Red Eye Flashcards
Name 12 dangerous associated features with red eye
1) Severe ocular pain
2) Photophobia
3) Persistent blurred vision or decreased visual acuity
4) Proptosis
5) Irregular corneal light reflection
6) Worsening signs after 3 days of pharmacologic treatment
7) Corneal epithelial defect or opacity
8) Pupil unreactive to direct light
9) Ciliary flush
10) Reduced ocular movements
11) Compromised host: neonate, immunosuppressed, contact lens wearer
12) Severe HA with nausea
Name 10 DDx of red eye
Abnormalities of the lids or lashes
Conjunctivitis (allergic, bacterial, viral or chemical)
Periorbital (preseptal) or orbital cellulitis
Corneal abrasion (trauma)
Chemical burn
Subconjunctival hemorrhage
Contact lens related problem
Ocular inflammation from systemic disease (uveitis, episcleritis)
Neoplasms
FB
Name 7 systemic diseases associated with red eyes
Collagen vascular disorders Juvenile Rheumatoid arthritis Infectious diseases (varicella, measles, mumps, otitis media) Kawasaki disease IBD Cystic fibrosis Stevens-Johnson syndrome
What are the clinical characteristics of bacterial conjunctivitis?
Mucopurulent discharge
Involves one but can spread to the other eye
Bulbar conjunctivitis
Pathogens:
H. flu
Streptococcus pneumoniae
Staph
Tx:
Topical antibiotic eye drops q4-6h or ointment TID for younger kids
Polytrim
What is hyperacute bacterial conjunctivitis?
Profuse purulent discharge
Marked chemosis and lid swelling
Tender preauricular adenopathy
Neisseria gonorrhoeae
Can cause keratitis
Cx the eye discharge
Associated with genital, hands and urethritis
Needs admission and IV Abx
Describe the distinguishing features of stye, chalazion, and hordeolum and their treatment
Hordeolum - can be a stye (external) or a chalazion (internal)
Stye - external - acute infection of the Zeis’ gland
- Caused by Staph or S. epidermidis
- Tx - warm compresses and pluck out the eyelash of the involved eyelash follicle
Chalazion - internal - obstruction of the mebomian gland
- sterile inflammation
- mild or absent pain
- RF - seborrhea, acne, blepharitis
- Tx - warm compresses, and topical Abx if infected
What symptoms distinguish between allergic and viral conjunctivitis?
Itching
Others:
Grittiness
Burning
Irritation
Associated with Hx of atopy, seasonal or specific allergy
What are the different forms of allergic conjunctivitis?
ACUTE
Sudden onset once in contact with a known allergen - resolves in 24h with removal of the allergen
SEASONAL
Milder
More persistent Sx during a particular pollen season
PERENNIAL
Related to year round environmental allergens (usually indoor)
Tx with topical or oral antihistamine +/- mast cell stabilizer
(Ketotifen)
What is the most common cause of conjunctivitis in a newborn?
Few hours old - chemical conjunctivitis (likely due to prophylaxis for prevention of ophthalmia neonatorum
True neonatal conjunctivitis doesn’t occur before 48h
Infectious conjunctivitis (onset):
- N. gonorheae (2-4 days)
- Staph or Streptococci (4-7 days)
- Chlamydia (4-10 days)
- H. flu (5-10 days)
- HSV Type 1 (6 days to 2 weeks)
Name 2 groups most often diagnosed with gonococcal conjunctivitis
Neonates
Sexually active adolescents
Name the classic signs of orbital cellulitis
Erythema/edema of the eyelids Decreased EOM Proptosis Decreased vision Papilledema
What are the potential complications of orbital cellulitis?
Vision loss Meningitis Cavernous sinus thrombosis Brain abscess Death
How do you manage orbital cellulitis
Admit
IV Abx
CT head to identify abscess formation, sinusitis (cause)
Ophtho consult for possible drainage
Define periorbital cellulitis
Preseptal cellulitis
Infection of the tissues of the eyelids that does NOT involve the posterior orbit
Normal visual acuity and EOM
Need CT to differentiate from orbital cellulitis if eye so swollen you can’t assess it fully
Can Tx with PO Abx or outpatient IV with close FU in 24-48h
Admit if not responding to Tx or worsening disease
Name RF for periorbital cellulitis
Eyelid trauma
Impetigo
Dacrocystitis (infection of the tear sac)
Infections of the oil glands/lid margins of the eyelid
