Red eye Flashcards
what are some common causes of a red eye?
Conjunctivitis (blepharo-conjunctivitis ) Keratitis Anterior uveitis Scleritis / Episcleritis Acute Angle Closure Glaucoma
what are some rarer causes of red eye?
subconjunctival haemorrhage
orbital disease - cellulitis
what are important ocular history questions to ask in a red eye presenting complaint?
Pain itch discharge / tearing photophobia visual loss past ocular disorders contact lenses
what is blepharitis?
inflamed eyelid
what two types of blepharitis are there?
anterior and posterior
what are some causes of an anterior blepharitis?
seborrhoeic (squamous) - scales on the lashes
staphylococcal - infection involving the lash folicle
how will an anterior blepharitis often present?
lid magin redder than the deeper part of the lid
what is a cause of posterior blepharitis?
meibomian gland dysfunction (MGD)
how does posterior blepharitis often present?
redness in deeper part of lid
lid margin often quite normal looking
what are the symptoms of blepharitis?
similar to conjunctivitis
gritty eyes / foreign body sensation
mild discharge
what are some signs of a seborrhoeic anterior blepharitis?
lid margin red
scales
dandruff
no ulceration - lashes unaffected
what are some signs of staphylococcal anterior blepharitis?
lid margin red
Lashes distorted, loss of lashes, ingrowing lashes - trichiasis
Styes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)
How does Meibomian gland disease” present?
Lid margin skin and lashes unaffected
M.G. openings pouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian Cysts (chalazia)
what diseases is Meibomian gland disease commonly associated with?
acne rosacea - 50%
what is the treatment for blepharitis?
lid hygiene - daily bathing
supplementary tear drops
oral doxycycline for 2-3 months
What are some infective causes of conjunctivitis?
viral
bacterial
chlamydial
what are some non-infective causes of conjunctivitis?
allergic
chemical/drugs
skin diseases - eczema
what are the symptoms of conjunctivitis?
red eye foreign body sensation – gritty eye discharge – sticky eye Itch = allergy VISION UNAFFECTED
what are the signs of conjunctivitis?
Red eye - note pattern of redness – diffuse more towards the fornices
Discharge -
Papillae or Follicles (bumps on inside of eyelid
Sub conj. haemorrhage
Chemosis = oedema
Pre-auricular glands (if viral)
what is a key sign in bacterial conjunctivitis?
sticky discharge
what are the most common infecting organisms in bacterial conjunctivitis?
staph. aureus
strep. pneumoniae
H. influenzae
when is follicular conjunctivitis seen?
viral
chalmaydial
drugs - propane / trruspot
what is chemosis?
conjunctival oedema
what are some causes go chronic conjunctivitis?
blepharitis chlamydial infection lacrimal disease sensitivity of topical glaucoma medication sub-tarsal foreign body
what are some causes of infective corneal ulcers?
viral
fungal
bacterial
acanthamoeba
where do central corneal ulcers present?
centrally
what are some autoimmune causes of corneal ulcer?
Rheumatoid arthritis
hypersensitivity
where do autoimmune corneal ulcers tend to present?
peripherally
what are some symptoms of a corneal ulcer
pain - needle like photophobia profuse lacrimation possible reduced vision red eye- circumcorneal
what are some signs of a corneal ulcer?
redness - circumcorneal
abnormal corneal reflex
corneal opacity
what investigations would you do for a suspected corneal ulcer?
corneal scrape for gram stain and culture
Staining with fluorescein
hypopon - white blood cells forming a fluid level in eye
what shape to ulcers caused by H. simplex tend to be?
dendritic
what diseases are associated with exposure keratitis
thyroid problems VII palsy (bells palsy)
what disease is associated with Keratoconjunctivitis sicca - dry eye
sjogrens
what vitamin deficiency can cause corneal ulcers?
Vitamin A
what is the problem in neurotrophic keratitis?
reduced sensation in the eye
what are some causes of neurotrophic keratitis?
Diabetes
H zoster
V1 problem
what is the treatment of a bacterial corneal ulcer?
ofloxacin hourly
What is the treatment for a herpetic corneal ulcer?
Aciclovir ointment 5 x day
What is the treatment of an autoimmune corneal ulcer?
anti-inflammatory agents - oral / topical steroids
what are some autoimmune causes of anterior uveitis?
Reiter’s, Ulc colitis, Ank Spondylitis, Sarcoidosis
What are some infective causes of anterior uveitis?
T.B. Syphylis, Herpes simplex, Herpes zoster
What are some malignant causes of anterior uveitis?
leukemia
what are the symptoms of anterior uveitis?
Pain (+ referred pain) Vision may be reduced Photophobia Red eye (circumcorneal) (often mistaken as conjunctivitis)
what are the signs of anterior uveitis?
Ciliary injection (i.e. circum-corneal ) Cells & flare in anterior chamber Keratic precipitates Hypopyon Synechiae - Small or irregular pupil
what is the management of anterior uveitis?
topical steroids - red forte 1% hourly tapering over 4-8 hours
mydriatics - Cyclopentolate 1% BD
Investigate for systematic association
what is associated with episcleritis?
gout
what is scleritis associated with?
serious systemic vasculitides e.g. Rh arthritis, Wegener’s
uveitis
what are the signs and symptoms of scleritis?
painful
injection of deep vascular plexus - violaceous hue
what test can be done for scleritis?
phenylephrine test
what is the treatment for episcleritis?
self-limiting
lubricants
topical NSAIDs
what is the treatment for scleritis?
oral NSAIDs
Oral steroids
steroid sparing agents
is acute closed angle glaucoma common or rare?
rare
What happens in acute closed angle glaucoma?
IOP rises do to the drainage angle being closed
what are the signs and symptoms of acute closed angle glaucoma?
severe pain and nausea circumcorneal injection cloudy cornea mid dilated pupil stony hard eye
