Red Eye

Question 1

what are possible causes of a unilateral red eye?

Answer 1

rarely conjunctivitis. May be keratitis, corneal ulcer, foreign body, trauma, uveitis or acute glaucoma

Question 2

what are possible causes of keratitis?

Answer 2

herpes simplex, herpes zoster, adenovirus, measles, fungal infection, bacterial infection, inflammatory condition eg ankylosing spondylitis

Question 3

what are the 5 key questions on history for a red and tender eye?

Answer 3

history of trauma
vision
degree and type of discomfort
presence of discharge
presence of photophobia

Question 4

What diseases must be considered if a patient presents with a purulent eye discharge within a few days of life?

Answer 4

chlamydia + gonorrhoea

Question 5

what is trachoma?

Answer 5

chlamydia conjunctivitis

Question 6

at what age do you expect a blocked neonatal tear duct to be resolved?

Answer 6

6 months

Question 7

what causes of red eye should be considered in the elderly?

Answer 7

acute glaucoma, uveitis, herpes zoster

Question 8

what is the typical fluorscein staining pattern of primary herpes simplex infection?

Answer 8

dendritic ulceration

Question 9

what diseases may scleritis be associated with?

Answer 9

connective tissues diseases especially rheumatoid arthritis, herpes zoster, sarcoidosis and tuberculosis

Question 10

what is the presentation of iritis?

Answer 10

The eye is red, with injection particularly over the ciliary body. Eye pain. Increased tearing. sensitivity to light. Floaters in vision. Small pupil
The iris is sticky and sticks to the lens. The pupil may become small because of adhesions and the vision is blurred. Causes include autoimmune related diseases such as ankylosing spondylitis, SLE, IBD and some infections (eg toxoplasmosis)

Question 11

what is the presentation of acute glaucoma?

Answer 11

suspect in patient over 50 presenting with acutely painful red eye. The attack characteristically occurs in the evening when the pupil becomes semidilated.
\+/- nausea and vomiting
haloes around lights
hazy cornea
fixed semidilated pupil
eye feels hard

Question 12

How should a penetrating eye injury be treated?

Answer 12

urgent referral to opthalmologist
ADT
transport by land
injection of antiemetic
If significant delay then giv eone dose of IV gentamycin + ceftriaxone or vancomycin + oral cipro