Red eye

Question 1

What are causes of red eye?

Answer 1

Anterior uveitis
Keratitis
Scleritis
Conjunctivitis 
Orbital cellulitis
Entropion/ectropion
Blepharitis
Dry eye 
Corneal ulcer
Corneal abrasion
Foreign body 
Subconjunctival haemorrhage
AACG

Question 2

What is anterior uveitis?

Answer 2

inflammation of the iris and ciliary body

Question 3

What is anterior uveitis associated with?

Answer 3

HLA-B27 conditions:

• Ank spond
• Reactive arthritis
• UC/Crohns
• Sarcoidosis

Question 4

What are the features of anterior uveitis?

Answer 4

• Acute onset ocular discomfort + pain
• Photophobia
• Blurred vision
• Lacrimation
• Reduced acuity
• Small irregular pupil
• Hypopyon - visible fluid level due to pus in anterior chamber

Question 5

What investigations/tests would u do for anterior uveitis?

Answer 5

+ve Talbots test - pain on convergence (eyes move inward toward each other)
Slit lamp - white precipitates on back of cornea

Question 6

What is the management of anterior uveitis?

Answer 6

1. Pred - eye drops

2. Cycloplegics - dilate pupil to relieve pain + photophobia - atropine, cyclopentolate

Question 7

What is keratitis?

Answer 7

USUALLY INFECTIOUS

inflammation and damage to the cornea

Question 8

What are RFs for keratitis?

Answer 8

contact lens
corneal trauma
corneal abrasions
poor immune function

Question 9

what are the sx of keratitis?

Answer 9

Red
EXTREMELY painful
Poor acuity
Highly photophobic

Question 10

What can be seen on examination in keratitis?

Answer 10

Corneal ulcer

Corneal oedema and opacification

Question 11

What ix can be done for keratitis?

Answer 11

corneal scraping MC+S

Question 12

What is the management of keratitis?

Answer 12

1. Topical abx combos or quinolone - depends on cause

2. Sx relief - atropine

Question 13

How does conjunctivitis present?

Answer 13

red itchy burning lacrimating eyes

Sticky discharge

Question 14

What self care advice is given for conjunctivitis?

Answer 14

Most acute infectious cases are self-limiting in 1-2w: cleaning in sterile saline, cool compresses, lubricating drops
don’t wear contact lenses
V contagious so don’t share towels

Question 15

When are abx required for conjunctivitis? What would u give?

Answer 15

if severe
Topical chloramphenicol
Topical fusidic acid if pregnant

Question 16

What is allergic conjunctivitis most commonly associated w?

Answer 16

hay fever

Question 17

What are the features of allergic conjunctivitis?

Answer 17

Bilateral erythema and swelling
Itch
Swollen eyelids 
Hx of atopy 
Seasonal

Question 18

What is the treatment of allergic conjunctivitis?

Answer 18

antihistamine drops

Question 19

How does scleritis present?

Answer 19

severe ocular pain (deep boring) and redness
no discharge
reduced visual acuity

Question 20

What is scleritis associated w?

Answer 20

CTDs

RA

Question 21

What tests would u do in scleritis?

Answer 21

ESR

ANCA - AAV

Question 22

What is treatment of scleritis?

Answer 22

oral steroids/immunosuppression - ciprofloxacin

Question 23

How does episcleritis present?

Answer 23

red eye
classically not painful
watering and mild photophobia
sometimes bilateral

Question 24

What is the management of episcleritis?

Answer 24

Topical or systemic NSAIDs

Question 25

How does herpes simplex keratitis present?

Answer 25

dendritic corneal ulcers w fluorescein dye
V photophobic
Poor acuity
Hx of cold sores

Question 26

Why does herpes keratitis need aggressive rx? what is the rx?

Answer 26

Risk of blindness!!!!

ACICLOVIR

Question 27

Where does orbital cellulitis tend to spread from?

Answer 27

spread via paranasal sinus infection from URTI

peri-orbital cellulitis progression

Question 28

What are the usual causative organisms of orbital cellulitis>

Answer 28

staphs
strep pneumoniae
strep pyogenes

Question 29

What age is typically affected by orbital cellulitis?

Answer 29

children 7-12yrs

Question 30

How does orbital cellulitis tend to present?

Answer 30

redness + swelling around the eye
severe ocular pain
visual disturbance 
Proptosis
Pain w eye movements (ophthalmoplegia)
Ptosis

Question 31

What investigations would u do for orbital cellulitis?

Answer 31

FBC
CT w contrast - MUST BE DONE
Blood culture + microbiological swab

Question 32

What is found on examination in orbital cellulitis?

Answer 32

decreased vision
afferent pupillary defect
proptosis
dysmotility
oedema + erythema

Question 33

What is the rx of orbital cellulitis?

Answer 33

admit for prompt abx, CT, ENT

Question 34

what is preseptal cellulitis?

Answer 34

aka periorbital cellulitis
infection of th soft tissue anterior to orbital septum - eyelids, skin and subcut tissue of face but NOT the contents of the orbit

Question 35

what age tends to be affected by preseptal cellulitis?

Answer 35

children - <10yrs

Question 36

How would u differentiate preseptal from orbital cellulitis?

Answer 36

Orbital has orbital signs:
- pain/restriction on eye movement 
- proptosis (bulging of the eye)
- visual disturbance
- chemosis 
- RAPD - relative afferent pupillary defect 
ALSO
Contrast CT of the orbit

Question 37

How does preseptal cellulitis present?

Answer 37

ptosis

erythema and oedema of eyelids

Question 38

What is the management of preseptal cellulitis?

Answer 38

oral abx - co-amox

admission for observation

Question 39

What are corneal abrasions?

Answer 39

any defect of the corneal epithelium

Question 40

What are the most common causes of corneal abrasion?

Answer 40

local trauma
foreign bodies
contact lenses

Question 41

Whatare the clinical features of corneal abrasion?

Answer 41

eye pain
photophobia
poor visual acuity in affected eye
foreign body sensation

Question 42

What is used to investigate corneal abrasion?

Answer 42

fluorescein examination - yellow stained abrasion

apply drop of local anaesthetic before examination

Question 43

What is the management of corneal abrasion?

Answer 43

Removal of foreign body