Red eye Flashcards
to be or not to be?
a
causes of red eye (7)
conjunctivitis (blepharitis) keratitiis anterior uveitis scleritis/episcleritis acute angle closed glaucoma subcunjunctival haemorrhage orbital disease e.g cellulitis
History
- PC and what this suggests (7)
- general (4)
-Pain: FB or ache
itch: allergy
Discharge: watery=viral mucoid=alllergy
photophobia
Visual loss: acute, pattern
past ocular disorders
Contacts/glasses
-PMH: eczema/acne
Dhx: might develop allergy
Fam Hx: glaucoma
Social hx: smoking
Examination of the red eye
facial appearance e.g. acne
lids: margins and lashes for ulcers
Conjunctivae: where is the redness, if at cornea suggests karratitis
Cornea: any abrasions
Ant chamber: hypopyon
iris/pupil: irregularity
intra ocular pressure: palpate, acute glaucoma= pebble
Blepharitis
- what is it and types?
- signs of each type (10) and (5)
- treatment (3)
-inflamed eyelids, anterior (seborrhoeic (4) & staphylococcal) and posterior
-anterior: seborrhoeic: lid margin red many scales dandruff lashes unaffected staphylococcal: lid margin red lashes distorted or absent styes/ulceration on lid margin corneal staining, marginal ulcers
Posterior: lid margin unaffected meibomian gland openings swollen dried secretion at gland openings meibomian cysts assoc with acne rosacia
-lid hygeine- daily bathing and warm compress
supplementary tear drops and oral doxycicline
Conjuntivitis
- types (6)
- symptoms (4)
- signs (7)
-infective (viral, bacterial, chlamydial)
other (allergic, chemical/drug, skin disease)
-red eye
foreign body sensation
discharge: very sticky in bacterial
itch: allergy
-red towards fornices
discharge: serous/mucopurulent
papilllae (bacterial)
follicles (viral, allergic, chlamydial)
subconjuntival haemorrhage
chemosis
mild effects on vision
4 features of acute bacterial conjunctivitis
papilllae
red sticky eye
self limiting
commonly staph aureus/staph pneumonia/H.influenza
Herpes Zoster in which distribution causes corneal keratitis?
V1
Examination in suspected keratitis
use anaesthetics if photophobic corneal reflex (absent in opacification) fluorescein to look for abrasions vascularisation opacity oedema
corneal ulcers
- name the two types
- symptoms
- signs
- management
-central (infective) and peripheral (autoimmune)
-pain, needle like and severe photophobia profuse lacrimation vision reduced circum corneal red eye
-corneal reflex abnormal
corneal opacity
may be hypopyon
-Corneal scrape to determine cause
features and treatment of each of the following corneal ulcers:
- bacterial (3)
- Dendritic
- autoimmune
-central location, pupil obscured by white fluid level
inflammation causes collagen deposition and permanent effect on vision
treat: ofloxacin hourly
-herpes simplex, branching and visible on fluorescein use
might reduce sensation if recurrent
treat:aciclovir
-assoc RA, can cause corneal melt and perforation
occur at periphery
treat: anti-inflammatory (oral/topical steroid)
Anterior uveitis
- types (3)
- symptoms (4)
- signs (5)
- management (2)
-Autoimmune e.g. ank spond, sarcoidosis
infective e.g. TB, HS, HZ
malignancy e.g. leukemia
-pain (reffered)
reduced vision
photophobia
red eye
-ciliary injection cells and flare in ant chamber keratotic precipitates hypopyon synechiae (iris adheres to cornea/lens)
-topical steroids- prednisolone
mydriatics
investigate if chronic/recurrent
Episcleritis
- assoc
- indicates what
- treatment
- gout
- tired or dry eyes
- self limiting, lubricants, topical NSAIDs, mild steroids
Scleritis
- assoc
- presentation (2)
- treatment
-systemic vasculitis e.g. granulomatosis with polyangitis, RA
-very painful
injection of vascular plexus giving violaceous hue
-oral NSAIDs, oral steroids, steroid sparing agent
Acute close angle glaucoma
- what is it
- predisposed population
- presentation
- IOP rises acutely due to the drainage angle being closed
- elderly hypermetropic
-severe pain and nausea circum corneal injection cornea cloudy and oedematous pupil mildly dilated unilateral and stony hard on palpation
