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3C week 2 - ophthalmology > red eye > Flashcards

red eye Flashcards

1
Q

where is aqueous humour drained

A
  1. 85% through the conventional pathway (trebecular meshwork, IOP dependent)
  2. 15% through uveoscleral pathway (IOP independemt)
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2
Q

2 most important things hen taking a Hx of red eye

A
  1. onset (duration, location, laterality);
  2. associated symptoms (pain, itching, discharge, visual change)
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3
Q

what are the 4 “coats” that comprise the external eye

A
  1. eyelids
  2. conjunctiva
  3. episclera
  4. sclera
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4
Q

what is the most common eyelid cause of red eye

A

herpes simplex virus - can manifest w conjunctivitus

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5
Q

treatment for herpes simplex eyelid infection

A

topical acyclovir - quickly resolves

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6
Q

what is an internal hordeolum and how is it treated

A

an internal style, treat with hot compress

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7
Q

how does blepharitis present

A

gritty eye; increased watering of eye; red eye; discharge along root of the lashes (if anterior blepharitis)

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8
Q

blepharitis treatment (3)

A
  1. hygeine (johnsons baby shampoo to clean around lacrimal glands)
  2. oral doxycyline is severe inflammation
  3. steroid/abx drops
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9
Q

what can blepharitis develop into

A

marginal keratitis

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10
Q

what is marginal keratitis

A

inflammatory reaction to the staph growing in the eye lid - a cross reaction

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11
Q

what is a cross reaction

A

reactivity of an observed agent which initiates reactions outside the main reaction expected e.g. allergies

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12
Q

what happens to the eye in marginal keratitis

A

ulceration of the lateral cornea

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13
Q

marginal keratitis treatment (2)

A
  1. topical steroid
  2. topical Abx
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14
Q

what is entropion

A

rolling inward of the eyelid against the eyeball which can cause infection

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15
Q

what is herpes zoster ophthalmicus

A

unilateral painful skin rash in one or more dermatome distributions of CN V (trigeminal nerve), shared by the eye and ocular adnexa

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16
Q

what is hutchingson’s sign

A

an early indicator of ophthalmic (eye) shingles -> It refers to painful vesicles or bumps at or near the tip of your nose

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17
Q

what eye condition is common as a result of herpes zoster ophthalmicus (esp if hutchingson’s sign)

A

uveitis

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18
Q

herpes zoster ophthalmicus treatment

A
  1. oral acyclocir (5x a day for a week);
  2. topical steroids (for inflammation)
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19
Q

what is molluscum contagiosum (eye)

A

umbilicated lesions along the lid margin, common in children

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20
Q

treatment of molluscum contagiosum (eye)

A

quick curettage of the lesions to stop them spreading

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21
Q

what are the 2 types of conjunctivitis and which is a cause for concern

A
  1. conjunctival congestion (widespread, all around the cornea);
  2. perilimbal congestion (circumconeal congestion - red blood cells pointing towards the cornea)
    this is a cause for concern -> corneal infection, gluacoma etc.w
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22
Q

what can cause conjunctivitis (4)

A
  1. bacteria (simple, gonococcal);
  2. viral (adenoviral, molluscum, herpes);
  3. chlamydial;
  4. allergic/vernal
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23
Q

simple bacterial conjunctivitis presentation (5)

A
  1. crusted eyelids
  2. conjunctival injection
  3. red eye
  4. discharge (mucopurulent)
  5. eyelashes stuck together in the morning
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24
Q

how can conjunctivitis be treated

A

topical abx + good hygeine (e.g. not sharing towels)

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25
Q

when should gonococcal conjunctivitis be a cause for concern

A

if neonatals get it- can be life threatening

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26
Q

gonococcal conjunctivitis treatment

A

systemic cephalosporins and topical Abx drops

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27
Q

what is follicular conjunctivitis

A

collection of lymphoid tissue usually due to a viral or chlamydial conjunctivitis

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28
Q

2 types of adenoviral keratoconjunctivitis, who they usually affect and what other symptoms

A
  1. pharyngoconjunctival fever - adenovirus types 3/7; affects children; upper resp tract infection associated;
  2. epidemic keratoconjunctivitis - types 8/19; very contagious; no systemic symptoms; keratitis in 80% of cases
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29
Q

what is keratitis

A

inflammation of the cornea and is characterized by corneal edema, infiltration of inflammatory cells, and ciliary congestion

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30
Q

what is trachoma

A

a disease of the eye caused by infection with the bacterium Chlamydia trachomatis (serotypes A, B, Ba, C)

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31
Q

what is a major vector for trachoma

A

flies

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32
Q

treatment for trachoma

A

systemic azithromycin

33
Q

7 complications of trachoma

A
  1. acute follicular conjunctivitis;
  2. conjunctival scarring;
  3. herbert pit;
  4. pannus formation;
  5. trichiasis;
  6. cicatricial entropion;
  7. loss of vision
34
Q

what is a pannus

A

growth of blood vessels into the peripheral cornea

35
Q

what is a herbert pit

A

When infectious follicles heal, they are replaced by rounded, depressed, or flat scars aka herbert pitss

36
Q

what causes adult chlamydial keratoconjunctivitis and what is it accompanied with

A

infection with chlamydia trachomatis serotypes D-K; usually alongside genital infection

37
Q

treatment for adult chlamydial keratoconjunctivitis

A

topical tetracycline + oral tetracyclinr/macrolide + prompt sexual health referral

38
Q

what is allergic rhinoconjunctivitis andw hat is it associated with

A

hypersensitivity reaction to specific air born antigens; may be seasonal/perennial; assoicated with nasal symptoms

39
Q

what is vernal/atopic keratoconjunctivitis

A

a recurrent, bilateral allergic inflammation of the conjunctiva; frequently associated w atopy

40
Q

treatment for vernal/atopic keratoconjunctivitis (4)

A

prompt treatment with:
1. antihistamines (topical/opetimol);
2. cold compress;
3. lubricant to help wash out inflammation;
4. steroids if severe

41
Q

vernal/atopic keratoconjunctivitis presentation (2)

A
  1. upper tarsal giant papillae - lots of small papillae join together;
  2. thickening and opacification of the limbal conjunctiva as well as gelatinous appearing and sometime confluent limbal papillae;
42
Q

what is pterygium

A

a raised, wedge/wing-shaped growth of the conjunctiva that extends onto the cornea, normally on the nasal side

43
Q

pterygium/pingueculum treatment

A

surgical removal

44
Q

what is hyphema

A

blood pooling behind the cornea and iris

44
Q

pingueculum vs pterygium

A

Pinguecula may contain deposits of protein, fat, or calcium;
Pterygium is a growth of fleshy tissue (has blood vessels) that may start as a pinguecula

44
Q

2 causes for sub conjunctival haemorrhage

A
  1. spontaneous - poss due to increased BP (so check BP)
  2. trauma
45
Q

what is episcleritis

A

swelling and reddening of the outer sclera

46
Q

episcleritis presentation

A

gritty, uncomfortable eye

47
Q

epidcleritis treatemnt

A

may self resolve, otherwise give topical steroids to treat; investigations may be warranted if recurring

48
Q

what is sceleritis

A

inflammation of the sclera - deeper vessels

49
Q

causes of scleritis

A

usually and underlying systemic cause e.g. syphillis, RA, SLE -> investigate if not resolving

50
Q

scleritis presentation

A

severe pain in the eye and eye is tender to touch

51
Q

scleritis progression (3)

A
  1. avascular patches
  2. scleral necrosis and visibilty of uvea
  3. spread and coalescence of necrosis
52
Q

scleritis treatment (3)

A
  1. oral steroids
  2. immunosuppressive agents e.g. cyclosporin, azathioprine etc.
  3. combined IV steroids and cyclophosphamide (if unresponsive)
53
Q

what is photophobia

A

discomfort in bright light - light goes through the axis and causes a glare

54
Q

what condition is photophobia most commonly seen in

A

uveitis

55
Q

when should fluoroscein be used

A

as a tracer in cornea/kerat- abrasions/abnormalities

56
Q

what is a corneal abrasion

A

scratched cornea

57
Q

corneal abrasion treatment

A

promt treatment needed -> topical abx, should resolve without complications

58
Q

what is photokeratitis (arc eye/snow blindness)

A

painful condition arising from the exposure of the eye to UV light -> extreme photophobia is present and it is often self resolving

59
Q

4 types/causes of keratitis

A
  1. bacterial
  2. viral
  3. acanthamoeba
  4. fungal
60
Q

what is a risk factor for keratitis

A

contact lens wearing (esp w poor hygeine)

61
Q

bacterial keratitis presentation

A

severe, painful, photophobic eye

62
Q

bacterial keratitis investigations

A

scrapings to find pathogen

63
Q

pathology of bacterial keratitis (advanced)

A

inflammatory cells within the eye come together to forma hypopyon (accumulation of white blood cells that form a whitish layer of fluid in the lower portion of the eye’s anterior chamber)

64
Q

viral keratitis presentation

A

multiple white disc shaped lesions; can last for months-years

65
Q

viral keratitis treatment (2)

A
  1. topical steroids - UNLESS HSV causing (but usually recurs one stopped)
  2. topical lubricants
66
Q

herpes simplex keratitis presentation

A

dendritic ulcer (branching pattern on the corneal epithelium); eye pain; swollen epithelial boarders;

67
Q

herpes simplex keratitis managment

A

occasionally self limiting -> otherwise acylovir
avoid steroids

68
Q

3 behaviours contact lens wearers do which may result in acanthamoebe karatitis

A
  1. poor hygeine with extended wear lenses;
  2. washing lens in tap water;
  3. wearing lenses for swimming
69
Q

acanthamoebe karatitis presentation

A

very painful eye; grey-dirty epithelium; multifocal stromal infiltrates; ring infiltrates; scleritis + iris atrophy (late stage)

70
Q

acanthamoebe karatitis treatment

A

topical cationic antiseptic - very resistant to treatment though

71
Q

what workforce is fungal keratitis common in

A

farmers (aspergillous)

72
Q

fungal keratitis presentation

A

elevated edges, branching ulcers, feathery margins, rough texture, and satellite lesion

73
Q

fungal keratitis Mgx

A

Topical antifungals; Subconjunctival injections of antifungal agents e.g. miconazole if not compliant; systemic antifungal if resistant;
slow to heal and needs long term management

74
Q

what is irisitis/anterior uveitis and how does it present

A

swelling/inflammation of the iris; presents with eye pain, blurry vision and possibly abnormally shaped pupils

75
Q

iristitis managment

A
  1. topical steroids;
  2. cycloplegic drops (temporarily paralyzes the ciliary body)

does not tolerate eye drops

76
Q

what is endophthalmitis

A

inflammatory condition of the intraocular cavities (ie, the aqueous and/or vitreous humor)

77
Q

what is pupillary block and what can it lead to

A

the flow of aqueous humor from the posterior chamber to the anterior chamber is obstructed by a functional block between the pupillary portion of the iris and the lens -> increased pressure from the posterior chamber causes iris bombe (pressure in the posterior chamber rises, resulting in anterior bowing of the peripheral iris and obstruction of the trabecular meshwork) -> IOP is raised -> leads to acute angle-closure glaucoma

3C week 2 - ophthalmology (6 decks)

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