Red Eye Flashcards
What is the 5th vital sign of the eye?
What are three exceptions when you dont have to check it?
Visual acuity
Oopen globe (rigid shield), caustic injury (start irrigating), sudden visual loss (getting them to ct to rule out a stroke)
Outline relevent anatomy of the eye (Rosen’s diagrams)
What are 3 conditions that are vision threatening that will not present with pain or redness?
Retinal detachment
CRVO
CRAO
(diagnosed with fundoscopy)
Why do you get a cherry red spot with CRAO?
The perfused choroid shows through the inner fovea
What are pivotal findings much more likely to be something serious?
Severe occular pain
Exopthalamous
Persistently blurred vision
Corneal epithelial defect or opacity
Reduced occular light reflection
Ciliary flush
Pupil unreactive to light
Think overall bad, anterior chamber penetrating injury bad, and then interior structures bad
What are 6 key questions to ask on your optho history?
- Do you wear contacts
- Do you wear glasses
- Any previous eye injury or surgery
- Past medical history
- Medications
- Allergies
First three help to establish vision at baseline, next three basic HPI
Link the following with their common differential:
FB sensation
Itching
Burning
Sharp pain
Dull pain
Intense Pain
FB sensation - corneal problem, keratitis, abrasion, ulcer
Itching - irritation/ infection, dry eye, conjunctivits, blepharitis
Burning - Superficial problems, pinguecula, pteryium, episcleritis
Sharp pain - anterior eye uvea or cornea
Dull pain - headache/ generalized think increased IOP with glaucoma, AACG, reffered pain sinusitis or migraine
Intense Pain - obrital compartment syndrome, retrobulbar hematoma
Discharge - conjunctivitis - allergic, viral, bacterial, Blepharitis, dacryocystitis, and canaliculitis (infection of two little tubes that drain into tear duct)
What is most common diagnosis with red eye that is completely asymptomatic (looks worse than is)
Spontaneous subconjunctival hemmorhage
Usually after straining, coughing or no trigger
What is the evidence for trying to tell if viral or bacterial conjunctivitis? Is this clinically relevent?
No redness at 20 feet
No AM eyelid matting
Presentation in summer
Less likely bacterial. Even if it was bacterial if you are immunocompetent, do not wear contact lenses, and dont have a trauamtic injury no need for drops anyways
What are 8 components of the eye exam?
VVEEPP
Visual acuity
Visual field
External exam
Extraoccular movements
Pupils
Pressure
+slit lamp and fundoscopy
Slit lamp for any trauma, fb or altered vision
Outline your approach for testing visual acuity
Ideally Snellen chart read at 6m, one eye at a time, can use pinhole for refractory errors
For kids can do an Allen chart (shapes)
If they cant do letters do a qualitiative test i.e. read at this distance
If they are really struggling you can do in order
Can they count fingers
Can they see hand motion
Can they see light
What is a scotoma?
Medical term for blind spot
Usually a retina problem
think glaucoma if crescent shaped
think brain if hemi or quandrant loss
Most common cause of endopthalamous in ED?
Pseduo - other eye is actually just protuding
What are punctate follicles in eyelid? What do they represent?
Punctate “follicles” are hypertrophy of lymphoid tissue in Brunch glands along the conjunctival surface of one or both lower lids. Relatively specific for viral etiology
Alternative diagnosis is trachoma, a form of chronic keratitis conjucntivitis with chalymdia that also has the same findings
What are the most common causes of irregular shaped pupils?
Blunt or penetrating trauma
Previous surgery (iridotomy or cataract extraction)
Synechiae from prior iritis or inflammatory changes
Drugs
Toxins
if just one is constricting with direct light worry about bad optho stuff liek globe problem, afferent nerve problem, ciliary muscle problem, uveitis ect
What is normal for IOP? What are relevent cut offs to know?
10-20 is normal
>20 reasonable to be seen by optho
>30 requires rapid treatment
Someone explain wtf “cupping” of the optic disc is to me please
Cupping is a clinical sign of increased IOP seen on fundoscopy. As IOP increases it pushes back on the optic nerve creating a “cup” shape. We see this as the transition from a small flat well rounded circle to a wide high contrast circle.
Thank you Frank
What should you do if you see a baby with red eyes? What are some relevent differentials?
Red eyes in a baby or neonate is always abnormal
Corneal abrasions - inconsolable infant
Hepres Keratitis - birth canal or caregivers fingers
Conjunctivtis - first few days think gonorrhea, 1-2 weeks think chlamydia
6 components of you slit lamp exam
Lids and lashs
Conjunctiva and scelra
Cornea
Anterior chamber
Iris
Lens
Outside and peripheral to inside and central
What does corneal edema look like on a slit lamp exam? Why might this be tricky if you have a junior trainee? What is one diagnosis this is relevent for?
Increased interstitial water creates a whitish cladding of the normally clear tissue at base or adjacent to lesion
best seen without the fluroscein staining
corneal ulcers can have this around them indicating concomitant keratitis
When might an open globe be really hard to diagnose
Projectile to the back of the eye
Lean on imaging (CT - cant MRI if something is in there)
Alternatively very small FB - might only see small entrance wound of scleral bruising. Trick is to have a high index of suspicion if any projectile mechanism.
5 occular diagnoses you might be able to make with US?
Retinal detchament
Vitreous hemmorage
Vitreous detachment
Open globe (hopefully not)
Intraoccular FB
6 reasons you cant see a red reflex or optic fundus?
Which burns need to be seen by optho?
Full thickness
