Red Eye

Question 1

differentials for painless red eye

Answer 1

conjunctivitis
epislceritis
subconjunctival haemorrhage

Question 2

differentials for painful red eye

Answer 2

closed angle glaucoma
anterior uveitis
scleritis 
keratitis 
corneal abrasions
endopthalmitis

Question 3

what is conjunctivitis

Answer 3

inflammation of the conjunctiva 
can be
- viral
- bacterial
- allergic

Question 4

what causes viral conjunctivitis

Answer 4

adenovirus

Question 5

symptoms of viral conjunctivitis

Answer 5

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

Question 6

management of viral conjunctivitis

Answer 6

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

Question 7

what organisms can cause bacterial conjunctivitis

Answer 7

staph or strep

gonorrhoea / chlamdydia – consider in babies under 1 month

Question 8

symptoms of bacterial Conjunctivitis

Answer 8

acute red eye

purulent discharge

Question 9

management of bacterial conjunctivitis

Answer 9

chloramphenicol eye drops

Question 10

management of bacterial conjunctivitis in pregnancy

Answer 10

topic fusidic acid

Question 11

features of allergic conjunctivitis

Answer 11

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

Question 12

management of allergic conjunctivitis

Answer 12

antihistamines

• oral: cetirizine
• topical: azelastine

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

Question 13

what is Episcleritis

Answer 13

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

Question 14

what conditions is Episcleritis associated with

Answer 14

Rheumatoid arthritis

Inflammatory Bowel Disease

Question 15

symptoms of Episcleritis

Answer 15

non-painful red eye
watery eye
foreign body sensation

Question 16

what can be used to confirm diagnosis of Episcleritis

Answer 16

phenylephrine

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

Question 17

management of Episcleritis

Answer 17

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

Question 18

what is a Subconjunctival haemorrhage

Answer 18

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

Question 19

what often precedes a subconojuncitval haemorrhage

Answer 19

strenuous activity

• heavy coughing
• weight lifting
• straining when constipated

Question 20

symptoms of Subconjunctival haemorrhage

Answer 20

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

Question 21

what is scleritis

Answer 21

inflammation of the sclera

Question 22

what are 50% of scleritis cases associated with

Answer 22

systemic connective tissue disease

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

Question 23

symptoms of scleritis

Answer 23

painful red eye
photophobia
blurred vision
watery eye

Question 24

management of scleritis

Answer 24

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

Question 25

what is anterior uveitis

Answer 25

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

Question 26

what gene and subsequent conditions is anterior uveitis associated with

Answer 26

HLA-B27: - Ankylosing spondylitis - IBD - reactive / psoriatic arthritis

Question 27

symptoms of anterior uveitis

Answer 27

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

Question 28

management of anterior uveitis

Answer 28

same day assessment by opthalmologist - topical steroids - dexamethasone - antimuscarinic cytoplegics - cyclopentolate (dilate pupil + reduce pain associated with ciliary spasm)

Question 29

what is keratitis

Answer 29

inflammation of the cornea | - can progress to ulceration

Question 30

what is the most common cause of keratitis

Answer 30

herpes simplex- 'herpes simplex keratitis'

Question 31

other causes of keratitis

Answer 31

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

Question 32

symptoms of keratitis

Answer 32

``` acute red eye photophobia severe pain foreign body sensation purulent discharge - pseudomonas ```

Question 33

investigations of suspected keratitis

Answer 33

fluorescein staining corneal scrape slit lamp

Question 34

what causes a dendritic ulcer

Answer 34

herpes simplex keratitis

Question 35

treatment of herpes simplex keratitis

Answer 35

topical acyclovir

Question 36

management of keratitis

Answer 36

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

Question 37

what is Endophthalmitis

Answer 37

inflammation of the aqueous / vitreous humour - usually infective

Question 38

when does Endophthalmitis typically occur

Answer 38

3-5 days post cataract surgery

Question 39

most common organism in endopthalmitis

Answer 39

staph epidermidis

Question 40

symptoms of endopthalmitis

Answer 40

red eye pain blurred vision hypopyon

Question 41

management of endopthalmitis

Answer 41

intravitreal vancomycin

Question 42

what are corneal abrasions

Answer 42

scratches / damage to the cornea | - cause painful red eye, photophobia, foreign body sensation, blurred vision, watery eye

Question 43

common causes of corneal abrasions

Answer 43

``` contact lenses foreign bodies finger nails eyelashes ectropion (inward turning of eyelid) ```

Question 44

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

Answer 44

infection with pseudomonas

Question 45

what is used to diagnose corneal abrasion

Answer 45

fluorescein staining

Question 46

management of corneal abrasion

Answer 46

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

Question 47

symptoms of acute closed angle glaucoma

Answer 47

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

Question 48

management of acute closed angle glaucoma

Answer 48

pilocarpine eye drops | oral acetazolamide