Red eye Flashcards by S O

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

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What are the symptoms of conjunctivitis?

No reduction in vision, Red, itchy, sore eyes, FB sensation, Diffuse conjunctival injection, chemosis, discharge

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What are the causes of conjunctivitis?

Infectious (Viral and bacterial), Allergic

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What are the symptoms of viral conjunctivitis?

Watery discharge
Swollen lymph nodes
Conjunctivitis follicles
Corneal involvement
Longer course
Highly infectious
Supportive Tx

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What are the symptoms of bacterial conjunctivitis?

Purulent discharge

Sticky lids

Good response to topical abx,

Chloramphenicol qds 5/7

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What are the symptoms of allergic conjunctivitis?

IRMC

Itching that starts bilaterally
Rapid onset
Mucus discharge
Chemosis

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What should be done for subconjunctival hemorrhage?

check……. and …………

Check BP and discharge

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What is the treatment for blepharitis?

Lid hygiene
Warm compresses and massage
Topical antibiotics
Oral doxycycline
Artificial tears
Incision and drainage (I&D) for chalazia or lid cysts which persist

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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

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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

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What are the common causes of anterior uveitis?

IIA

Most commonly idiopathic but can be injury, infection, or an autoimmune condition.

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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)

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What are the symptoms of angle closure glaucoma?

5 PVFHS

Pain, vomiting, Fixed mid dilated pupil, Hazy cornea, Shallow AC

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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

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What are the symptoms of post-op endophthalmitis?

P, R VA, R, H, N

Pain, Reduced vision, Red eye, Hypopyon, No view of fundus

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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

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What is the immediate action for chemical injury to the eye?

IRRIGATE IMMEDIATELY with 2l normal saline or copious amounts of clean water

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What are the symptoms of blunt eye injury?

Hyphaema, 20 bleed, Raised IOP, Endothelial staining

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What is the management for blunt eye injury?

R, T S and M, T

Rest, Topical steroid, Topical mydriatic, Treat IOP

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What do the pupils need to be if hyphaemia (increased blood flow to tissues) is being examined?

Dilated pupil exam

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What are the signs of penetrating eye injury?

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

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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

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What is the treatment for dendritic ulcer?

A or C ointment and how many times a day

Ointment Aciclovir (or ganciclovir) 5 daily

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What is the treatment for corneal ulcer?

L,M

-Levofloxacin every hour and
-Mydriatic

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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 ## Footnote 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