Red eye Flashcards
What are the red flags of acute red eye?
R, P, C, R, U
Reduced vision
Pain
CL wear
Recent surgery or injection or trauma
Unilateral
What are the symptoms of conjunctivitis?
No reduction in vision, Red, itchy, sore eyes, FB sensation, Diffuse conjunctival injection, chemosis, discharge
What are the causes of conjunctivitis?
Infectious (Viral and bacterial), Allergic
What are the symptoms of viral conjunctivitis?
7
Watery discharge
Swollen lymph nodes
Conjunctivitis follicles
Corneal involvement
Longer course
Highly infectious
Supportive Tx
What are the symptoms of bacterial conjunctivitis?
Purulent discharge
Sticky lids
Good response to topical abx,
Chloramphenicol qds 5/7
What are the symptoms of allergic conjunctivitis?
IRMC
- Itching that starts bilaterally
- Rapid onset
- Mucus discharge
- Chemosis
What should be done for subconjunctival hemorrhage?
check……. and …………
Check BP and discharge
What is the treatment for blepharitis?
6
Lid hygiene
Warm compresses and massage
Topical antibiotics
Oral doxycycline
Artificial tears
Incision and drainage (I&D) for chalazia or lid cysts which persist
What are the symptoms of anterior uveitis?
Pain inside eye
More pain on accommodation
Ciliary injection
Small pupil
Cells in AC cells and flare
KP’s
Post synechiae- iris abnormality
Photophobia
Inflammation in ciliary apparatus
What are the 2 management options for anterior uveitis?
C and S
Cyclo 1% is used x2 daily -to prevent synechie formation (pupil abnormality)
Strong steroids are used houry or 2 hourly
What are the common causes of anterior uveitis?
IIA
Most commonly idiopathic but can be injury, infection, or an autoimmune condition.
What is the treatment for scleritis?
Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immunosuppressants
If severe- Prednisolone if severe (Oral ibuprofen 400mg tds, Oral prednisolone guided by specialist)
What are the symptoms of angle closure glaucoma?
5 PVFHS
Pain, vomiting, Fixed mid dilated pupil, Hazy cornea, Shallow AC
What is the treatment for angle closure glaucoma?
A, P, P
Acetazolamide 500mg IV stat
Acetazolamide 250mg po qds
Pilocarpine 2% qds BOTH eyes
Peripheral iridectomy BOTH eyes
What are the symptoms of post-op endophthalmitis?
P, R VA, R, H, N
Pain, Reduced vision, Red eye, Hypopyon, No view of fundus
What is the treatment for post-op endophthalmitis?
T and I
Urgent ‘tap and inject’
Tap = take a sample of vitreous +/- aqueous
Inject = Broad spectrum intravitral antibiotics (e.g. ceftazidime and vancomycin)
Early vitrectomy surgery probably of benefit
What is the immediate action for chemical injury to the eye?
IRRIGATE IMMEDIATELY with 2l normal saline or copious amounts of clean water
What are the symptoms of blunt eye injury?
Hyphaema, 20 bleed, Raised IOP, Endothelial staining
What is the management for blunt eye injury?
R, T S and M, T
Rest, Topical steroid, Topical mydriatic, Treat IOP
What do the pupils need to be if hyphaemia (increased blood flow to tissues) is being examined?
Dilated pupil exam
What are the signs of penetrating eye injury?
9
History of high-velocity injury
Reduced VA
Low IOP
Conjunctival or subconjunctival haemorrhage
Dark tissue in cornea or sclera
Distortion of pupil
Unusually deep AC
Cataract
Vitreous haemorrhage
What is the management for penetrating eye injury?
A, N, S, S I, S, T
Admit to hospital
NBM( nil by mouth- pt should not eat or drink) Shield
Surgical repair
Intra-ocular +/- systemic antibiotics
Tetanus
What is the treatment for dendritic ulcer?
A or C ointment and how many times a day
Ointment Aciclovir (or ganciclovir) 5 daily
What is the treatment for corneal ulcer?
L,M
-Levofloxacin every hour and
-Mydriatic
What are the symptoms of corneal abrasion?
7- cause and symptoms and how is it easily seen
Surface epithelium sloughed off
Usually due to trauma
Stains with fluorescein easily
Pain
FB sensation
tearing
red eye
What is the treatment for corneal abrasion?
L, A, M
Lubricants
Antibiotics
Mydriatic (reduce pain associated with the ulcer by minimizing the reflex inflammation of the iris)
What is the management for intraocular foreign bodies?
X, O
-X ray
-Ophthalmic referral regardless of appearance
What are the characteristics of preseptal cellulitis?
3
Infection of lid structures alone
Periorbital inflammation
Normal vision, eye movements and pupils and no proptosis
What is the treatment for preseptal cellulitis?
Oral antibiotics (e.g. Flucloxacillin)
What are the ocular characteristics of orbital cellulitis?
8
commonly effects children
- Vision loss which can lead to blindness
- Deeply painful, subtly proptosed eye
- Conjunctival injection (redness)
- Chemosis (swelling)
- Painful eye movements
- Diplopia
- opthalmoplegia
- RAPD may be present
What is the management/ further investigations needed for orbital cellulitis?
- MRI or CT scan
- Intravenous antibiotics and ENT or orbital surgery
What is the treatment for dacryocystitis?
Treat acute infection
Need a DCR ( creates new way for tears to drain between eyes and nose )
What are the aims of the session on red eye?
Distinguish between serious and self-limiting causes of red eye
Know common causes of red eye
Know first line pharmacological treatments for common causes of red eye
What secondary causes need to be excluded when diagnosing anterior uveitis
IIM categories
Infectious (syphilis, TB, HSV, VZV)
Inflammatory (HLA-B27, Sarcoid, Psoriatic arthritis, Crohn’s disease)
Malignancy (lymphoma)
Does conjunctivitis effect vision
No
can cause mild blur but usually no decrease in VA
What is a dendritic ulcer and what virus causes it
inflammation or ulcer on the cornea, caused by the herpes simplex virus (HSV).
Causes of a catarcact
ABCDE
Aging
Bang: trauma, other injuries (eg infrared)
Congenital
Diabetes and other metabolic disturbances (eg steroids)
Eye diseases: glaucoma, uveitis
Causes of cherry red spots on macula
an ocular emergency
metabolic storage diseases, central retinal artery occlusion
A patient presents with gradual peripheral vision loss, increased cup-to-disc ratio, and an IOP of 28 mmHg. Which of the following is the most likely diagnosis?
primary open angle glacuoma
A patient presents with a history of dry, itchy eyes, cobblestone papillae on the upper tarsal conjunctiva, and stringy mucus discharge. What is the most appropriate initial treatment?
mast cell stabiliser
A 60-year-old hypermetropic woman presents with a severe headache, nausea, vomiting, and a red eye with a fixed mid-dilated pupil. Which of the following is the best immediate management?
Acetazolamide IV
A 45-year-old patient with a history of rheumatoid arthritis presents with a unilateral, painful red eye. The eye is tender to palpation, and the redness does not blanch with phenylephrine.
What is the best initial management?
Topical NSAIDs
Which condition is most commonly associated with HLA-B27?
anterior uveitis
When can endopthalmitis occur
after cataract surgery
What kind of disease is the most common underlying cause of scleritis?
autoimmune disease
Is bacterial conjunctivits painful
No but there is discomfort
What blanches with phenylephrine
episcleritis
scleritis does not and this is the main differentiator
What is the typical IOP for chronic glaucoma
above 21 mmHg
What is the difference between acute angle-closure glaucoma and primary open-angle glaucoma
onset and symptoms
Acute angle-closure glaucoma is a sudden, severe condition
Primary open-angle glaucoma develops slowly with minimal symptoms in the early stages
What is anterior uveitis associated with
Autoimmune conditions (e.g., HLA-B27-related diseases) rather than bacterial infections.
Which test is most useful in confirming the diagnosis of posterior uveitis?
fluorescein angiography
What is the most common cause of post-surgical endophthalmitis?
SE
Staphylococcus epidermidis
What doea bacterial conjuncitivits present with?
purulent discharge and lid stickiness
What does viral conjunctivits particularly adenoviral conjunctivitis present with ?
preauricular lymphadenopathy
watery discharge
gritty sensation
What is present in orbital cellulitis
that is absent in preseptal cellulitis
proptosis, restricted eye movement, and sometimes vision loss
Is chronic (open angle) glaucoma asymptomatic in the early stages
YES
A 7-year-old child presents with red, itchy eyes, photophobia, and a stringy mucus discharge. Examination reveals cobblestone papillae on the upper tarsal conjunctiva. What is the most likely diagnosis?
vernal keratoconjunctivitis
What is classic for vernal kertoconjunctivits
Cobblestone papillae on the upper tarsal conjunctiva and stringy mucus discharge
A 65-year-old woman presents with a headache, nausea, and severe unilateral eye pain. Examination reveals a mid-dilated fixed pupil, corneal edema, and an intraocular pressure of 50 mmHg. What is the best initial treatment?
IV acetazolamide
What is a differnce between episcleritis and scleritis
pain and discomfort
Episcleritis- mild discomfort and no significant pain and photophobia.
Scleritis- more painful and associated with systemic diseases.
What differentiates anterior uveitis from conjunctivitis?
about injection
Circumcorneal injection (enlarged blood vessels around cornea) is seen in** uveitis** and not conjunctivitis
Which of the following is the best initial management for a patient with orbital cellulitis?
investigation test
MRI or CT scan of the orbits
Which test is most useful in confirming the diagnosis of chronic glaucoma?
Visual field testing
What can posterior uveitis cause?
FB
floaters and blurred vision
Which of the following is NOT a typical cause of a red eye with a painless presentation?
Scleritis
A patient with a history of rheumatoid arthritis presents with a painful, red eye that does not blanch with phenylephrine. Examination reveals scleral thinning and possible necrosis. What is the most appropriate treatment?
Systemic corticosteroids
Which type of conjunctivitis is associted with raised lymph nodes
allergic
What are the swollen lymph nodes in AC also know as
preauricular lymphadenopath
Which lymph nodes are swollen in AC
ones in front of the ear
Which red eye conditions are painful
7 AS KUE OC
Acute angle closure glaucoma
Scleritis
Keratitis (Bacterial, Viral, Fungal)
Uveitis (Anterior Iritis)
Endophthalmitis
Orbital Cellulitis
Chemical Burns
Which red eye conditions are not painful
4 SECD
Conjunctivitis (Viral, Bacterial, Allergic)
Episcleritis
Subconjunctival Hemorrhage
Dry Eye Syndrome
A patient presents with a red, painful eye after wearing contact lenses overnight. There is a corneal infiltrate with an epithelial defect. What is the most appropriate management?
Intensive topical antibiotics
A 25-year-old contact lens wearer presents with severe eye pain, photophobia, and a dendritic corneal ulcer on fluorescein staining. What is the most appropriate initial treatment?
topical antiviral drugs
A patient presents with a history of high-velocity trauma to the eye. Examination reveals a teardrop-shaped pupil and a dark tissue prolapse. What is the most appropriate next step?
Perform immediate surgical repair
What effect does anterior uveitis have on the pupil?
small, irregularly shape and constricted
Which red eye condition causes deep pain that is worse at night
scleritis
