Red Eye Flashcards
1
Q
red eye ddx
A
- acute angle glaucoma: serious
- iritis, iridocyclitis, uveitis: inflammation of uveal tract (iris, ciliary body, choroid)
- herpes simplex keratitis: corneal inflammation, common, serious, leads to scarring and other sequelae
2
Q
conjunctivitis as part of red eye ddx
A
- hyperemia of conjunctival blood vessels
- very common
- can be viral, allergic, bacterial, toxic, or systemic
- usually not serious
3
Q
episcleritis
A
- often sectorial inflammation of episclera b/w conjunctiva and the sclera
- uncommon
- no discharge
- some pain (if over the eye m.)
- usually not serious
4
Q
scleritis
A
- localized or diffuse scleral inflammation
- not common, serious
- deep boring pain is classic
- often protracted
- may indicated collagen vascular disease
5
Q
adnexal disease
A
- eyelids (stye and blepharitis, not serious)
- lacrimal apparatus including dacrocystitis and orbit
- secondary causes include basal cell carcinoma, squamous cell cancer, molluscum contagiosum, thyroid disease, vascular lesions (serious)
6
Q
spontaneous subconjunctival hemorrhage
A
- common, NOT serious but very alarming to pt and some drs
- heme in the potential space b/w the conjunctiva and sclera
- causes: increase in ocular venous pressure, coughing, sneezing, vomiting or vigorous eye rubbing; if recurrent it could indicate a bleeding disorder
7
Q
pterygium
A
- starts as a pinguecula
- solar elastotic degeneration of the conjunctiva
- advances over the cornea
- region b/w 2 eyelids is most common location; 3 and 9o’clock position and can grow onto cornea
- medical or surgical tx
8
Q
keratoconjunctivitis sicca
A
- dry eyes, lacrimal insufficiency, many systemic associations
- Sjogren’s syndrome: dry eyes, dry mouth, rheumatoid arthritis
- usually not serious
9
Q
irriatative hyperemia
A
- can be result of abrasions and foreign bodies
10
Q
abnormalities of lid function
A
- Bell’s palsy
- thyroid ophthalmopathy
- ectropion
- entropion
- other lid lesion lead to red eye
11
Q
red eye signs: types of discharge and what they suggest
A
- hyperemia: non specific
- discharge: big important clue
- purulent suggests bacterial cause
- mucopurulent suggest bacterial, viral or mixed causation
- serous suggests viral cause
- scant white stringy discharge suggests allergy or dry eyes (keratitis sicca)
- oily discharge w/ greasy lids suggests blepharitis; w/ focal telangiectasia of lid margins = Acne Rosacea
- profuse purulence: r/o serious bacterial infection like N. gonorrheae
- lymphadenopathy: preauricular is common in viral conjunctivitis, possible in severe bact. conjunctivitis, and present in chronic granulomatous conjunctivitis
12
Q
reduced visual acuity
A
- reduced visual acuity: serious disease, should never occur in a simple conjunctivitis
13
Q
ciliary flush
A
injection of deep conjunctival and episcleral vessels overlying ciliary region near limbus; best seen in sunlight, appears violaceous, usually not seen in simple conjunctivitis
14
Q
corneal opacity
A
could be KPs, corneal edema, ulcers, leukomas
15
Q
epithelial disruption
A
- conjunctival or corneal
- look at light reflex in different positions and look for distortion or irregularities
16
Q
pupils
A
- iritis will cause miosis on affected side and photophobia in both eyes
- chronic or previous iritis may cause synechiae or adhesions b/w the iris and lens
- acute NAG usually has a fixed oval mid-dilated pupil w/ a shallow anterior chamber
- conjunctivitis does not affect the pupil
17
Q
elevated IOP
A
- in acute angle glaucoma
- rarely in iritis due to trabeculitis
- not found in conjunctivitis alone
18
Q
proptosis
A
- forward displacement of the globe
- sudden onset suggests serious orbital or cavernous sinus disease
- kids may have orbital cellulitis, rhabdomyosarcoma, neuroblastoma
- adults commonly have thyroid related immune oritopathy or tumors
19
Q
itching
A
- nonspecific
- usually indicates allergy
20
Q
exudation
A
- “mattering” –> the sandman, lids stuck together in the morning
- due to lid or conjunctival irritation
- nonspecific
21
Q
blurred vision
A
- in conjunctivitis, blepharitis, dry eyes
- will clear w/ blinking
22
Q
severe pain
A
- keratitis, corneal ulcer, scleritis (deep boring pain common), iritis, acute glaucoma
- conjunctivitis and other surface diseases cause scratchiness or mild irritation
23
Q
photophobia
A
- pts w/ conjunctivitis may c/o photophobia
- observed w/ bright illumination especially c/l photophobia
- suggest serious ocular disease like iritis
24
Q
colored haloes
A
- usually from corneal edema
- causes include acute NAG (narrow angle glaucoma)
25
red eye: systemic associations
- URI and fever: adenovirus type 3 and 7 cause pharnygoconjunctival fever
- allergy: seasonal rhinitis and hay fever
- erythema multiforme (Stevens-Johnson syndrome): allergic mediated response often to meds like sulfa; can result in scarring and blindness
26
red eye: lab dx
- don't need it for mild cases
- cases w/o improvement after several days of tx should be referred
- hyperpurulent conjunctivitis w/ copious d/c should be cultured and referred
27
blepharitis
- inflammation of the eyelid
- chronic disease w/ frequent relapses
- eradicate staphylococci w/ antibiotic e.g. erythromycin ointment
- tx of scalp seborrhea w/ antidandruff shampoos
- cleansing of lids w/ warm water and dilute baby shampoo
28
stye
- hordeolum: acute inflammation of glands or hair follicles of the lid, external or internal
- chalazion: chronic inflammation of meibomian glands, may follow a hordeolum
- tx w/ hot compresses and antibiotic ointment
- incision and curettage if not resolving
- persistent or recurrent lesion may be cancer
29
conjunctivitis
- tx w/ antibiotic drops e.g. tobramycin 0.3% QID
- consider ointments esp. in kids
- hot compresses for bacterial, cool for allergic
- viral conjunctivitis has no specific tx, avoid spreading
30
red eye: tx warnings
- topical anesthetics should NEVER be prescribed for analgesia b/c they inhibit growth and healing of corneal epithelium
- may produce allergic rxn
- corneal anesthesia eliminates the blink reflex, exposes the cornea to dehydration, injury and infection
31
red eye: steroids
- never use corticosteroids to tx infectious conjunctivitis
- avoid antibiotic-steroid combo drops
- side effects: exacerbation of herpetic and fungal keritis; eye may feel better while it melts away and perforates
- cataract from prolonged local or systemic administration
- elevated IOP and secondary glaucoma
