conjunctivitis

A
  • Eye redness
  • Itching
  • Irritation
  • Excessive tearing
  • Discharge from the eyes, which can vary in consistency based on the cause
  • Photophobia, which suggests corneal involvement (keratoconjunctivitis)
  • Notably, visual acuity should not be affected by conjunctivitis.

YEAR 4 OPTHAM (17 decks)

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