RED EYE Flashcards
Pain, moderate to severe (usually acute onset, rapid progression)
Redness, photophobia (may be severe), discharge, blurred vision (especially if lesion on visual axis)
Awareness of white or yellow spot on cornea
Usually unilateral
Microbial keratitis (bacterial)
Pain, burning, irritation, photophobia, blurred vision, redness
atopic px
Herpes simplex keratitis
Eye moderately red and slightly watery
Mild foreign body sensation
Mild photophobia
(NB: symptoms vary in severity; some cases are asymptomatic)
CLs wearer
contact lens-associated infiltrative keratitis
signs of chlamydial conj
oedema/ptosis
lymph node swelling
conj- hyperaemic/chemiosis
infiltrates on cornea
History usually more than two weeks
Ocular gritty sensation and sticky discharge
Drooping upper lid(s) (often unilateral
pain/irritation/swelling
chlamydial conjunctivitis
management for marginal keratitis
lid hygeine
sun glasses for photophobia
usually resolves by itself, but it may be dealt with more quickly if steroid and antibiotic drops are prescribed.
1 wk urgent referral to opthalmologist- they will take microbial cultures and investigates px immune system
management of CL- infiltrative keratitis
Temporarily discontinue lens wear
Most signs and symptoms resolve within 48 hours
infiltrates resolve over 2-3 weeks
Advise against extended wear
Warn about possibility of recurrence. If condition recurs, switch to disposable CLs
Lid hygiene if blepharitis present
Ocular lubricants for symptomatic relief
Topical antibiotic (chloramphenicol, azithromycin [off-licence use]) / oral antibiotic (tetracycline group) may be indicated for blepharitis (see Clinical Management Guideline on Blepharitis (lid margin disease))
management of viral conj
ensure serious hygiene - wash hands/equipment
normally self-limiting, resolving within one to two weeks
condition is highly contagious for family, friends and work colleagues (do not share towels, etc)
you remain infectious for after 2wks - stay away from other if in close px contact
cold compress
discontinue cl wear
antihistamines for itching
if corneal involvement the refer emergently to ophthalmologist
RF for Microbial keratitis (bacterial)
CL wearers >
increased days of wear
poor hand, lens and storage case hygiene
youth
male gender
smoking
internet purchase of lenses, particularly cosmetic lenses
corneal exposure
immune compromised
lid infection
DD of allergic conjunctivitis
seasonal allergic conj
preseptal/orbital cellulitus
insect bite/sting
management of allergic conjunctivitis
no eye rubbing
Reassure- self resolving
cool compresses
avoid allergen
Anti histamines(anti allergy drops)
signs of Microbial keratitis (bacterial)
Lid oedema
Epiphora
Discharge (mucopurulent or purulent)
Conjunctival hyperaemia and infiltration
Corneal lesion usually single (central or mid-peripheral)
necrosis, oedema, ac activity
signs of Marginal keratitis
Ulcer (stromal infiltrate with overlying epithelial loss) which may be round or arcuate, single or multiple, unilateral or bilateral, adjacent to limbus, and separated from limbus by interval of clear cornea
Ulcer stains with fluorescein
Hyperaemia and oedema of adjacent bulbar conjunctiva
management for acute HSK
aciclovir 3% (the treatment should continue for at least 3 days after healing is complete)
ganciclovir 0.15% ophthalmic gel (treatment should continue for 7 days after the healing is complete).
monitor closely for 72hrs- if no improvement refer urgently to ophthalmologist
in severe cases/bilateral/children/CL wearers same day emergency referral to opthalmologist- corneal swabs/biopsy / antiviral
management of chlamydial conj
avoid cl wear
ocular lubricants
refer urgently to gp with a view to refer onwards to gent-urinary clinic
they are given antibiotics- then resolves
sexual partners need treatment
Ocular discomfort increasing to pain
Lacrimation
Red eye
Photophobia
Condition tends to be recurrent
marginal keratitis- toxic reaction to bacteria
Sudden eyelid swelling
Ocular itching
May be unilateral
Watery or mucoid discharge (mild)
Chemiosis
Acute allergic conjunctivitis
signs of contact lens-associated infiltrative keratitis
Peripheral anterior stromal infiltrate, single or multiple
Usually small (generally less than 1.0mm in diameter)
Overlying epithelium usually stains with fluorescein
Conjunctival hyperaemia, mild
Epiphora, mild (or absent)
Anterior chamber quiet or mildly inflamed
No lid oedema
Usually unilateral
Risk factors of HSK
Poor general health, immunodeficiency, fatigue
Systemic or topical steroids, or other immunosuppressive drugs
Possible aggravating factors
sunlight (UV), fever, extreme heat or cold, infection (systemic or ocular), trauma (ocular)
History of previous attacks of ocular herpes simplex infection (key diagnostic feature)
Severe atopic disease
signs of viral conj
Watery discharge
Conjunctival hyperaemia (may be intense) and chemosis
Follicles on palpebral conjunctiva, especially upper and lower fornix
management for microbial keratitis
same day emergency referral to opthalmologist - swabs- px needs to take cos and case with them- antibiotic drops or anti-fungal depending on cause
compliance discussion in terms of CLs
Differential diagnosis of Marginal keratitis
HSK
CL- infiltrative keratitis
microbial keratitis
Acute onset
redness
discomfort, usually described as burning or grittiness
watering
Blurred vision if central cornea involved
Systemic malaise
Viral conjunctivitis
