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Year 4: Opthalmology > Red Eye > Flashcards

Red Eye Flashcards

1
Q

differentials for painless red eye

A

conjunctivitis
epislceritis
subconjunctival haemorrhage

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2
Q

differentials for painful red eye

A 
closed angle glaucoma
anterior uveitis
scleritis 
keratitis 
corneal abrasions
endopthalmitis
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3
Q

what is conjunctivitis

A 
inflammation of the conjunctiva 
can be
- viral
- bacterial
- allergic
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4
Q

what causes viral conjunctivitis

A

adenovirus

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5
Q

symptoms of viral conjunctivitis

A

acute red eye
watery discharge – may dry to form yellow crust
gritty sensation
associated viral URTI – dry cough, sore throat

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6
Q

management of viral conjunctivitis

A

self resolves 1-2 weeks
good hygiene to avoid spread - e.g. regularly hand washing, avoid sharing towels
avoid use of contact lenses

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7
Q

what organisms can cause bacterial conjunctivitis

A

staph or strep

gonorrhoea / chlamdydia – consider in babies under 1 month

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8
Q

symptoms of bacterial Conjunctivitis

A

acute red eye

purulent discharge

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9
Q

management of bacterial conjunctivitis

A

chloramphenicol eye drops

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10
Q

management of bacterial conjunctivitis in pregnancy

A

topic fusidic acid

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11
Q

features of allergic conjunctivitis

A

acute red eye
chemosis ( tearing)
itchy, watery eyes
usually seasonal (e.g. hay fever) or recurring (e.g. dust mites)

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12
Q

management of allergic conjunctivitis

A

antihistamines

  • oral: cetirizine
  • topical: azelastine

topical mast cell stabiliser (sodium cromoglicate) is an alternative for long term control in severe cases

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13
Q

what is Episcleritis

A

inflammation of the episclera - thin vascular sheet between the conjunctiva and the sclera

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14
Q

what conditions is Episcleritis associated with

A

Rheumatoid arthritis

Inflammatory Bowel Disease

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15
Q

symptoms of Episcleritis

A

non-painful red eye
watery eye
foreign body sensation

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16
Q

what can be used to confirm diagnosis of Episcleritis

A

phenylephrine

  • causes blanching of episcleral + conjunctival vessels (but not scleral vessels)
  • if redness improves after phenylephrine = Episcleritis
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17
Q

management of Episcleritis

A

most self resolve 1-2 weeks
lubricating eye drops for symptom relief
severe cases may benefit from oral NSAIDS / topical steroid drops

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18
Q

what is a Subconjunctival haemorrhage

A

small blood vessel within conjunctiva ruptures and releases blood into the space between conjunctiva and sclera

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19
Q

what often precedes a subconojuncitval haemorrhage

A

strenuous activity

  • heavy coughing
  • weight lifting
  • straining when constipated
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20
Q

symptoms of Subconjunctival haemorrhage

A

patch of bright red blood
no pain / does not affect vision
- harmless and will self-resolve in roughly 2 weeks

21
Q

what is scleritis

A

inflammation of the sclera

22
Q

what are 50% of scleritis cases associated with

A

systemic connective tissue disease

  • RA
  • SLE
  • IBD
  • GPA (wegners)
  • Sarcoidosis
23
Q

symptoms of scleritis

A

painful red eye
photophobia
blurred vision
watery eye

24
Q

management of scleritis

A

same day assessment by opthalmologist – sight threatening condition
NSAIDS - topical / oral
Steroids - topical / oral
Condition specific Immunosuppression - e.g. methotrexate in RA

25
Q

what is anterior uveitis

A

inflammation of anterior part of uvea (iris, ciliary body, choroid)
anterior chamber of the eye becomes infiltrated with neutrophils, lymphocytes and macrophages (usually autoimmune)

26
Q

what gene and subsequent conditions is anterior uveitis associated with

A

HLA-B27:

  • Ankylosing spondylitis
  • IBD
  • reactive / psoriatic arthritis
27
Q

symptoms of anterior uveitis

A 
acute red eye
deep aching pain 
photophobia 
blurred vision / floaters
hypopyon - pus/inflammatory cells in anterior chamber (seen on slit lamp)
28
Q

management of anterior uveitis

A

same day assessment by opthalmologist

  • topical steroids - dexamethasone
  • antimuscarinic cytoplegics - cyclopentolate (dilate pupil + reduce pain associated with ciliary spasm)
29
Q

what is keratitis

A

inflammation of the cornea

- can progress to ulceration

30
Q

what is the most common cause of keratitis

A

herpes simplex- ‘herpes simplex keratitis’

31
Q

other causes of keratitis

A

bacterial - staph / pseudomonas
fungal - candida / aspergillus
contact lens acute red eye
UV light

32
Q

symptoms of keratitis

A 
acute red eye 
photophobia
severe pain 
foreign body sensation
purulent discharge - pseudomonas
33
Q

investigations of suspected keratitis

A

fluorescein staining
corneal scrape
slit lamp

34
Q

what causes a dendritic ulcer

A

herpes simplex keratitis

35
Q

treatment of herpes simplex keratitis

A

topical acyclovir

36
Q

management of keratitis

A

stop wearing contacts until symptoms resolve
topical ofloxacin drops (1st line)
cyclopentolate for symptom relief

37
Q

what is Endophthalmitis

A

inflammation of the aqueous / vitreous humour - usually infective

38
Q

when does Endophthalmitis typically occur

A

3-5 days post cataract surgery

39
Q

most common organism in endopthalmitis

A

staph epidermidis

40
Q

symptoms of endopthalmitis

A

red eye
pain
blurred vision
hypopyon

41
Q

management of endopthalmitis

A

intravitreal vancomycin

42
Q

what are corneal abrasions

A

scratches / damage to the cornea

- cause painful red eye, photophobia, foreign body sensation, blurred vision, watery eye

43
Q

common causes of corneal abrasions

A 
contact lenses
foreign bodies
finger nails
eyelashes
ectropion (inward turning of eyelid)
44
Q

corneal abrasion associated with contact lens wearing should make you consider what

A

infection with pseudomonas

45
Q

what is used to diagnose corneal abrasion

A

fluorescein staining

46
Q

management of corneal abrasion

A

simple analgesia e.g paracetamol
lubricating eye drops
antibiotic drops – chloramphenicol
usually heal 2-3 days – bring patient back after 1 week to check it has healed

47
Q

symptoms of acute closed angle glaucoma

A

severely painful red eye
blurred vision
haloes around lights
nausea + vomiting

48
Q

management of acute closed angle glaucoma

A

pilocarpine eye drops

oral acetazolamide

Year 4: Opthalmology (8 decks)

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