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RED EYE Flashcards

1
Q

What makes up the anterior segment of the eye?

A

Conjunctiva

Sclera/episclera

Cornea

Iris

Lens

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2
Q

What are the differential diagnoses for a red eye?

A

Subconjunctival haemorrhage

Blepharitis - inflammation at base of eyelash

Conjunctivitis

Trauma - abrasion / foreign body

Keratitis - inflammation of the cornea

Anterior uveitis (iritis)

Episcleritis

Scleritis

Primary angle closure glaucoma

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3
Q

What is the most common cause of a red eye?

A

Spontaneous subconjunctival haemorrhage

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4
Q

What is likely to cause a spontaneous subconjunctival haemorrhage?

A

Sneezing

Coughing

Valsava manoeuvre, including straining on the toilet

Antiplatelet/anticoagulation medication

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5
Q

When might apparent subconjunctival haemorrhage be an indication of something more sinister?

A

If they are bilateral

If there is no posterior border

Can be a sign of base of skull fracture

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6
Q

What is blepharitis?

A

Inflammation of the eyelid margins.

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7
Q

What is the difference between anterior blepharitis and posterior blepharitis? Which is more common?

A

Anterior blepharitis is due to sebarrhoeic dermatitis or staphylococcal infection.

Posterior blepharitis meibomian gland dysfunction.

Posterior blepharitis is more common.

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8
Q

What are the conditions associated with blepharitis?

A

Rosacea

Molluscum contagiosum

Allergic dermatitis

Contact dermatitis

Seborrheic dermatitis

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9
Q

What is the purpose of the meibomian glands?

A

They secrete oil onto the eye surface to prevent rapid evaporation of the tear film. Problems with the glands such as blepharitis can therefore cause drying of the eye and irritation.

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10
Q

What are the clinical features of blepharitis?

A

Grittiness and discomfort around eyelid margin

Sticky eyes in the morning

Red eyelid margin

Swollen eyelids

Styes and chalazions - compications of blepharitis

Entropion: in-turning of the eyelids

Ectropion: out-turning of the eyelids

Secondary conjunctivitis may occur

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11
Q

How do we manage someone with blepharitis?

A

Softening of the lid margin using hot compresses twice a day

Mechanical removal of the debris from lid margins - cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used or alternatively a tea-spoon of sodium bicarbonate in cooled boiled water

Artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

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12
Q

What is a stye?

A

Infection of the glands of the eyelid

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13
Q

What are the different types of stye?

A

External (hordeolum externum): infection (usually staphylococcal) of the glands of Zeis (sebum producing) or glands of Moll (sweat glands).

Internal (hordeolum internum): infection of the Meibomian glands. May leave a residual chalazion (Meibomian cyst)

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14
Q

How do we manage someone with a stye?

A

Hot compresses and analgesia

Topical antibiotics if associated with conjunctivitis

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15
Q

What is a chalazion and how is it managed?

A

Also called a Meibomian cyst - it is a retention cyst of the Meibomian gland in the eyelid. It presents as a firm painless lump in the eyelid.

Majority of cases resolve spontaneously but some require surgical drainage.

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16
Q

What are the three main types of conjunctivitis?

A

Bacterial

Viral

Allergic

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17
Q

What are the features of bacterial conjunctivitis?

A

Sore red eye

Sticky purulent discharge

Eyes may be stuck together in the morning.

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18
Q

What are the features of viral conjunctivitis?

A

Sore red eye

Serous discharge

Recent URTI

Preauricular lymph nodes

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19
Q

What are the features of allergic conjunctivitis?

A

Symptoms will be bilateral

Itchy red eyes

History of atopy

Seasonal history: pollen

Perennial history: dust mite, washing powder, etc

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20
Q

How might you tell the difference between viral and bacterial conjunctivitis?

A

Viral - inflammed conjunctiva injected with follicles (small white bumps on the conjunctiva) with or without tender pre-auricular lymphadenopathy. Subconjunctival haemorrhage may also be present.

Bacterial - inflammed conjunctiva, injected with subtarsal and bulbar papillae (red cobblestone appearance to conjunctiva). Excessive purulent discharge also often a feature.

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21
Q

How do we manage someone with infective conjunctivitis?

A

Usually self-limiting within 1-2 weeks

Topical antibiotics can be used - chloramphenicol is first line

May want to do swabs to confirm culture and sensitivity

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22
Q

What is the second line topical antibiotic for conjunctivitis, and the one that should be used in pregnant women?

A

Topical fusidic acid BD

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23
Q

What advice should you give to someone who has conjunctivitis?

A

Avoid use of contact lenses

Do not share towels

24
Q

Is school exclusion necessary for a child with conjunctivitis?

25
How do we manage allergic conjunctivitis?
Topical or systemic antihistamines - Emedastine difumarate (Emadine) Topical mast-cell stabilisers - sodium cromoglicate and nedocromil
26
What is keratitis?
Inflammation of the cornea
27
What are the infective causes of keratitis?
Viral: herpes simplex, herpes zoster Bacterial: S. aureus, Pseudomonas (with contact lens wearers) Fungal Amoebic: acanthamoebic keratitis Parasitic: onchocercal keratitis (river blindness)
28
What are the environmental causes of keratitis?
Photokeratitis: e.g. welder's arc eye Exposure keratitis Contact lens acute red eye (CLARE) - a non-ulcerative sterile keratitis associated with colonization of Gram-negative bacteria on contact lenses
29
What is Acanthamoeba keratitis?
A rare disease in which amoebae invade the cornea of the eye. It may result in permanent visual impairment or blindness. It is associated with prolonged contact lens use.
30
What are the clinical features of keratitis?
Red eye Pain Infiltrates - whitish, cloudy lesion Gritty sensation Hypopyon Epiphora - excessive tear production Decreased visual acuity
31
What might help you examine the cornea of a patient?
Topical fluorescein and illumination with cobalt blue light.
32
How do we manage herpes simplex keratitis?
Immediate referral to an ophthalmologist Topical aciclovir
33
What is the uvea and what are its 3 components?
Vascular middle layer of the eye: Iris Ciliary body Choroid
34
What are the infectious causes of anterior uveitis?
Brucellosis Leptospirosis Lyme disease Presumed ocular histoplasmosis syndrome Syphilis Toxoplasmic chorioretinitis Tuberculosis
35
What are the non-infectious autoimmune causes of anterior uveitis?
Behçet disease Crohn's disease Fuchs heterochromic iridocyclitis Granulomatosis with polyangiitis HLA-B27 related uveitis Juvenile idiopathic arthritis Sarcoidosis Spondyloarthritis Sympathetic ophthalmia Tubulointerstitial nephritis and uveitis syndrome
36
What are the clinical features of anterior uveitis?
Acute onset Pain, especially when moving the eye Blurred vision Photophobia Red eye Small fixed oval pupils Ciliary flush Hypopyon Visual acuity initially normal but becomes impaired
37
What is hypopyon in the context of anterior uveitis?
Pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
38
How do we manage a patient with anterior uveitis?
Ophthalmology review Cycloplegics - Atropine, cyclopentolate (dilates the pupil which helps to relieve pain and photophobia) Steroid eye drops
39
What is scleritis?
Inflammation of the sclera
40
What are the different types of scleritis?
Anterior (98%) Posterior (2%) Within anterior: Non-necrotising (common) and necrotisiing (13%)
41
What is the pathophysiology of scleritis?
Normally non infectious. Features of chronic granulomatous disorder. May be evidence of vasculitis
42
What is the difference between episcleritis and scleritis?
Episcleritis is inflammation of the superficial, episcleral layer of the eye. It is relatively common, benign and self-limiting. Scleritis is inflammation involving the sclera. It is a severe ocular inflammation which is painful, often with ocular complications, which nearly always requires systemic treatment.
43
What are the clinical features of scleritis?
Redness of sclera and conjunctiva - can take on violet colour Distention of all the scleral and episcleral vessels which may appear tortuous. Severe aching pain when lid is pressed directly over the area. Pain on movement Photophobia Decreased visual acuity
44
What diseases are associated with scleritis?
Rheumatoid arthritis Granulomatosis with polyangiitis Systemic vasculitis Seronegative spondylo-arthropathies
45
What are the clinical features of episcleritis?
Less striking (than scleritis) reddish hue
46
What is an easy way to dissociate between scleritis and episcleritis if you are not sure about the diagnosis after clinical examination?
Use a single drop of 2.5% phenylephrine - this will constrict episcleral vessels, making the eye appear blanched (whiter). The same will not happen in scleritis.
47
How do we manage scleritis?
Refer for urgent review by ophthalmologist Oral corticosteroids NSAIDs to help with pain
48
What are the symptoms of acute angle closure glaucoma? (see specific deck for more info)
Severe pain - may be ocular or headache Decreased visual acuity Patient sees halos Tunneling of vision Red eye
49
What are the signs of acute angle closure glaucoma seen on examination? (see specific deck for more info)
Red eye Decreased acuity Semi-dilated pupil Hazy/cloudy cornea
50
If a patient with a red painful eye reports visual loss, what is this suggestive of?
Corneal involvement: Microbial keratitis Herpetic keratitis Corneal oedema in primary angle closure Large corneal abrasion Significant inflammatory component - scleritis or iritis
51
If a patient described the pain of their red eye as involving grittiness and irritation, what would this be suggestive of?
Conjunctivitis Blepharitis (infection of the base of an eyelash)
52
If a patient with a painful red eye was photophobic, what would this be suggestive of?
Anterior uveitis or iritis Keratitis Scleritis
53
If a patient with a painful red eye described the pain as a dull, boring ache, what would this be suggestive of?
Anterior scleritis - the pain despite being dull and boring might still be enough to keep them awake at night.
54
If a patient presents with a history of a red, discharging eye which has lasted over a period of months, what is this suggestive of?
Unlikely to be bacterial or viral conjunctivitis, however it could be chlamydia. Floppy eyelid syndrome. Molluscum contagiosum - skin lesion which can cause these symptoms if on the eyelid (in the younger age group)
55
How would you describe the discharge of the eye associated with a chlamydia infection?
Thick and accumulates in rope-like strands
56
If a patient with a painful red eye reports excessive lacrimation, what is this suggestive of?
Corneal abrasion Corneal foreign body Subtarsal foreign body (body until top eyelid) Trichiasis (eyelash in the eye)
57
What is clear discharge with stickiness of the eyelids in the morning suggestive of?
Blepharitis

ophthalm (13 decks)

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