Red Eye Flashcards
(36 cards)
How do we diagnose the cause of Acute Red Eye?
We base it on pain, redness, discharge & vision
What are the causes of acute red eye? [4]
- Uveitis
- Conjunctivitis (Bacterial, viral, chlamydial, allergic)
- Scleritis
- Acute (closed angle) Glaucoma
- Keratitis/Corneal Ulcer
- Orbital Cellulitis
What are the types of conjunctivitis? [2]
Bulbar - affects conjunctiva over the sclera
Palpebral - affects conjunctiva on inside of lids
(Can be both)
What is the presentation of Conjunctivitis? [5]
Explain how discharge can guide ddx [3]
Causes [5]
Rx [3]
- Red/pink conjunctiva
- Eyelids stick together
- Vision unaffected, no pain
- +/- photophobia
- Purulent (bacteria)
Bacterial = Pus Viral = Watery Allergic = Mucous
Causes: adenoviruses - small lymphoid aggregates appear as follicles on conjunctiva, bacterial or allergic, chlamydial infection, ophthalmia neonatorum
Rx
- Chloramphenicol 4-6h
- Allergic, give emedastine, sodium cromoglicate, steroids
What is uveitis? [3]
What is the anterior uvea [2]
Inflammation of the middle vascular layer of the eye (ciliary body, iris & choroid)
Anterior uvea - iris and ciliary body
How does anterior uveitis present? [4]
Describe what happens to the pupil with the natural history of anterior uveitis [2]
What diagnostic test is used in suspected anterior uveitis [2]
- None/mild irritation
- Pericorneal Redness
- No Discharge
- Blurred Vision
Fixed constricted pupil
Small pupil initially from iris spasm [1] Pupil may become irregular/dilate due to adhesions between lens and iris (synechiae) [1]
Talbot’s test - pain increases as the eyes converge [1] and pupils constrict ( ask the patient to watch their finger approach their nose) [1]
What are the types of Uveitis? [4]
Ix [2]
Ant - Iris
Intermediate - Ciliary Body
Post - Choroid
Panuveitis
Slit lamp
Ocular imaging
Slit lamp appearance in:
- Anterior uveitis [2]
- Intermediate uveitis [2]
Anterior
- Inflammatory cells leak from iris into Aqueous humor
- > Hazy cell filled Ant chamber [1] and Hypopyon (cells settled inferiorly in ant chamber) [1]
Intermediate
- Inflammatory cells leak from ciliary body in Vitreous Humour [1]
- > Patient has hazy vision or “floaters” [1]
Causes of Uveitis:
- Anterior [4]
- Intermediate [3]
- Posterior & panuveitis [4]
Anterior:
- AS, Still’s
- Sarcoid, Behcets
- Crohn’s, Reiter’s
- Herpes, TB, syphilis, HIV
Intermediate
- MS
- Lymphoma
- Sarcoid
Posterior & Panuveitis
- HSV, toxoplasmosis, TB, CMV, endophthalmitis
- Lymphoma, sarcoidosis
- Behcets
Treatment of uveitis [3]
Complications [4]
1) 0.5%-1% prednisolone 2h
2) cyclophenolate 1%/8h to keep pupil dilated, preventing adhesions between lens and iris (synechiae)
3) Monitoring
Complications:
- prolonged inflammation causes disruption to aqueous flow and glaucoma +/- adhesions
- also get cystoid macular oedema, cataracts, chorioretinal scarring, retinal detachment and vitreous opacities
What is scleritis [2]
How does scleritis present [4]
Ix [2]
Mx
Generalised inflammation with edema of conjunctiva [1] and scleral thinning [1]
- Severe boring type headache, photophobia, pain on eye movement
- Diffuse redness, tender eye
- Normal vision
- No discharge
- Visual acuity may be decreased
Ix
- ESR, ANCA (for anti-neutrophil cytoplasmic antibody-assoc vasculitis)
- Slit lamp examination
Mx
- Refer to specialist urgently
Corneal ulcer symptoms [3]
RF
Ix
Mx [2]
- Eye pain
- photophobia
- Eye watering
RF: contact lens users
Ix: fluorescein staining
Mx: remove contact lenses, abx or antifungal drops
What are the types of eye cellulitis? [2]
Preseptal
Orbital
What causes both types of cellulitis? [2]
Preseptal cellulitis:
- Lid cyst or insect bite
Orbital Cellulitis
- Sinusitis & Dental Infection
How do the types of cellulitis present? [6]
Severe Pain Redness Lid Swelling Decreased eye mobility Diplopia, blurred vision Exophthalmos
Causative organisms of orbital cellulitis
Staphs
Strep pneomoniae
Strep pyogenes
Orbital cellulitis management [4]
Admit for prompt CT, ENT and ophthalmic opinion
Antibiotics
Surgery - prevent extension of infection to meninges or cavernous sinus
Subconjunctival haemorrhage
Causes [2]
Tx [1]
Spontaneous esp if on anticoagulants
Traumatic - local, basal skulll
Tx: reassurance
Keratitits - inflammation of cornea
Causative organisms [3]
Causes:
- HSV
- Adenoviral
- Bacterial
Keratitis: HSV
Presentation
Ix
Tx [2]
Dendritic ulcer
Stains with flourescein or rose bengal
Treatment: topical acyclovir and immediate referral to an ophthalmologist
Keratitis: adenoviral
Presentation [2]
Tx
Punctate opacities of cornea, which may stain with fluorescein
Preauricular Lymphadenopathy + history of viral illness/sore throat
Treatment: supportive, refer if no improvement or excessive pain/loss of vision
Keratitis: Bacterial
Presentation [3]
Mx
- Infiltrate or ulcer on cornea (look for fluorescein staining)
+ presence of hypopyon
+ history of contact lens wear
Treatment: refer urgently
Foreign body management [3]
Visualise
Remove with cotton bud if superficial
Chloramphenicol drops for infection prevention
Radiation burn Define Ax [2] Symptoms [4] Ix Mx
UV light damages cornea Ax: arc welding, sunbeds Presentation: - Foreign body sensation - Blepharospasm - Watering - Intense pain 6-12h after exposure Ix: slit lamp Mx: same as corneal abrasion with topical anesthetics
