Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ophthalmology > Red Eye > Flashcards

Red Eye Flashcards

1
Q

What are some causes of red eye?

A 
Subconjunctival haemorrhage
Episcleritis
Scleritis
Anterior uveitis
Acute glaucoma
Conjunctivitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is subconjuntival haemorrhage?

A

Harmless but alarming pool of blood behind the conjunctiva from a small bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the difference between episcleritis and scleritis

A

Inflammation of the sclera
Episcleritis is frequently self-limiting and usually benign.
Scleritis is much rarer and very painful with sight threatening sequelae.
Episclera lies superificially and so the episcleral vessels will move when probed with a cotton bud and blanch with the application of 10% phenylephrine
Deep scleral vessels will neither move nor blanch.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe episcleritis. Management?

A

Inflammation below the conjunctiva in the episclera is often seen with an inflammatory nodule.
70% women
30% bilateralAcute onset
Focal hyperaemia - sclera may look blow below a focal cone-shaped wedge of engorged vessels that can be moved over the area.

Dull ache and tender over inflamed area
Visual acuity normal
No discharge
May or may not be photophobia

Symptomatic relief with artificial tears and topical/systemic NSAIDs

HPPVADCPPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Things to consider in red eye

A 
Hyperaemia
Pain
Photophobia
Visual acuity
Discharge
Cornea - fluorescein eyedrops to see - ulcers? trauma?
Pupil
Intraocular pressure
Referral?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is scleritis? Association? Management?

A

Generalised inflammation of sclera itself with oedema of conjunctiva and scleral thinning

Anterior and posterior

Necrotizing variety can cause globe perforation

Associated with RA, granulomatosis with polyangitis

Constant severe dull ache ‘bores into eye’, painful ocular movement due to EO muscle attachment
Headache
Photophobia possible

URGENT Referral
Non-necrotising antieorr scleritis - oral NSAIDs and oral high dose prednisolone
Posterior scleritis or evidence of necrotising changes - cyclophosphamide, rituximab and course of methylprednisolone

Globe perforation requires surgery
Prognosis follows that of underlying systemic disorder
Visual loss common in patients with necrotising form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which red eyes require urgent referral?

A

Acute glaucoma
Acute iritis
Corneal ulcers
Scleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is uveitis?

A

The urea is the pigmented part of the eye (iris, ciliary body, choroid)
Anterior uvea comprises of the iris and ciliary body.
Inflammatory processes in this anterior chamber are termed anterior uveitis/iritis

Posterior uvea comprises of the choroid

Intermediate uveitis affects the vitreous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are causes of anterior uveitis? Intermediate? Posterior?

A 
Ankylosing spondylitis
Sarcoidosis
Behcet's 
IBD
Reactive arhritis
Herpes, TB, syphilis, HIV

MS
Lymphoma
Sarcoid

Posterior
Herpes simplex,zoster
TB
CMV
Lymphoma
Sarcoidosis
Behcets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does anterior uveitis present?

A

Conjunctival infection around the junction of the cornea and sclera and increased lacrimation
Photophobia
Pain
Blurred vision
Pupils may be small initially from iris spasm, later irregular or dilate irregularly due to adhesions between lens and iris (synechiae)
Onset - hours to days
Associated with headaches/symptoms of systemic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is anterior uveitis diagnosed?

A

Slit lamp with dilated pupil to visualise the location of inflammatory cells - can see leucocytes in the anterior chamber in anterior uveitis.
OCular imaging such as fundus fluorescein and indocyanide green-angiography are used for retinal, choroidal disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is management for anterior uveitis?

A

Urgent referral to eye clinic
MDT for systemic disease control
Slit lamp to monitor inflammation

Aim to prevent damage from prolongedd inflammation
Disrupts the flow of aqueous - glaucoma and adhesions between iris and lens - synechiae

Prednisolone to reduce inflammation
Cyclopentolate 1%/atropine (keeps pupil dilated_ to prevent synechiae and to relieve ciliary body spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe acute closed-angle glaucoma.

A

Rise in intraocular pressure secondary to angle of anterior chamber narrowing acutely causing a sudden rise in itraocular pressure >30 (normal is 15-20) due to impairment of aqueous outflow.
Pupil becomes fixed and dilated and axonal cell death occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is acute glaucoma presentation

A 
Hard red eye
Severe pain
No photophobia
Reduced visual acuity
No discharge
Steamy or hazy cornea due to oedema
Large pupil
Raised IOP

Symptoms worse with mydriasis - in dark room watching TV
Haloes around lights
Nausea and vomiting
Semi-dilated non re-acting pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are predisposing factors?

A

Hypermetropia
Pupillary dilatation - topical cyclopentolate for uveitis
Lens growth associated with age - thick lens
Thin iris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Management for acute glaucoma?

A

Urgent referral
Beta blockers to suppress aqueous humour production (timolol)
Pilocarpine topical (miosis opens a blocked closed drainage angle)
Acetazolamide - reduces aqueous formation

analgesia and antiemetics
Admit to monitor IOP
Peripheral iridectomy - laser or surgery - once IOP is controlled - piece of iris is removed at 12 o clock in both eyes to allow aqueous flow.

17
Q

What are complications of angle closure glaucoma?

A

Visual loss
Central retinal artery or retinal vein occlusions
Repeated episodes in either eye.

18
Q

Describe the flow of aqueous humour

A 
Produced by ciliary body
Flows through posterior chamber
Through pupil
Anterior chamber
Drainage angle through canna of Schlemm in trabecular meshwork.
19
Q

Describe conjunctivitis

A

Conjunctiva red and inflamed
Exclusion diagnosis
Acuity, pupil responses and cornea are unaffected
Eyes itch, burn and lacrimal.
Bilateral with discharge sticking lids together.

20
Q

What are non-infectious and infectious causes of conjunctivitis?

A 
Allergic
Contact lenses
Toxic
Auto-immuine
Neoplastic

Non-herpetic viral
Adenoviruses
Bacterial - purulent discharge more prominent, staph are common, gonococcal infection

21
Q

What investigations in conjunctivitis?

A

Conjunctival cultures only required if gonococcal/chlamydial infection, neonatal infection, or recurred disease not responding

22
Q

What management for conjunctivitis?

A

Symptomatic relief with artificial tears and topical anti-histamines.

Viral - Hand and face washing to prevent transmission.

Bacterial - self limiting within 1-2 weeks but topical antibiotics can reduce the duration of symptoms and reduce transmission risk.
Start abx immediately if sexual disease is suspected, contact lens wearers, or immonucompromised patients
Chloramphenicol 0.5%

Consider chlamydial infection in prolonged conjunctivitis.

For allergic conjunctivitis - try antihistamine drops - emedastine, olopatadine.

23
Q

What is keratitis?

A

Corneal inflammation - identified by a white area on the cornea indicating a collection of white cells in corneal tissue
Keratoconjunctivitis refers to conjunctivitis with associated corneal involvement.

24
Q

What is corneal abrasion?

A

Epithelial breach causing pain, photophobia and reduced vision.
Non-infective corneal ulcers may result from accidental scratches from sharp objects, contact lenses, trauma, chemical injury

Corneal lesions stain green on fluorescein drops and blue light on slit lamp.
Drops are orange and become more yellow on contact with eye
Always invert the eyelid to look for forming bodies

25
Q

What are corneal ulcer causes?

A 
Bacterial - pseudomonas may progress rapidly
Herpetic
Fungal (candida, aspergillus
Protozoal
Vasculitis e.g. in RA
26
Q

Describe management of corneal ulcers.

A

Get urgent help for diagnostic smear, gram stain
In early stages of ophthalmic shingles use oral acyclovir
Cycloplegics ease photophobia

Remove contact lenses
Test cranial nerve V
HIV +?

Until cultures, alterant chloramphenicol drops (for gram +) and ofloxacin drops for gram -
or cefuroxime drops with gentamicin drops

Adapt in light of cultures

Ophthalmology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions