Red eye Flashcards
conjunctiva vs sclera
conjuntiva
- mucous membrane; blood supply
sclera
- fibrous connective tissue; structural rigidity
problem focused exam: red eye
- visual acuity
- Tonometry
- Slit lamp (pen light) exam
presbyopia
age-related focus dysfunction
if vision is worse than 20/400, what steps should you take to assess vision?
- count fingers at given distance
- hand motion
- light perception
- no light perception
tonometry
- measurement of intraocular pressure
- 0-80 mm Hg (no emergency if < 30)
what does slit lamp offer than pen light does not when assessing a lesion
depth of lesion
2 big categories of causes of red eye
- inflammatory (infectious/non-infectious)
- Traumatic
questions to ask when assessing red eye
- duration
- trauma?
- contact lens use
what is blepharitis
eyelid inflammation
clinical presentation
- chronic itching, burning scratchy
- worse in AM
- PE: no vision decrease; erythema, scales
blepharitis
management of blepharitis
- warm compress
- baby shampoo lid scrubs
- Abx/steroids
identify
pingueculum: a yellowish patch on the white (sclera) of the eye.
- associated with aging
- usually no vision loss
identify
pterygium: triangular thickening of bulbar conjunctiva that grows slowly across outer surface of cornea usually from nasal side
** may interfere with vision as it reaches pupil
clinical presentation
- acute onset of pain, swelling, and +/- systemic
- PE: +/- vision decrease; warm, edema, erythema, tender
cellulitis
preseptal vs orbital (involvement of extraocular muscles)
blepharitis can contribute to what syndrome
dry eye syndrome: deficient aqueous tear production
clinical presentation
- chronic itching, burning, scratchy
- “tired” eyes, esp in PM
- PE: vision fluctuation; poor tear film, punctate epithelial erosions
dry eye
treatment of preseptal or orbital cellulitis
- systemic abx
- ophthalmology referral
managment of dry eye
- artificial tears
- topical cyclosporin
- punctal plugs
clinical presentation
- acute onset
- bilateral
- itching, burning, soreness
- mild to severe redness
- watery discharge
- URI symptoms; preauricular LAD
viral conjunctivitis
clinical presentation
- acute onset
- unilateral
- burning, general irritation
- mod to severe redness
- mucopurulent dx
- adherent lids
bacterial conjunctivitis
clinical presentation
- chronic (seasonal) onset
- bilat eyes affected
- itching
- mild to mod redness
- stingy, mucoid dx
- chemosis
allergic conjunctivitis
treatment of viral conjunctivitis. duration of symptoms
- tears/ compress vasoconstrictors
- days to weeks
treatment of bacterial conjunctivitis. duration of illness
- topical abx +/- systemic abx
- days to weeks
treatment of allergic conjunctivitis. duration of illness
- artificial tears; topical antihistamine
- weeks to months
clinical presentation
- acute
- asymptomatic
- PE: vision unaffected; diffuse red patch
** management??
subconjunctival hemorrhage
managment: reassurance
what is episcleritis/scleritis
inflammation of episcleritis or scleritis tissue; can be associated with systemic autoimmune disease
clinical presentation
- subacute onset of foreign body sensation/pain
- PE: vision usually unaffected
- focal injection: scleritis: deep, bluish hue
- +/- nodule
episcleritis/scleritis
mangement of episcleritis/scleritis
ophthalmology referral
clincal presentation
- acute onset of pain, FB sensation, epiphora (watery eyes)
- PE: +/- vision affected; epithelial defect; fluorscein staining +
corneal abrasion
managment of cornal abrasion
- topical lubricant
- topical Abx
- oral pain meds
- do not give topical anesthetic drops
managment of chemical injury
**vision decreased
- irrigate ASAP
- topical lubricant
- refer to ophthalmology
managment of corneal foreign body
- remove via irrigation or cotton-tipped aplicator
- lubricant/abx
- +/- refer to ophthalmology
clinical presentation
- acute onset of pain
- mucous discharge
- contact lens abuse
- PE: vision usually decreased
- white infiltrate
keratitis/ corneal ulcer
management of keratitis/corneal ulcer
- intensive topical abx
- ophthalmology referral
keratitis associated with a dendritic pattern. Diagnosis? Treatment?
HSV
treat with topical antivirals
do not use steroids
* refer to ophthalmology
what is included in uveal tissue
- iris; ciliary body; choroid
clinical presentation
- acute onset photophobia
- PE: +/- vision decrease; ciliary flush
iritis/uveitis
management for iritis/uveitis
ophthalmology referral
hyphema
blood in anterior chamber: trauma to iris or uvea
clinical presentation
- acute onset pain
- photophobia
- PE: +/- vision decrease; layered heme
hyphema
management of hyphema
- eyeshield
- control intraocular pressure
- refer to ophthalmology
what is acute angle closure glaucoma
acute rise of intraocular pressure due to outflow obstruction (rare in real life)
clinical presentation
- acute decreased vision
- halos around lights
- nausea, +/- pain
- feeling of pressure
- PE: decreased vision; ciliary flush, steamy cornea, mid-dilated pupil, narrow anterior chamber
acute angle closure glaucoma
management of acute angle closure glaucoma
- ophthalmology referral
- topical anti-ocular hypertensives
- laser peripheral iridotomy
what topical abx is commonly used for eye infections
erythromycin ointment
