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Ophthalmology > Red Eye > Flashcards

Red Eye Flashcards

1
Q

What are the key features of a red eye history?

A 
Duration
One eye or both
Photophobia
VISUAL LOSS
DISCHARGE
PAIN
Past medical history
Contact lenses?
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2
Q

How should visual loss be interpreted in the context of a red eye?

A

Mild/moderate loss –> common, especially with watering/discharge
Severe loss –> urgent referral

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3
Q

What would a scratchy/gritty pain suggest in the context of a red eye?

A

External/surface problem –> look at lids, conjunctiva, cornea

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4
Q

What would a deep aching pain suggest in the context of a red eye?

A

Intra-ocular/orbital pathology

e.g. iritis, scleritis, angle closure glaucoma

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5
Q

What should be checked first on examination of a red eye?

A

Visual acuity

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6
Q

What are you looking for on examination of the eyelids?

A

Any lid malposition e.g. entropion or ectropion

Foreign body under lid

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7
Q

What is is the difference between an entropion and an ectropion?

A

Entropion –> lid curled in

Ectropion –> lid curled out

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8
Q

What are you looking for on examination of the conjunctiva?

A

Distribution of redness

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9
Q

What does the distribution of redness tell you?

A

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)

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10
Q

What is another term for redness around the cornea?

A

Circumcorneal injection

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11
Q

How do you examine for corneal abrasions/ulcers?

A

Use fluorescein blue dye + blue light

–> stains any epithelial defect and fluoresces ulcer blue light

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12
Q

What is the name for inflammation of the eyelids?

A

Blepharitis

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13
Q

What are the different types of blepharitis?

A

Anterior:

  • seborrhoeic (squamous)
  • staphylococcal

Posterior:
- meibomian gland disease

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14
Q

How can you tell the difference between anterior and posterior blepharitis?

A

Anterior –> lid margin redder than deeper part of lid, lashes affected
Posterior –> redness in deeper lid, lid margin skin + lashes unaffected

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15
Q

What are the features of seborrhoeic blepharitis?

A

Red lid margin
Scales/dandruff
No ulcers, lashes not affected

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16
Q

What are the features of staphylococcal blepharitis?

A

Infection of lash follicle

  • red lid margin
  • lashes distorted, loss of lashes
  • trichiasis (ingrowing lashes)
  • styes
  • ulcers of lid margin
  • corneal stringing, marginal ulcers
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17
Q

What are the features of Meibomian gland disease?

A

Redness in deeper lid
Gland openings pouting + swollen
Dried secretions at gland openings
Meibomian cysts (chalazia)

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18
Q

Which condition is Meibomian gland disease associated with?

A

Acne rosacea

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19
Q

What is the management of blepharitis?

A

Lid hygiene - daily bathing/warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
(very difficult to eradicate)

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20
Q

What are the different types of conjunctivitis?

A 
Bacterial
Viral 
Follicular (chlamydial)
Allergic
Chemical/drugs
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21
Q

What are the clinical features of bacterial conjunctivitis?

A 
Red sticky eye
Purulent discharge
Gritty discomfort
Mild chemosis (oedema)
Papillae
Usually bilateral but starts in one eye
22
Q

How is bacterial conjunctivitis managed?

A

Topical chloramphenicol

23
Q

What are the features of viral conjunctivitis?

A 
Often bilateral
Watery discharge
Moderate chemosis
Gritty/burning
Pre-auricular lymph nodes
24
Q

What is the management of viral conjunctivitis?

A

Supportive –> cool compresses/lubricants

25
Q

What are the causes of follicular conjunctivitis?

A

Chlamydia
Viruses e.g. adenovirus, herpes simplex, herpes zoster
Drugs e.g. propine, trusopt

26
Q

What are the features of chlamydia conjunctivitis and how should it be managed?

A

Follicular conjunctivitis in young patient
Usually unilateral

–> chlamydia PCR swab + GUM referral

27
Q

What is corneal inflammation called?

A

Keratitis

28
Q

What are the causes of corneal ulcers?

A

Infective (central):

  • viral
  • fungal
  • bacterial
  • acanthamoeba

Autoimmune (peripheral):

  • RA
  • hypersensitivity
29
Q

What are the symptoms of a corneal ulcer?

A

Pain - severe, needle-like
Photophobia
Reduced vision
Profuse lacrimation

30
Q

What might be seen on examination of a corneal ulcer?

A 
Circumcorneal redness
Abnormal corneal reflex
Corneal opacity
Staining with fluorescein
Hypopyon
31
Q

What is a hypopyon?

A

Pus in the anterior chamber

32
Q

What are the risk factors for a bacterial corneal ulcer?

A

Corneal abrasion
Contact lenses
Dry eye
Iatrogenic

33
Q

Which investigation should be done for a suspected bacterial corneal ulcer?

A

Corneal scrape to determine cause e.g. staph/strep

34
Q

How is bacterial corneal ulcer treated?

A

Hourly Ofloxacin (topical antibiotic)

35
Q

What is characteristic about a herpetic corneal ulcer?

A

Dendritic ulcer

36
Q

How is a herpetic ulcer treated?

A

Topical aciclovir 5x a day for 7-10 days

37
Q

Which treatment should be avoided in herpetic ulcers and why?

A

DO NOT use topical steroids

–> geographic corneal ulcer

38
Q

What is anterior uveitis?

A

Inflammation of iris (iritis) and ciliary body

39
Q

What are the symptoms of anterior uveitis?

A

Ache
Photophobia
Lacrimation
Blurred visual acuity

40
Q

What are the signs of anterior uveitis?

A

Circumcorneal redness
Cells/flare in the anterior chamber
Hypopyon if severe
Small/irregular pupil (posterior synechiae)

41
Q

Why should anterior uveitis be investigated if chronic or recurrent?

A

Strong association with HLA-B27 conditions

–> ankylosing spondylitis, IBD, psoriatic arthritis, Reiter’s

42
Q

How is anterior uveitis treated?

A

Topical steroids –> pred forte 1% hourly

43
Q

Which is worse; episcleritis or scleritis?

A

Scleritis

44
Q

What are the features of episcleritis?

A

Mild discomfort

Localised, superficial injection on sclera

45
Q

What are the features of scleritis?

A

Severely painful

Diffuse, deep redness with ‘violaceous hue’

46
Q

Which test can be done to tell the difference between scleritis and episcleritis?

A

Apply topical phenylephrine

  • redness blanches in episcleritis
  • does not blanch in scleritis
47
Q

Which conditions is scleritis associated with?

A

Connective tissue diseases e.g. RA, GPA

48
Q

What is the treatment for episcleritis?

A

Topical lubricants or NSAIDs

49
Q

What is the treatment for scleritis?

A

Oral NSAIDs/steroids

Immunosuppression if necrosis

50
Q

Which type of glaucoma presents with a red eye?

A

Acute angle closure glaucoma

–> ophthalmic emergency

Ophthalmology (12 decks)

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