Red Eye Flashcards
what is included in complete eye exam?
- vision
- external eye exam
- pupils
- motility
- anterior segment
- opthalmoscopy
- pressures
- visual fields
danger signs of red eye?
- reduced vision
- ocular pain
- photophobia
- conjunctival injection
- circumcorneal injection
- corneal staining
- abnormal pupil size
- high or low IOP
Are acidic or alkaline burns a greater emergency? what is #1 critical tx for chemical burns?
alkaline: eats thru tissue until it neutralizes itself
IMMEDIATE IRRIGATION
How are chemical burns of eye treated initially?
- topical anesthesia
- irrigation
- removal of FB
- debride necrotic corneal or conjunctival tissue
what is involved in secondary treatment of chemical eye burns?
- topical cycloplegic (stops lens movement)
- topical antibiotic
- patch eye
- referral
what is symblephron?
adhesion of palpebral conjunctiva to cornea of eye from trauma or disease
what are common symptoms of corneal abrasions?
- FB sensation
- pain
- tearing
- photophobia
what is the treatment for corneal abrasions?
- topical cycloplegic
- topical antibiotic
- pressure patch over eye (maybe not for sm. abrasion)
- check for seidel’s sign
what is seidel’s sign?
stain eye
black water droplet = aqueous fluid dripping out of eye… area between outside of eye and anterior chamber (FB in eye)
what are non-traumatic possible causes of red eye?
- conjunctivitis
- iritis
- corneal inflammation
- acute glaucoma
what are signs of allergic conjunctivitis?
- itching
- conjunctival injection
- papillae
- discharge
- trantas
if discharge from eye is “thick and ropy” what could it be a sign of?
VKC (vernal ketatoconjunctiviti)
what causes palpebral conjunctival papules?
LT CL wear
signs of VKC?
- thick discharge
- trantas dots
- palpebral conjunctival papules
- conjunctival injection
who does atopic keratoconjunctivitis affect?
individuals with hay fever, atopic dermatitis, and asthma
how does AKC differ from VKC? how are they similar?
AKC is chronic and more serious; presentation similar
how does AKC present?
thickened, macerated, red eyelids
advance stages: symblpharon and cicatrization
what is cicatrization?
scaring
what is the treatment for AKC?
- antihistamines
- lubricants
- mast cell stabilizers
- steroids
treatment for allergic conjunctivitis?
- remove allergen
- lubricants
- topical decongestants
- mast cell stabilizers
- steroids
what is giant papillary conjunctivitis? how should u tx it?
big bumps under eye lid, remove CL or allergen
signs of bacterial conjunctivitis?
- bilateral
- mucopurulent d/c
- lid crusting
- chemosis (swelling of conjunctiva)
- conjunctival papillae
- no preauricular adenopathy
- red
- FB sensation
- heat in and around eye
- tightness
treatment for bacterial conjunctivitis?
- broad spectrum antibiotics (polytrim, gentamicin, tobramycin, fluroquinolones)
- steroids?
4x/day - q1h
when should you NOT give steroids?
cataracts or HSV
signs of viral conjunctivitis?
- bilateral
- preauricular lymphadenopathy
- conjunctival inflammation
- watery discharge
- itching
- burning
- FB sensation
- conjunctival follicles
- subepithelial infilrates
- pseudomembrane
- subconjunctivitis hemorrhages
what are viral conjunctivitis treatment?
- usually self-limiting
- cold compresses
- artificial tears
- topical vasoconstrictors
- steroids
- very contagious 10-12 d from onset
what is chronic conjunctivitis? who is at risk for it?
- chalamydial inclusion conjunctivitis
- found in sexually active, hx of vaginitis, cervicitis, urethritis
signs of chalamydial inclusion conjunctivitis? (STI)
- inferior tarsal conjunctival follicles
- superior pannus (vessel growing into eye)
- preauricular node
- SEI peripheral
- stringy mucous discharge
- giemsa stain
- corneal meltdown
- young adult
- conjunctival follicles
signs of bacterial keratitis?
- unilateral
- painful
- photophobia
- vision reduced
- tearing
- opacification
- corneal edema
- conjunctival vessels deeply engorged
what is bacterial keratitis?
infection of the cornea
what is tx for bacterial keratitis?
- culture ulcer
- fluroquinolone q 15 minutes x 6 hours; then q 30 min x 18 hrs
- atropine BID
predict the etiology of the following discharge types and signs:
- purulent
- serous/clear
- stringy/white
- preauricular lymph node enlargement
- purulent: bacterial
- serous/clear: viral
- stringy/white: allergic
- preauricular lymph node enlargement: viral
what are the signs of iritis?
- photophobia
- deep ocular pain
- blurred vision
- constricted pupil
- circumcorneal injection
- low IOP
tx for iritis?
- homatropine 5% TID/QID
- prednisolone 1% q2h-3h & taper
- blood test if recurrent (serology… autoimmune?)
what are the symptoms of dacryocystitis?
- pain
- redness***
- swelling over the innermost lower lid
- tearing
- discharge (puss out of puncta)
- fever
- tender swelling ***
treatment of dacryocystitis?
- augmentin (500 mg PO q8)
- keflex (500 mg PO q6)
- topical antibiotic
- warm compress
- pain medications
- I&D
- dacryocystorhinostomy DCR (bone removed to allow drainage thru silicone tube straight to nasal mucosa)
symptoms of dacryoadenitis?
- unilateral pain
- redness***
- swelling over outer 1/3 of upper lid***
- tenderness***
- ipsilateral preauricular lymphadenopathy ***
- chemosis ***
- fever ***
- elevated WBC***
- tearing
- discharge
- kids or young adults
treatment for viral and bacterial dacryoadenitis?
bacterial:
- augmentin (500 mg q8)
- keflex (500 mg q6)
- ancef (1 gm IV q8)
viral:
- cool compress
- analgesics
what is blepharitis?
common, persistent inflammation of eye lids by bacteria that thrives on skin at base of eyelash
inflammation results in irritation and overactivity of oil glands resulting in dandruff like scales
when is blepharitis common?
- oily skin
- dandruff
- dry eyes
symptoms of blepharitis?
- dandruff like scales
- itching
- stinging
- burning
- redness
- discharge
what is usually the cause of posterior blepharitis?
meibomian gland dysfunction from ocular rosacea
what is usually the cause of anterior blepharitis?
- staph (hard brittle scales forming around base of eyelashes forming balls)
- corynebacterium (seborrheic) soft, greasy, eyelashes stuck together
tx for blepharitis?
- lid scrubs BID or TID
- antibiotic ointment qHS or BID
- artificial tears
- steroid/antibiotic combos BID to QID
- oral antibiotic for chronic cases
- watch for rosecea
symptoms of hordeolum?
- eyelid lump
- swelling
- pain
- tenderness
- redness
tx of hordeolum?
- warm compress
- topical antibiotic
- oral antibiotic
- kenelog injection (may lead to permanent depigmentation)
- surgery
signs of ectropian?
- tearing
- eye or eyelid irritation
- outward turning of lid
- SPK (corneal exposure)
- conjunctival injection
- thickening of lid margin
- keratinization
tx of ectropian?
- lubricating agents
- warm compresses
- antibiotics
- taping eyelid
- surgical treatment is only thing that will resolve it
symptoms of entropian?
- ocular irritation
- FB sensation
- tearing
- redness
- inward turning of eyelid margin
- SPK (infiltrates of cornea)
tx of entropian?
- antibiotic ointment tid for SPK
- taping lid margin away from globe
- surgery for permanent correction
signs of hyphema?
- redness
- pain
- increased IOP (blockage of trabecular meshwork)
- blood in AC (can cause scaring in angles)
- tears in CB and iris
Treatment for hyphema?
- hospitalized bed rest for 6 days
- head elevated clearing superior angle
- presnisone
- anti glaucoma meds for IOPs?
8 ball hyphema results in…
total vision loss
what are signs of HSV?
- unilateral red eye
- pain
- photophobia
- tearing
- decreased vision
- skin rash on eyelid
- dendritic or stallate keratitis
- decreased corneal sensitivity (no rxn to wisp)
- corneal ulceration
- heaped up swollen epithelial cells stain with rose bengal
treatment for HSV?
- viroptic or Vira A ointment q3h
- cyclogel
- oral acyclovir (400 mg 5x/d 7-14 d)
- ganciclovir (1 ggt 5x/d until lesion heals and then 1 get BID or TID for 7 days)
treatment for chlamydia?
tetracycline (500 mg PO QID)
erythromycin (ung 2-3/d)
follow up 1-3 weeks
how does metal in eye present?
rust ring
corneal edema
treatment for rust ring?
take out with needle, burr out rust
how does a blow out fracture present?
- huge bruise under eye
- eye doesn’t raise up/diplopia
- inferior rectus trapped in sphenous area of inferior orbit (broken)
- blowing nose= conjunctival tissue poking out
