Red Eye Flashcards
Primary care red eye probloems
- bilateral
- asymptomatic/scratchy/itchy
- bright red
- normal VA
- dryness or wateriness
Tertiary care red eye problems
- unilateral
- painful
- deep red
- decreased VA
- photophobia
Examples of primary care red eye problems
- blepharitis
- conjunctivitis
- foreign body
- subconjunctival haemorrhage
- pterygium/ pingeculum
Useful diagnostic feaures of viral conjunctivitis
- preauricular nodes
- history of URTI
- becomes bilateral
Treatment of viral conjunctivitis
- stay at home
- symptomatic treatment
Treatment of bacterial conjunctivitis
- wash frequently with boiled water on a clean swab
- topical antibiotic (chloromycetin)
Treatment for gonococcal conjunctivitis
- ceftriaxone 125mg IMI stat
- topical ciprofloxacin half hrly
How to diagnose chlamydial conjunctivitis
- immunofluorescence of conjunctival swab
Treatment of chlamydial conjunctivitis
- topical tetracycline ointment
- systemic tetracycline if STD symptoms
Signs of vernal conjunctivitis
- Tranta’s dots (dark skin)
- tarsal papillae in pale skine
Treatment of acute itchy eye (allergic)
- remove the cause
- topical or systemic antihistamine
Treatment of seasonal/perennial/atopic conjunctivitis
- if mild, topical antihistamines, vasoconstrictors or lubricants
- if chronic, prophylactic sodium chromoglycate QID
- if severe, refer for steroid treatment
What causes a phlycten?
- TB or staph hypersensitivity
Treatment of a phylcten
- treat cause
- refer for eye management
Causes of pterygium and pingueculum
- UV light exposure
- living in a dry dusty environment
- hereditary factors
Treatment of pterygium and pingueculum
- artificial tears for scratchy burny lesions
- vasoconstrictors
- topical NSAIDS for inflamed lesions
- steroids may be used by ophthalmologists
When is surgery used for a pterygium
- if the pupil margin is invaded
Complications of pyterygium surgery
- scleral melt
- severe pain
- recurrence
Treatment of arc eye
- panado
- cold compress
- reassure that it should improve in 48hr
- max 1 drop LA
What is trichiasis
ingrown eyelash
Characteristics of episcleritis
- pricking pain
- superficial redness
- blanches with phenylephrine
Treatment of episcleritis
- none if mild
- topical or systemic NSAIDS if marked discomfort
Treatment of Meibomian cyst/ chalazion
- lid massage with hot compress
- drain if large
- doxycycline 100mg po dly for 3 months is recurrent/multiple
Treatment of a stye
- warm compress
- topical antibiotic ointment
What is blepharitis?
- inflammation of the eyelid
Treatment of blepharitis
- twice daily scrubs with baby shampoo
Treatment of chronic blepharitis
- doxycycline 100mg PO dly
Examples of tertiary care red eye problems
- keratitis
- endophthalmitis
- uveitis/ iritis
- acute scleritis
- acute glaucoma
Types of keratitis
- viral
- bacterial
- fungal
- immune
Treatment of primary herpes simplex
- if no corneal staining, treat symptomatically
- if staining, refer for acyclovir
Features of a dendritic ulcer
- characteristic staining pattern (grey line without fluorescein)
- reduced corneal sensation
Treatment of a dendritic ulcer
- refer for acyclovir ointment
- never prescribe steroids!
Complications of herpes simplex
- scarring and vascularisation
- geographic ulcer from steroid use
Characteristics of bacterial keratitis
- round grey infiltrate which may stain
- bacterial ulcers can perforate, causing endophthalmitis and blindness
- refer within 24hrs
Characteristics of a fungal abscess
- fluffy grey infiltrate and satellite lesions
- refer
What causes mardinal keratitis
staphylococcal hypersensitivity (refer)
What is endophthalmitis?
infection of the inside of the eye after surgery, injury or septicaemia
- causes rapid blindness
What is hypopyon?
Leukocytic exudate in anterior chamber
Possible signs of uveitis
- keratic percipitates
- hypopyon
- ciliary flush
- posterior synechiae and iris granuloma
Characteristics of scleritis
- beefy red injection not blaching with phenylephrine
- boring ache that keeps patient awake at night
