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Ophthalmology > Red Eye > Flashcards

Red Eye Flashcards

1
Q

Hx w/ Red Eye

A 
Symptoms:
blurred vision?
Pain? (irritation/foreign body sensation vs. deep boring pain)
Eyelid/eye swelling
Tearing
Mattering/discharge
Photophobia
Flashes
Floaters
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2
Q

Red Eye Past Ocular Hx

A

Contact lens use
Trauma
Surgery

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3
Q

PE w/ Red Eye

A

Vital signs of eye

Eyelids/lashes, Conjunctiva/sclera, cornea, anterior chamber, iris, lens

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4
Q

Hordeolum/Chalazion (stye)

A

Inflammatory nodules in eyelid caused by blockage of sebaceous gland +/- infection

Signs/Sx: Focal lid swelling/redness/pain

Treatment: warm compress +/- topical antibiotic drops/ointment

Typically self-limited

When to refer? lesions present >1 mo

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5
Q

Blepharitis

A

Chronic inflammation of eyelid margin often caused by staph

Signs/Sx: Burning, irritation, thickened/hyperemic lid margin & crusting

Treatment: warm compress, scub eyelids w/ baby shampoo, artificial tears PRN

When bad, can get ulcers on cornea

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6
Q

Demodex

A

mites that live on eyelashes & can cause inflammation of eyelid margin

Treat w/ tea tree oil

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7
Q

Contact dermatitis

A

DELAYED hypersensitivey to agents that come into contact w/ skin (e.g. eye drops, cosmetics)

Signs/Sx: Itching, eyelid redness, swelling

Tx: Stop the offending agent

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8
Q

Herpez Zoster Ophthalmicus

A

Reactivation of varicella zoster virus in V1 dermatomal distribution

Signs/Sx: Painful, vesicular rash that respects midline

Tx: Oral acyclovir or Valacyclovir

Refer when: Evaluation of eye involvement –> Decreased in vision or Hutchinson’s sign

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9
Q

Hutchinson’s sign

A

Rash on tip of nose w/ herpes zoster ophthalmicus

Nasociliary involvement of V1 –> eye involvement

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10
Q

Preseptal cellulitis

A

Infection of eyelids & soft tissue ANTERIOR to orbital septum (May be secondary to skin infection, trauma, sinus infection)

Signs/Sx: Eyelid edema & erythema, NORMAL motility, pupils & visual acuity

If suspect orbital cellulitis? CT w/ contrast to look for abscess

Tx: systemic abx; hospital admission if severe or young patient

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11
Q

Orbital cellulitis

A

Infection POSTERIOR to orbital septum (may begin as preseptal cellulitis, sinusitis, tooth abscess)

MEDICAL EMERGENCY

Signs/Sx: lid edema & erythema, IMPAIRED ocular motility, proptosis, chemosis, DECREASED vision, RAPD

Tx: Hospital admission, Emergent ophtho consult, blood cultures, CT orbits, IV abx +/- abscess drainage

COMPLICATIONS: Optic nerve damage (from compression), Meningitis (2%), Cavernous sinus thrombosis

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12
Q

Dacrocystitis

A

Infected lacrimal sac
Most common in infants (delayed opening of nasolacrimal passage)
In adults, occurs when nasal passage blocked by trauma, neoplasm or inflammation

Signs/Sx: Tearing, discharge, medial lower lid swelling/redness

Tx: NLD massage in infants +/- abx, abx in adults

Refer when: No improvement or recurrent

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13
Q

Conjunctivitis

A

Non-specific term for conjunctiva inflammation
Causes: bacterial, viral (most common), allergic (does it itch?), autoimmune

Hx to help w/ etiology: sick contacts? has it spread? tearing? discharge? itchiness? vision changes? contact use?

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14
Q

Bacterial conjunctivitis

A

Signs/sx: Chemosis, redness, prurulence

Tx: Swab/culture, broad abx drops (polytrim, ocuflox, ciloxan). Delay may result in vision loss

Gonococcal infection? Systemic abx & possible hospitalization (consider sexual assault when in kids)

Refer when? No improvement OR immediately if its gonococcal

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15
Q

Viral conjunctivitis

A

Signs/sx: watery mucoid discharge, often spreads to other eye, URI, enlarged lymph nodes

Commonly adenovirus, enterovirus

Self-limited (should resolve in 7-10 days)

Tx: Supportive (ATs, cool compresses)

HIGHLY CONTAGIOUS Quarantine until discharge resolves; frequent hand washing; wash clothes, pillow cases, etc.

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16
Q

Allergic conjunctivitis

A

Seasonal or perennial

Signs/sx: Itching, chemosis, tearing, papilla bumps on eyelid margin

Tx: topical antihistamines or oral agent if respiratory component, OTC eye drops

17
Q

Autoimmune conjunctivitis

A

Associated w/ systemic disorders such as Grave’s, vasculitides, sarcoidosis

Signs/sx: diffuse redness, orbitopathy

Tx: treat autoimmune disease & sx in meantime

18
Q

Subconjunctival Hemorrhage (Hyposphagma)

A

Dramatic but benign
Often result of sneezing, nose blowing, eye rubbing
Associated w/ use of antiplatelet agents & anticoag

Signs/Sx: Mild foreign body sensation, NO VISION CHANGES

If recurrent –> Consider eval for blood dyscrasias, HTN.

No blood thinners? Get CBC platelet count

19
Q

Scleritis & Episcleritis

A

Autoimmune inflammation of episclera or sclera

Episcleritis Signs/sx: Focal tenderness, redness, swelling, mild pain
Scleritis Signs/sx: Deep aching pain, redness, +/- scleral thinning

Scleritis usually associated w/ systemic connective tissue disease (i.e. lupus) VISION THREATENING

Tx: oral/topical NSAIDS for episcleritis, systemic immunosuppressants for scleritis

Difficult to distinguish on exam

Refer in 1-2 days for eval

20
Q

Pinguecula & Pterygia

A

Dysplastic conjunctiva ass w/ sun and wind exposure
Becomes pterygium when it grows onto cornea

Signs/sx: sudden eye pain and redness when inflamed

Tx: ATs for comfort, +/- surgical excision of pterygium if visually significant
Sunglasses when outside, lubrication

21
Q

Fluorescein Staining

A

Fluorescein dye stains corneal basement membrane exposed by corneal epithelial defects

22
Q

Corneal Abrasion

A

Hx FB, trauma, CL

Signs/sx: Severe pain, redness, tearing, light sensitivity, +/- blurred vision

Dx: pain improves w/ proparacaine, epithelial defect stains w/ fluorescein

Tx: time, abx ointment for comfort & prophylaxis

23
Q

Corneal Foreign Body

A

Lodged on corneal surface

Signs/sx: Pain, tearing, redness, photophobia, FB that stains w/ fluorescein

Tx: Remove w/ wet cotton tip, 30g needle or burr (refer), abx drops for prophylaxis

When to refer? If needle or burr needed to remove, high speed injury

Often occurs w/ metalworkers, grinder use

24
Q

Corneal ulcer

A

Serious cornea infection
Hx FB, trauma, CL

Signs/sx: Severe pain, redness, tearing, light sensitivity, blurred vision, white corneal infiltrate that stains w/ fluorescein

Tx: Scrapings/culture, intensive medical management w/ drops, +/- surgical intervention

*SAME DAY referral to OPHTHO**

25
Q

Herpetic Keratitis

A

Ocular infection w/ HSV involving corneal epithelium

Classically dendritic lesion w/ fluorescein

HSV can cause disease anywhere in eye

Tx: Oral acyclovir

Refer in 1-2 days

26
Q

Chemical injuries

A

OCULAR EMERGENCY
Acid v. alkali
Denaturing proteins –> permanent vascular ischemic damage

Flush immediately

Check pH, evaluate for surface damage & presence of limbal ischemia!

Red eye = better; Whitening around cornea = ischemia concern & stem cell deficiency

Further tx: ab drops, tetanus, pain relief

SAME DAY REFERRAL

27
Q

Alkali chemical injury

A

More damaging
Lipophilic
Penetrates tissue rapidly

28
Q

Acidic chemical injury

A

Protein coagulation of corneal epithelium,

More superficial injury

29
Q

Dry Eyes

A

Common cause of eye irritation, redness
Seen in post-menopausal women, systemic conditions like Sjogren’s patients with blepharitis

Signs/sx: dry scratchy, irritated, tearing, +/- blurred vision, puctuate corneal staining

Tx: ATs, ointment

Refer if no improvement (could be punctal plug)

30
Q

Anterior Uveitis

A

Inflammation of iris & ciliary body
Ass w/ collagen vascular disease (lupus, HLA B-27)
Signs/sx: eye pain, photophobia, blurred vision, perilimbal flush +/- poorly reactive or irregular pupil, AC cell/flare
No improvement w/ proparacaine eye drops

Tx: Topical steroids, Cycloplegia

Same day referral

31
Q

Acute angle closure glaucoma

A

Sudden increase in IOP caused by obstruction of eye’s drainage system

Signs/sx: deep pressure/pain or HA, halos, vision loss, NV, fixed mid-dilated pupil, narrow AC, corneal edema (blunted light reflex), IOP>30!!

OCULAR EMERGENCY!! IMMEDIATE REFERRAL!! - damages nerve tissue

T: pressure lowering eye drops +/- diamox, laser iridotomy

32
Q

Endophthalmitis

A

Infection w/in eye

Exogenous: entry wound after trauma or surgery (w/in 2 weeks is greatest risk)

Endogenous: Spread of infection from another body source (rare)

OCULAR EMERGENCY

Tx: aspiration of ocular fluid for culture, injections of abx

33
Q

True Emergency

A 
Gonococal conjunctivitis
Chemical injury
Orbital cellulitis
Acute angle closure
Endophthalmitis
34
Q

Same Day Referral

A

Anterior uveitis
Corneal ulcer
Corneal foreign body
Episcleritis/scleritis

35
Q

Refer in 1-2 days

A

Preseptal cellulitis
Corneal abrasion
Herpers zoster ophthalmicus (faster if vision diminished)
Herpetic keratitis

36
Q

Refer if no improvement

A 
Chalazion/hordeolum
blepharitis
dry eye
dacryocystitis
viral or bacterial conjunctivitis
subcong hemorrhage
pinguecula/pterygium

Ophthalmology (9 decks)

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