Red eye Flashcards
What are causes of red eye?
Anterior uveitis Keratitis Scleritis Conjunctivitis Orbital cellulitis Entropion/ectropion Blepharitis Dry eye Corneal ulcer Corneal abrasion Foreign body Subconjunctival haemorrhage AACG
What is anterior uveitis?
inflammation of the iris and ciliary body
What is anterior uveitis associated with?
HLA-B27 conditions:
- Ank spond
- Reactive arthritis
- UC/Crohns
- Sarcoidosis
What are the features of anterior uveitis?
- Acute onset ocular discomfort + pain
- Photophobia
- Blurred vision
- Lacrimation
- Reduced acuity
- Small irregular pupil
- Hypopyon - visible fluid level due to pus in anterior chamber
What investigations/tests would u do for anterior uveitis?
+ve Talbots test - pain on convergence (eyes move inward toward each other)
Slit lamp - white precipitates on back of cornea
What is the management of anterior uveitis?
- Pred - eye drops
2. Cycloplegics - dilate pupil to relieve pain + photophobia - atropine, cyclopentolate
What is keratitis?
USUALLY INFECTIOUS
inflammation and damage to the cornea
What are RFs for keratitis?
contact lens
corneal trauma
corneal abrasions
poor immune function
what are the sx of keratitis?
Red
EXTREMELY painful
Poor acuity
Highly photophobic
What can be seen on examination in keratitis?
Corneal ulcer
Corneal oedema and opacification
What ix can be done for keratitis?
corneal scraping MC+S
What is the management of keratitis?
- Topical abx combos or quinolone - depends on cause
2. Sx relief - atropine
How does conjunctivitis present?
red itchy burning lacrimating eyes
Sticky discharge
What self care advice is given for conjunctivitis?
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
When are abx required for conjunctivitis? What would u give?
if severe
Topical chloramphenicol
Topical fusidic acid if pregnant
What is allergic conjunctivitis most commonly associated w?
hay fever
What are the features of allergic conjunctivitis?
Bilateral erythema and swelling Itch Swollen eyelids Hx of atopy Seasonal
What is the treatment of allergic conjunctivitis?
antihistamine drops
How does scleritis present?
severe ocular pain (deep boring) and redness
no discharge
reduced visual acuity
What is scleritis associated w?
CTDs
RA
What tests would u do in scleritis?
ESR
ANCA - AAV
What is treatment of scleritis?
oral steroids/immunosuppression - ciprofloxacin
How does episcleritis present?
red eye
classically not painful
watering and mild photophobia
sometimes bilateral
What is the management of episcleritis?
Topical or systemic NSAIDs
How does herpes simplex keratitis present?
dendritic corneal ulcers w fluorescein dye
V photophobic
Poor acuity
Hx of cold sores
Why does herpes keratitis need aggressive rx? what is the rx?
Risk of blindness!!!!
ACICLOVIR
Where does orbital cellulitis tend to spread from?
spread via paranasal sinus infection from URTI
peri-orbital cellulitis progression
What are the usual causative organisms of orbital cellulitis>
staphs
strep pneumoniae
strep pyogenes
What age is typically affected by orbital cellulitis?
children 7-12yrs
How does orbital cellulitis tend to present?
redness + swelling around the eye severe ocular pain visual disturbance Proptosis Pain w eye movements (ophthalmoplegia) Ptosis
What investigations would u do for orbital cellulitis?
FBC
CT w contrast - MUST BE DONE
Blood culture + microbiological swab
What is found on examination in orbital cellulitis?
decreased vision afferent pupillary defect proptosis dysmotility oedema + erythema
What is the rx of orbital cellulitis?
admit for prompt abx, CT, ENT
what is preseptal cellulitis?
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
what age tends to be affected by preseptal cellulitis?
children - <10yrs
How would u differentiate preseptal from orbital cellulitis?
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
How does preseptal cellulitis present?
ptosis
erythema and oedema of eyelids
What is the management of preseptal cellulitis?
oral abx - co-amox
admission for observation
What are corneal abrasions?
any defect of the corneal epithelium
What are the most common causes of corneal abrasion?
local trauma
foreign bodies
contact lenses
Whatare the clinical features of corneal abrasion?
eye pain
photophobia
poor visual acuity in affected eye
foreign body sensation
What is used to investigate corneal abrasion?
fluorescein examination - yellow stained abrasion
apply drop of local anaesthetic before examination
What is the management of corneal abrasion?
Removal of foreign body
