Red Eye Flashcards
Urgent ocular signs (red flags)
- moderate to severe eye pain or photophobia
- marked redness of one eye
- reduced visual acuity
Causes of subconjunctival hemorrhage
- increase in intrathoracic pressure
- trauma (blunt trauma, vigorous rubbing)
- medication induced (warfarin)
- systemic disorder (blood dyscrasia)
Management of subconjunctival haemorrhage
- reassurance, conservative, spontanenous resolution 1-2 weeks
- artificial tears can be given if irritation
Types of hordeolum and organisms involved
- external (stye): acute bacterial infection (lash follicle, gland of zeis or Moll)
- internal: acute bacterial infection of Meibomian gland
Organisms: staphylococcal
Symptoms and signs of hordeolum
Symptoms
- tender lump in eyelid
- epiphora (watery eye)
- local redness of eye and lid
Signs
- external: tender inflamed of lid, multiple abscesses
- internal: tender inflamed within tarsal plate, painful
Management of hordeolum
- traditional remedies: hot spoon bathing and/or warm compresses may relieve symptoms
- in presence copious mucopurulent discharge, consider antibiotic drops or ointment (chloramphenicol)
- severe/recurrent cases: systemic broad spectrum antibiotic
Causes of chalazion
- poor eyelid hygiene
- acnae rosacae
- blepharitis
Clinical features of chalazion
- gradual enlarge eyelid nodule
- eyelid discomfort
- palpable nodule on eyelid, non erythematous, non fluctuant, non tender
- eversion of eyelid (if not apparent over skin surface)
Management of chalazion
- conservative tx: lid massage, moist heat, topical mild steroid
- intralesion steroid injection
- antibiotic (in cases of infection)
- incision and drainage
Complication of chalazion
- exert mass on cornea result in astigmatism and blurred vision
- acute secondary infection predispose to preseptal cellulitis
Causes of blepharitis
Anterior
- staphylococcal, dandruff of scalp and eyebrows
Posterior
- glands of eyelids irregularly produce oil
Symptoms of blepharitis
- red, irritated eye that is worse upon waking, itchy, crusted eyelids
Management of blepharitis
- eyelid hygiene: clean with mild soap (eyescrub solution), gentle lid massage, warm compress
- topical chloramphenicol erythromycin or bacitracin ointment if does not respond to eyelid hygiene
Causes and clinical features of acute viral conjunctivitis
Cause: adenovirus
Clinical features:
- conjunctival with/without chemosis and follicles
- mild photophobia
- eyelid edema with/without tender pre auricular lymphadenopathy
- pseudomembrane formation
Complication of acute viral conjunctivitis
Keratitis
Management of acute viral conjunctivitis
- spontaneous resolution within 2-3 weeks with supportive topical eye drops (artifical tears)
- pseudomembrane and keratitis may require topical steroid under supervision of ophthalmologist
Signs of acute viral conjunctivitis
- conjunctiva injection
- pseudomembrane formation
- follicles at tarsal membrane
Acute bacterial conjunctivitis
Causes
Clinic features
Complication
Causes
- s pneumonia
- s aureus
- h influenza
Clinical features
- mucopurulent discharge with eye redness
- eyelid edema with/without tender pre auricular lymphadenopathy
- conjunctival injection with/without chemosis
Complication
- corneal ulceration/ perforation
Acute bacterial conjunctivitis
- investigation
- management
Investigation
- swab c&s, PCR
Management
- none self limiting
- topical antibiotics: CMC, gentamicin
- oral antibiotics; ceftriaxone for gonococcal
- artificial tears
Causes of allergic conjunctivitis
- acute allergic
- seasonal or perennial
- VKC
- giant papillary conjunctivitis
Clinical features of allergic conjunctivitis
- itchiness, watery or mucus discharge and chemosis
- papillary hypertrophy
- limbitis: trantas dots in VKC
- keratitis: ‘shield ulcer’
allergic conjunctivitis
- diagnosis
- management
Diagnosis
- clinical
- skin prick test
Management
- avoidance
- topical antihistamines and mast cell stabilizers: olapantadine, sodium cromoglycate
- oral antihistamines
- ophthalmology referral: topical steroids, topical immune modulators
Types of dry eye
Aqueous deficiency
- sjogren syndrome
- primary: not associated with CTD
- RA, SLE, PAN
- non sjogren syndrome
- primary: age related
- secondary: sarcoidosis, amyloidosis, tb
Evaporative state
- intrinsic causes: meibomian gland ds, low blink rate
- extrinsic causes: keratoconjunctivitis, prolonged contact lens wear -> giant papillary conjuctivitis
Dry eye
- Clinical features
- investigation
- management
Clinical features
- burning, stinging, tearing
- sandy sensation
- blurring of vision
- light sensitivity
Investigation
- tear osmolarity (raised)
- cornea sensation
- schirmer test
- sjo test
Management
- artificial tears
- warm compression
- eyelash scrubs
Corneal abrasion
- causes
- clinical features
- management
Causes
Extrinsic: mechanical trauma, foreign bodies, contact lens wear, chemical burns
Intrinsic: corneal dystrophy - recurrent corneal erosion
Clinical features
- eye redness with pain, foreign body sensation
- blurring of vision, photophobia, watery discharge
- conjunctival injection
Mx
- eye pad
- prophylaxis topical abx
- oral vitamin c
- pain relief
Bacterial keratitis
- Causes
- Risk factors
- Clinical features
- Complication
Causes: pseudomonas aeruginosa, staph aureus
RF: contact lens user, trauma, ocular surface ds
Clinical features: painful red eye with/without mucopurulent discharge, hypopyon, conjunctival injection with/without chemosis
Complication: corneal thinning, scar, perforation
Bacterial keratitis
- Investigation
- Management
Ix: corneal scraping for gram stain and C&S
Mx:
- topical abx: fortified gentamicin
- cyclopegic/mydriatic: cyclopentoate
In corneal perforation: corneal patch with acrylic glue, therapeutic penetrating keratoplasty
Causes of fungal keratitis
Yeast: candida
Filamentous: fusarium
Fungal keratitis
Risk factors
Clinical features
Investigation
Mx
RF
- eye contact with vegetative material, immunocompromised, DM
Clinical features
- eye redness with discharge
- conjunctival injection with or without chemosis
- corneal infiltrate: feathery and satellite lesion (candida)
Complications
- corneal ulceration
Ix
- corneal scraping and mucopurulent discharge for gram and geimsa stains)
- sabaroud dextrose agar for C&S
Mx
- topical antifungal; amphotericin
- systemic fungal: fluconazole
Surgery:
- corneal perforation: surgical corneal patch
- progressive infection: therapeutic penetrating keratoplasty
Acanthamoeba keratitis
RF
Clinical features
Complication
Investigation
Management
RF
- contact lens use while swimming/bathing
- trauma
Clinical features
- eye redness, blurring of vision
- watery discharge
- eye pain
- ring stromal infiltrate/ulcer
Complication
- corneal ulcer and perforation
Investigation
- microbiology: corneal scrapping in E coli enriched non nutrient culture agar
- microscopy: corneal confocal miscroscopy
Mx
- corneal debridement if epithelial defect absent
- topical amoebicides: polyhexamethylene biguanide
Viral keratitis
Cause
Clinical features
Cx
Ix
Mx
Cause
- herpes simplex type 1/2, herpes zoster
Clinical features
- eye redness
- blurring of vision
- conjunctival injection
- dendritic corneal ulcer
Complication
- stromal keratitis
- corneal scarring
Ix
- corneal scrapping in transport media
- anterior chamber tap for culture
- PCR study
Mx
- corneal debridement (epithelial defect absent)
- antiviral
- corneal transplant
Supportive
- artificial tears
- topical steroid
Types of scleritis
Non infectious
- Malignancy: conjunctival tumours
- autoimmune ds: RA, systemic vasculitis
- medication s/e: bisphosphonates (osteoporosis)
Infectious
- virus
- bacteria
- fungi
- parasites
Scleritis
Clinical features
Ix
Mx
Clinical features
- eye redness with deep eye pain
- tender on touch
- scleral thinning
Ix
- uveitic screening; FBP, Rh factor, VDRL, CXR, ESR
Mx
- immune mediated: systemic NSAIDs, corticosteroids, immunosuppressive therapy
- infective: antimicrobial tx
Acute ant uveitis
Clinical features
Ix
Mx
Clinical features
- keratic precipitates
- hypopyon
- post synechiae
Ix
- fbc
- esr
- crp
- vdrl
Mx
- topical steroid
- peri ocular & systemic steroids
- mydriatic: tropicamide
Acute glaucoma
RF
Clinical features
Ix
Mx
Rf
- female
- fam history
- age > 40 y/o
- shallow ant chamber
Clinical features
- sudden painful unilateral blurring of vision
- haloes
- mid dilated pupil
- raised IOP
- gaukomflecken
Ix
- gonioscopy: types of glaucoma
- U/s biomicroscopy
- ant segment OCT
Mx
- medical: anti glaucoma eyedrops (b blockers, alpha agonist, carbonic anhydrase inhibitor, prostaglandin analogue)
- systemic medication: acetazolamide, mannitol
- laser: peripheral iridotomy
- surgery: cataract extraction, filtration surgery
Preseptal cellulitis vs orbital cellulitis
RF
Clinical features
Ix
Mx
Preseptal
RF: URTI, Dacrocystitis, hordeolum, impetigo
Clinical features preseptal : no proptosis, fever, erythema
Orbital cellulitis RF: acute sinusitis, trauma inc orbital fracture, dacrocystitis
Orbital cellulitis clinical features: proptosis, diplopia, pain on ocular movement, fever
Investigation for both; CT scan orbit & paranasal sinuses, MRI
Mx for both; IV antibiotics (ceftriaxone, ceftazidime), surgical drainage
Endophthalmitis
Types
clinical features
Ix
Mx
Types
Exo: post op, traumatic
Endo: immunosuppressive, procedures, systemic infection
Clinical features: reduce visual acuity, RAPD positive, eyelid swelling, chemosis, hypopyon
Ix: B scan us, AC, vitreous tap for C&S
Mx: intravitreal abx (ceftazidime, vancomycin), topical and systemic abx, pars plana vitrectomy
