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Ophthal > Red Eye > Flashcards

Red Eye Flashcards

1
Q

Urgent ocular signs (red flags)

A
  • moderate to severe eye pain or photophobia
  • marked redness of one eye
  • reduced visual acuity
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2
Q

Causes of subconjunctival hemorrhage

A
  • increase in intrathoracic pressure
  • trauma (blunt trauma, vigorous rubbing)
  • medication induced (warfarin)
  • systemic disorder (blood dyscrasia)
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3
Q

Management of subconjunctival haemorrhage

A
  • reassurance, conservative, spontanenous resolution 1-2 weeks
  • artificial tears can be given if irritation
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4
Q

Types of hordeolum and organisms involved

A
  • external (stye): acute bacterial infection (lash follicle, gland of zeis or Moll)
  • internal: acute bacterial infection of Meibomian gland

Organisms: staphylococcal

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5
Q

Symptoms and signs of hordeolum

A

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
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6
Q

Management of hordeolum

A
  • 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
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7
Q

Causes of chalazion

A
  • poor eyelid hygiene
  • acnae rosacae
  • blepharitis
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8
Q

Clinical features of chalazion

A
  • 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)
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9
Q

Management of chalazion

A
  • conservative tx: lid massage, moist heat, topical mild steroid
  • intralesion steroid injection
  • antibiotic (in cases of infection)
  • incision and drainage
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10
Q

Complication of chalazion

A
  • exert mass on cornea result in astigmatism and blurred vision
  • acute secondary infection predispose to preseptal cellulitis
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11
Q

Causes of blepharitis

A

Anterior
- staphylococcal, dandruff of scalp and eyebrows

Posterior
- glands of eyelids irregularly produce oil

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12
Q

Symptoms of blepharitis

A
  • red, irritated eye that is worse upon waking, itchy, crusted eyelids
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13
Q

Management of blepharitis

A
  • 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
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14
Q

Causes and clinical features of acute viral conjunctivitis

A

Cause: adenovirus

Clinical features:
- conjunctival with/without chemosis and follicles
- mild photophobia
- eyelid edema with/without tender pre auricular lymphadenopathy
- pseudomembrane formation

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15
Q

Complication of acute viral conjunctivitis

A

Keratitis

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16
Q

Management of acute viral conjunctivitis

A
  • spontaneous resolution within 2-3 weeks with supportive topical eye drops (artifical tears)
  • pseudomembrane and keratitis may require topical steroid under supervision of ophthalmologist
17
Q

Signs of acute viral conjunctivitis

A
  • conjunctiva injection
  • pseudomembrane formation
  • follicles at tarsal membrane
18
Q

Acute bacterial conjunctivitis
Causes
Clinic features
Complication

A

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

19
Q

Acute bacterial conjunctivitis
- investigation
- management

A

Investigation
- swab c&s, PCR

Management
- none self limiting
- topical antibiotics: CMC, gentamicin
- oral antibiotics; ceftriaxone for gonococcal
- artificial tears

20
Q

Causes of allergic conjunctivitis

A
  • acute allergic
  • seasonal or perennial
  • VKC
  • giant papillary conjunctivitis
21
Q

Clinical features of allergic conjunctivitis

A
  • itchiness, watery or mucus discharge and chemosis
  • papillary hypertrophy
  • limbitis: trantas dots in VKC
  • keratitis: ‘shield ulcer’
22
Q

allergic conjunctivitis
- diagnosis
- management

A

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

23
Q

Types of dry eye

A

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

24
Q

Dry eye
- Clinical features
- investigation
- management

A

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

25
Q

Corneal abrasion
- causes
- clinical features
- management

A

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

26
Q

Bacterial keratitis
- Causes
- Risk factors
- Clinical features
- Complication

A

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

27
Q

Bacterial keratitis
- Investigation
- Management

A

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

28
Q

Causes of fungal keratitis

A

Yeast: candida
Filamentous: fusarium

29
Q

Fungal keratitis
Risk factors
Clinical features
Investigation
Mx

A

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

30
Q

Acanthamoeba keratitis
RF
Clinical features
Complication
Investigation
Management

A

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

31
Q

Viral keratitis
Cause
Clinical features
Cx
Ix
Mx

A

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

32
Q

Types of scleritis

A

Non infectious
- Malignancy: conjunctival tumours
- autoimmune ds: RA, systemic vasculitis
- medication s/e: bisphosphonates (osteoporosis)

Infectious
- virus
- bacteria
- fungi
- parasites

33
Q

Scleritis
Clinical features
Ix
Mx

A

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

34
Q

Acute ant uveitis
Clinical features
Ix
Mx

A

Clinical features
- keratic precipitates
- hypopyon
- post synechiae

Ix
- fbc
- esr
- crp
- vdrl

Mx
- topical steroid
- peri ocular & systemic steroids
- mydriatic: tropicamide

35
Q

Acute glaucoma
RF
Clinical features
Ix
Mx

A

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

36
Q

Preseptal cellulitis vs orbital cellulitis

RF
Clinical features
Ix
Mx

A

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

37
Q

Endophthalmitis
Types
clinical features
Ix
Mx

A

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

Ophthal (9 decks)

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