Red Eye Flashcards
What are the differentials of a painless red eye?
Conjunctivitis
Episcleritis
Subconjunctival haemorrhage
What are the differentials of a painful red eye?
Glaucoma Anterior uveitis Scleritis Keratitis Foreign body
What are the three types of conjunctivitis and how do they present?
Bacterial: purulent discharge, worse in morning
Viral: raised pre auricular lymph nodes, clear discharge
Allergic: watery discharge and itch
Unilateral or bilateral
Red eye
Gritty sensation
Discharge
What is the management of conjunctivitis?
Usually gets better without any treatment in 2-3 weeks.
If bacterial, can give chloramphenicol eye drops.
How does a subconjunctival haemorrhage present and what are the causes?
Painless, bright red blood patch (burst blood vessel) between sclera and conjunctiva. Usually idiopathic or due to coughing, sneezing or heavy lifting.
Can cause it: Hypertension Bleeding disorders Whooping cough Blood thinners NAI
What occurs in anterior uveitis?
Inflammation in the anterior part of the uvea
Neutrophils, lymphocytes and macrophages invade the anterior chamber = floaters
What is anterior uveitis associated with?
HLA B27 conditions:
Ankylosing spondylitis
IBD
Reactive arthritis
How does anterior uveitis present?
Unilateral symptoms that start spontaneously Dull, aching, pain Ciliary flush Photophobia (ciliary muscle spasm) Excessive lacrimation Abnormally shaped pupil
What can be used to treat anterior uveitis?
Steroids
Cycloplegic-mydriatic medications (e.g. atropine, these dilate and fix the pupil)
Immunosuppresants (DMARDs, TNFi)
What is blepharitis?
Inflammation of the lid margins causing chronically irritable red eyes
Red margins or scales will be seen
Use hot compresses, lubricating eye drops and treat with fucithalmic ointment
What are complications of contact lens wear?
Corneal abrasion
Allergic reaction
Neovascularisation
Corneal ulcer
What are the symptoms of corneal abrasion?
A feeling like there is something in your eye
Pain
Tearing
Redness
What is a Stye?
Infection of the glands of Moll (sweat glands at base of eyelashes), glands of Zeis (sebaceous glands at base of eyelashes), infection of the Meibomian glands
What is a Chalazion?
When a Meibomian cyst becomes blocked up
Swelling in the eye that is typically not tender
What is preorbital cellulitis and how does this present?
Eyelid and skin infection in front of orbital septum (around the eye)
CT scan differentiates between this and orbital cellulitis
Systemic antibiotics
What is orbital cellulitis and how does this present?
Infection that involves tissues behind the septum
Differential features: pain on eye movement, reduced eye movements, changes is vision, abnormal pupil reactions
Requires admission and IV antibiotics urgently
Describe the pathophysiology of acute angle closure glaucoma
Ciliary epithelium secretes aqueous humor in the posterior chamber
Humor travels to the anterior chamber
Fluid flows out through the trabecular meshwork and into the canal of Schlemm and then into aqueous veins
In acute glaucoma this becomes fully blocked
Increased intraocular pressure causes atrophy of the outer rim of the optic nerve = peripheral vision loss
What are the clinical signs of acute angle closure glaucoma?
Optic nerve damage (disc cupping)
Visual field loss (peripheral, and sausage shaped blind spots)
High disc to cup ratio
Abrupt onset of eye pain, redness, blurry vision, headache, halos around yees
What is the initial management of acute angle closure glaucoma?
While waiting for an ambulance:
Lie patient on back,
Pilocarpine eye drops (pilocarpine acts on muscarinic receptors and causes pupil to constrict and the pathway to open up)
Acetazolamide 500mg (reduces production of aqueous humor)
What are the long term management options that can be used for glaucoma?
Topical prostaglandin (latanoprost): increases outflow of aqueous secretion
Topical B Blockers (timolol), and topical carbonic anhydrase inhibitors (dorzolamide): decrease aqueous humor production
Topical a agonists (brimonidine): decreases aqueous secretion and increases outflow
