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5 - ENT and Ophthalmology > Red Eye Things > Flashcards

Red Eye Things Flashcards

1
Q

Causes of a red eye?

A

Inflammation/infection - Conjunctivitis, keratitis, episleritis/scleritis, iritis/uveitits, endophthalmitis, orbital cellulitis.

Trauma - subconjunctival haemorrhage, corneal abrasion, corneal foregin body, globe rupture, penetrating injury, retrobulbar haematoma, chemical injury

Acute angle closure glaucoma.

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2
Q

Presentation and management of conjunctivitis?

A

Presentation - irritable, red eye with some discharge.

Management:
If bacterial give topical chloramphenicol
If viral then use cold compresses and lubricants.
If allergic then use cold compress, lubricants and anti-histamines,

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3
Q

Presentation and management of bacterial keratitis?

A

Symptoms - reduced vision, pain and often in contact lens wearers.
Management - Same day referral if contact lens wearer. frequent topical antibiotics (quinolones), cycloplegic for analgesia and close review and period of no contact lens use.

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4
Q

Presentation and management of HSV keratitis

A

Symptoms - recent cold sore on lip, painful, photophobic eye.
Ix - fluorescein staining may show epithelial ulcer
Management - immediate referal to ophthalmology. topical antivirals

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5
Q

Presentation and management of episcleritis?

A

Presentation - Red eye but clasically not painful where as scleritis is. There is watering and mild photophbia. The blood vessels are mobile and move with gentle presure (unlike in the sclera).
Management - conservative and sometimes use artificial tears

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6
Q

Presentation and management of iritis/anterior uveitis

A

Presentation - acute onset of painful, red photophobic eye (painful to constrict eye because iris is control of that), lacrimation, cilliary flush, hypopyon (pus and inflammatory cells in anterior chamber giving visbile fluid level.

Management - urgent ophthalmology review. Topical steroids (tapering course) and dilating drops (pain relief - stop eye constricting, like muscle rest)
If recurrent then screen for lupus, sarcoidosis.

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7
Q

Risk factors for endophthalmitis?

A

Recent intraocular surgery - takes 3-4 days to develop,
Infectious keratitis/ blebitis,
Recent intravitreal injections.
Microbaemia.

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8
Q

Conditions associated with iritis/anterior uveitis?

A

Ankolysing spondylitis,
Reactive arthritis,
Ulcerative colitis/ Crohn’s disease,
Behcet’s disease
Sarcoidosis

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9
Q

Presentation of endopthalmitis

A

Occular pain,
Reduced hazy vision,
Lid swelling,
Discharge,
Corneal oedema,
Hypopyon,
Raised IOP,
Poor red reflex,
Vitreous cells.

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10
Q

Management of endopthalmitis

A

Invravitreal tap + intravitreal abx.
Admission for daily review.
Vitrectomy if poor vision

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11
Q

location of Orbital cellulitis vs periorbital cellulitis

A

Post-septal - orbital cellulitis. Risk of increasing orbital pressure or brain infections.
Pre-septal - periorbital

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12
Q

Risk factors for periorbital cellulitis

A

Younger age,
Local skin trauma,
Lid or lacrimal infection
Sinusitis
Dental infections

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13
Q

Presentation of periorbital cellulitis

A

Swollen/erythematous lid and pain however the eye is white and the occular and orbital exam is normal.

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14
Q

Presentation of orbital cellulitis

A

Pain worse with eye movement,
Reduced vision,
Diplopia,
Pyrexia,
Reduced VA,
RAPD - due to compression of optic nerve.
Reduced colour vision,
Resritction of eye movement,
proptosis,
lid swlling.

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15
Q

Management of periorbiral cellulitis

A

Oral co-amoxiclav 625mg TDS for 1 week.
Chloramphenicol ointment TDS for 5 days if occular irritation.
Warm compresses and lid hygrine advice.
Strong worsening advice

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16
Q

Management of orbital cellulitis

A

Referral to and admission under ENT
IV antibiotics,
CT scan with contrast.
Daily ENT and ophthalmology review.
Surgical drainage if abscess.

17
Q

Risk factors for AACG?

A

Previous AACG,
Hypermetropia,
Narrow angles,
Older age,
Female,
Asian ethnicity,
Family history.

Secondary AACG - advanced cataracts because lens becomes more bulky

18
Q

Presentation of AACG

A

Severe occular pain,
Headache,
Reduced vision,
Halos around light,
Severe nausea and vomiting,
Corneal oedema,
Shallow anterior chamber peripherally,
Raised IOP,
Mid-dilated unreactive pupil,

19
Q

Management of AACG?

A

Reduce the intraocular pressure quickly - acetazolomide drops, mannitol, lie flat.
Then subsequently perform bilateral YAG later peripheral iridotomies

20
Q

Subconjunctival haemorrhage

A

Can be sponteanous, if you sneeze or rub eyes.
Benign - takes a few weeks to go away, like a bruise.

21
Q

Corneal abrasion manaement

A

Trauma to cornea - very sore, lacrimation, photophobia, decreased visual acuity

Ix - fluorescein staining

Treat with frequent chloramphenicol ointment (abx)
OTC analgesia.
If large, then give lubrication gel to reduced risk of recurrent corneal erosion syndrome.

22
Q

Management of corneal foreign body?

A

Remove the foreign body and give topical antibiotic prophylaxis.
Foreign bodies of organic material eg, soil or seeds should all be referred to ophthalmology due to high risk of infection.

23
Q

Signs of a penetrating eye injury?

A

Object through full thickness of the cornea.
Siedel’s +ve defect - dye/flurosine is diluted by aqueous fluid
May have peaked/irregular pupil +/- uveal prolapse.
Shallow anterior chamber in comparison to other eye.

24
Q

Management of penetrating eye injury?

A

Avoid pressure on globe,
Eye shild,
CT the orbits,
Keep NBM,
Give analgesia and antiemetics,
Tetanus,
Admit to ophthalmology ward.
Emergency exploration and repair in theater
IV Abx

25
Q

Retrobulbar haemorrhage

A

Emergency surgery - lateral canthotomy

26
Q

Presentation of chemical eye injury

A

Involvement of eyelids,
Conjunctival injection/blanching,
Limbal ischaemia,
Corneal opacification,
Epithelial defect.
Really bad sign if the eye is white - means sclera is ischaemic

27
Q

Management of chemical injury

A

IRIGATE!
Ph check
Topical proxymethacaine
Sweep forceps.
Examine with slit lamp once pH neutral. Give abx and topical steroids

28
Q

What is Blepharitis?

A

Inflammation of eyelid margins which may be due to meibomian gland dysfunction, seborrhoeic dermatitis or staphylococcal infection

29
Q

Presentation and management of blepharitis?

A

Symptoms are usuallt bilateral.
Grittiness and discomfort particularly around eyelid.
Eyes may be sticking in morning,
Eyelid margins may be red.
May have swollen eyelids if infective.
Secondary conjunctiveits may occur.

Management - Hot compresses 2x day, lid hygiene and artificial tears.

30
Q

How can you differentiate between episcleritis and scleritis?

A

Blood vessel movement with pressure - episcleritis will move. Scleritis will not move.

Phenylephrine drops - These will cause episcleritis vessels to blanch but not scleral vessels. So if redness reduces with these drops then diagnosis of episcleritis can be made.

31
Q

Risk factors for scleritis?

A

Rheumatoid arthritis,
SLE,
Sarcoiditis,
Granulomatosis with polyangiitis

32
Q

Presentation and management of scleritis?

A

Presentation - painful and incredibly sore eye (may be mild sometimes), lacrimation and photophobia, reduction in vision.

Management - Same day assessment by ophthalmology. Oral NSAIDs are first line. Can use oral steroids if more severe and immunosuppressants if resistant.

33
Q

What are the different causes of keratitis?

A

Bacterial - Typically S. aureus but Pseudomonas aeruginosa can be seen in contact lens wearers.
Fungal.
Amoebic - Acanthamoebic keratitis (increased incidence if contact with soil or contaminated water, associated with contact lens)
Parasitic - Onchocercal keratitis (river blindness)
Viral - HSV
Environmental - Photokeratitis, exposure keratitis or contact lens acute red eye (CLARE)

5 - ENT and Ophthalmology (16 decks)

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