Red Eye Flashcards
red eye disease physiology
dilating blood vessels
1) ciliary injection= inflammation of the cornea, iris, or ciliary body
- -> see localized redness around lumbus
2) conjuctival injection= consistent with superficial injection of conjuctiva
- -> diffuse pattern of redness
who should not get an MRI
foreign METAL body in the eye
when testing visual acuity when do you need to do other strategies
if worse than 20/400, then count fingers, check for hand motion, or perception to light
consider gram stain/cultures for
- Immunocompromised
- newborns
- patients that do not respond to treatment
conjuctivitis
inflammation of conjuctiva secondary to something invading the eye
what is the most common non-traumatic eye complaint
conjuctivitis
what is conjuctiva
the loose connective tissue covering surface of the eye (bulbar and palpebral–> inside)
y do we get exudate in conjuctivitis
inflammatory cells move to the conjuctiva epithelium (trying to flush out)–> combines w mucus and fibrin and you get EXUDATE
allergic conjuctivitis presentation
assoc w seasonal allergies, allergic rhinitis, asthma
chronic sx
itching, watery eyes, sneezing, mild photophobia
–> see mild/moderate diffuse conjuctival injection BILATERALLY
chemosis: thick boggy conjuctiva
“allergic shiners” bruised under eye from inflammation
tx for allergic conjuctivitis
- cool compress
- topical decongestants/antihistamines= Vasocon-A or Naphacon-A drops (dont use long term: rebound vasodilation)
- nonsteroid drops= ketorlac
- oral antihistamines
refer to ES
viral conjuctivitis etiology
pink eye
adults= most of time its bacterial kids= 50/50 bacterial and viral (kids rub eyes)
most commonly the adenovirus
where is viral conjuctivitis v common
winter and spring
very contagious –> school/daycare
________ sheds in tears for up to_______ weeks
viral conjuctivitis sheds in tears for up to two weeks
viral conjuctivitis clinical presentation
acute onset worse in first 3-5 days; bilaterally
itchy, burning, *feels like they have a foreign body
clear, watery discharge**
can also see URI sx
viral conjunctivitis PE findings
- moderate conjuctival injection
- water discharge
-follicular tarsal conjuctiva
possible to have a fever, preaurical adenopathy, rhinnorrhea
tx for viral conjuctivitis
- cool compress
- artificial tears
- consider abx (for kids to prevent secondary infxn) and antivirals (usually for herpes)
- contact precautions–> if in confined space, no school or work for 10 days= highly contagious; wash ur hands and don’t share washcloths
etiology for bacterial conjunctivitis
staph aureus
strep pneumoniae
(haemophilus influenzae)
clinical presentation bacterial conjuctivitis
acute onset
PURULENT discharge –> crusting along lid margins
- mild irritations
- moderate/severe conjuctival injection
can see some eyelid edema
what disease is usually unilateral but often then spreads to the other eye
bacterial conjuctivitis
which one has more redness; viral or bacterial conjuctivits
viral
bacterial conjunctivitis tx
culture if chronic infxn
cool (inflammation and irritation) v warm (loosen the discharge)
topical abx
1) erythro ointment, or polymyxin-trimethoprim drops, or sulfacetamide drops
(stick to 1st 3 usually unless chronic we can consider ofloxacin)
instructions for bacterial conjuctivits meds
infants and children–> ointments
night time use
bacterial conjunctivitis things to know precautions
wash hands before and after putting eye drops
dont let bottle touch eye
dont share towels
what is important about bacterial conjuctivitis
recheck if there is NO improvement within 48 hours
hyperacute bacterial conjuctivitis etiology
infxn w neirsseria gonorrhea
common w/ immunoC and newborns (use erythro as prophylaxis)
signs and sx for hyperacute bacterial conjuctivitis
LOTs of purulent drainage
injected conjunctiva
can be invasive and penetrate cornea
workup for hyperacute bacterial conjuctivitis
IMMEDIATE optho referral
1) culture!! (gram - dipplo)
tx for hyperacute bacterial conjuctivitis
1) hospitalization (topical AND systemic abx–> ceftriaxone)
2) IMMEDIATE optho referral
what is the #1 cause of preventable blindness world wide and etiology
trachoma – > chlamydia trachomatis
S/S trachoma
pruritus
moderate conjuctival injection
MINIMAL piain & discharge
inflammation and thickening of conjuctiva
- *yellow follicles on upper tarsal conjuctiva
- *Herbert’s pits –> the dots and pits near limbic margin
** remember its chronic and not really painful
(not ton of irritation on actual eye)
tx for trachoma
SAFE –> by WHO
Surgical–> if bad enough bc of damage to conjuctiva and eyelids
Abx: azithromycin SINGLE = regional too
Facial cleanliness
Environmental improvements –> flies (warmer climates)
what disease do we want to tx regional people like family unit and neighbors
trachoma
what can trachoma lead to
cicatricial disease
etiology of cicatricial disease
chronic or recurrent trachoma
what happens bc of cicatricial disease
see chronic scarring –> can lead to entropion and trichiasis
increased risk of blindness** abrasions to cornea leading to opacities
keratitis
nonsuppurative inflammation of the CORNEA
keratitis etiology
bacterial= staph strep pseudo
viral= usually herpex
parasitic= acanthamoeba (contacts)
what is the most common reason for corneal blindness in the US
Herpes simplex virus
presentation for keratitis
pain
photophobia
decreased vision
maybe injected conjuctiva
workup for keratitis
fluorescein stain
slit lamp exam
tx for keratitis
DO NOT patch (warm enviro for growth)
topicals= antivirals, FQ, PHGB, lubricating ointment
consider culture is scraping lesion
viral keratitis looks like
dendritic look
pseudonomas keratitis loks like
this goopy circle in the middle
bacterial presentation of keratinitis
this circle sitting on the cornea
kertoconjunctivitis sicca etiology
dry eye syndrome
1) aqueous tear deficiency (Srojen’s, gland dysfunction or obstruction, secondary to systemic meds
2) evaporative
- screwed up meibomian gland, ectropion or lid disorders (cant shut all the way), contacts
dx for kertoconjunctivitis sicca
1) clinical dx= presentation and questionnarires
or
2) tear breakup time = put fluorescein stain and see if ?????////
or
3) schrimer test (put anesthetic drops and filter paper in inner eye, close eyes for 5 mins and meausre)—> if there is less than 5 mm of wetting= abnormal
tx for kertoconjunctivitis sicca
1) enviro changes
2) lubrication
3) topical cyclosporine= anti-inflammatory, increased tear production
4) oral omega 3 maybe –> greasier tears
5) surgical correction to fix eyelid if needed
episcleritis
LOCALIZED conjuctival inflammation
(RA, TB, idiopathic)
resolves within 1-3 weeks
*want to rule out everything else; can look like subconjuctival hemorrhage but that goes away in a few days whereas this thing stays longer
refer to optho
scleritis
chronic and painful inflammation
anterior= diffuse or nodular
posterior= may have proptosis
its more serious than episcleritis bc deep vessels effected
pathophysiology of scleritis
thinning of sclera and choroid before it becomes visible –> bluish appearance
scleritis workup
check all ur ANCA, ESR, ANA stuff , PPD
Imaging–> MRI/CT
tx for scleritis
NSAIDS
Oral steroids
methotrexate
cyclophosphamide
what disease impacts the middle layer or the vascular tunic
uveitis
uveitis
inflammation of any part of the uveal tract (Iris, choroid, ciliary body)
there is anterior and posterior
anterior uveitis vs posterior
anterior is more common
anterior= iritis!!
posterior= choroiditis (uncommon)–> also HIV and CMV retinitis-
^ in gen more concerned it is something more srs
why do ppl get anteiror uveitis
exact patho unkown
trauma or systemic inflammatory disease (AI disorder like RA or lupus), infection related (herpes, syph, tb)
50% idiopathic
*its usually these pts that have high sed rate and you cannot figure it out
how does anterior uveitis present
acute onset painful red eye
UNILATERAL
blurred vision, photophobia, tearing
how does posterior uveitis present
onset of blurred vision
photophobia
FLOATERS
intermittent eye pain
can be uni or bilateral
PE findings for uveitis
external eye is good
CILIARY flush around limbus
decreased visual acuity
photophobia on exam
w posterior= hazy fundus, blurred optic disc, hemorrhages
uveitis dx
slit lamp exam
rule out corneal abrasions, ulcer, or FB
***hallmark or iritis= granulomatous keratitic precipitates (WBC on corneal epithelium)
look at anterior chamber for clarity (hazy flare–> iritis)
hallmark of iritis
***hallmark or iritis= granulomatous keratitic precipitates
tx for uveitis
1) optho within 24 hours
2) anterior (iritis)
- —–prednisolone solution
- —–scopolamaine OR
- —–cyclopentolate (dilate to relieve muscle spasm)
3) posterior
- ——-periocular or intraocular injection of glucocorticoids
4) systemic meds –> if resistant to topicals and still inflammed, oral glucocorticoids
when siuld you refer to optho
- acute change in vision
- ciliary flush (deeper issue)
- clouding of anterior chamber/corneal opacity
- fixed pupil, globe penetrates, rust ring
- tx response is inadequate
- worried patient OR PA
