Red Eye Flashcards
What are the key features of a red eye history?
Duration One eye or both Photophobia VISUAL LOSS DISCHARGE PAIN Past medical history Contact lenses?
How should visual loss be interpreted in the context of a red eye?
Mild/moderate loss –> common, especially with watering/discharge
Severe loss –> urgent referral
What would a scratchy/gritty pain suggest in the context of a red eye?
External/surface problem –> look at lids, conjunctiva, cornea
What would a deep aching pain suggest in the context of a red eye?
Intra-ocular/orbital pathology
e.g. iritis, scleritis, angle closure glaucoma
What should be checked first on examination of a red eye?
Visual acuity
What are you looking for on examination of the eyelids?
Any lid malposition e.g. entropion or ectropion
Foreign body under lid
What is is the difference between an entropion and an ectropion?
Entropion –> lid curled in
Ectropion –> lid curled out
What are you looking for on examination of the conjunctiva?
Distribution of redness
What does the distribution of redness tell you?
If redness greatest in conjunctival fornices (inside lids) –> likely surface infection or lid disease
If redness greatest around cornea –> likely intra-ocular problem (more severe)
What is another term for redness around the cornea?
Circumcorneal injection
How do you examine for corneal abrasions/ulcers?
Use fluorescein blue dye + blue light
–> stains any epithelial defect and fluoresces ulcer blue light
What is the name for inflammation of the eyelids?
Blepharitis
What are the different types of blepharitis?
Anterior:
- seborrhoeic (squamous)
- staphylococcal
Posterior:
- meibomian gland disease
How can you tell the difference between anterior and posterior blepharitis?
Anterior –> lid margin redder than deeper part of lid, lashes affected
Posterior –> redness in deeper lid, lid margin skin + lashes unaffected
What are the features of seborrhoeic blepharitis?
Red lid margin
Scales/dandruff
No ulcers, lashes not affected
What are the features of staphylococcal blepharitis?
Infection of lash follicle
- red lid margin
- lashes distorted, loss of lashes
- trichiasis (ingrowing lashes)
- styes
- ulcers of lid margin
- corneal stringing, marginal ulcers
What are the features of Meibomian gland disease?
Redness in deeper lid
Gland openings pouting + swollen
Dried secretions at gland openings
Meibomian cysts (chalazia)
Which condition is Meibomian gland disease associated with?
Acne rosacea
What is the management of blepharitis?
Lid hygiene - daily bathing/warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
(very difficult to eradicate)
What are the different types of conjunctivitis?
Bacterial Viral Follicular (chlamydial) Allergic Chemical/drugs
What are the clinical features of bacterial conjunctivitis?
Red sticky eye Purulent discharge Gritty discomfort Mild chemosis (oedema) Papillae Usually bilateral but starts in one eye
How is bacterial conjunctivitis managed?
Topical chloramphenicol
What are the features of viral conjunctivitis?
Often bilateral Watery discharge Moderate chemosis Gritty/burning Pre-auricular lymph nodes
What is the management of viral conjunctivitis?
Supportive –> cool compresses/lubricants
What are the causes of follicular conjunctivitis?
Chlamydia
Viruses e.g. adenovirus, herpes simplex, herpes zoster
Drugs e.g. propine, trusopt
What are the features of chlamydia conjunctivitis and how should it be managed?
Follicular conjunctivitis in young patient
Usually unilateral
–> chlamydia PCR swab + GUM referral
What is corneal inflammation called?
Keratitis
What are the causes of corneal ulcers?
Infective (central):
- viral
- fungal
- bacterial
- acanthamoeba
Autoimmune (peripheral):
- RA
- hypersensitivity
What are the symptoms of a corneal ulcer?
Pain - severe, needle-like
Photophobia
Reduced vision
Profuse lacrimation
What might be seen on examination of a corneal ulcer?
Circumcorneal redness Abnormal corneal reflex Corneal opacity Staining with fluorescein Hypopyon
What is a hypopyon?
Pus in the anterior chamber
What are the risk factors for a bacterial corneal ulcer?
Corneal abrasion
Contact lenses
Dry eye
Iatrogenic
Which investigation should be done for a suspected bacterial corneal ulcer?
Corneal scrape to determine cause e.g. staph/strep
How is bacterial corneal ulcer treated?
Hourly Ofloxacin (topical antibiotic)
What is characteristic about a herpetic corneal ulcer?
Dendritic ulcer
How is a herpetic ulcer treated?
Topical aciclovir 5x a day for 7-10 days
Which treatment should be avoided in herpetic ulcers and why?
DO NOT use topical steroids
–> geographic corneal ulcer
What is anterior uveitis?
Inflammation of iris (iritis) and ciliary body
What are the symptoms of anterior uveitis?
Ache
Photophobia
Lacrimation
Blurred visual acuity
What are the signs of anterior uveitis?
Circumcorneal redness
Cells/flare in the anterior chamber
Hypopyon if severe
Small/irregular pupil (posterior synechiae)
Why should anterior uveitis be investigated if chronic or recurrent?
Strong association with HLA-B27 conditions
–> ankylosing spondylitis, IBD, psoriatic arthritis, Reiter’s
How is anterior uveitis treated?
Topical steroids –> pred forte 1% hourly
Which is worse; episcleritis or scleritis?
Scleritis
What are the features of episcleritis?
Mild discomfort
Localised, superficial injection on sclera
What are the features of scleritis?
Severely painful
Diffuse, deep redness with ‘violaceous hue’
Which test can be done to tell the difference between scleritis and episcleritis?
Apply topical phenylephrine
- redness blanches in episcleritis
- does not blanch in scleritis
Which conditions is scleritis associated with?
Connective tissue diseases e.g. RA, GPA
What is the treatment for episcleritis?
Topical lubricants or NSAIDs
What is the treatment for scleritis?
Oral NSAIDs/steroids
Immunosuppression if necrosis
Which type of glaucoma presents with a red eye?
Acute angle closure glaucoma
–> ophthalmic emergency
