Red Eyes Flashcards
What are important questions to ask in suspected conjunctivitis?
- Does the patient have any allergies?
- Has the patient been sexually active recently?
- Has the patient been in contact with any people with red eyes?
- Does the patient wear contact lenses?
- Has the patient had an URTI recently?
What are the symptoms of conjunctivitis?
- Conjunctival injection (red sclera)
- Watery
- Purulent discharge (mucoid)
- Allergic triggers - abrupt onset post-exposure, bilateral with chemosis (swollen conjunctiva), pruritis and eyelid oedema
- Normal visual acuity
- Reactive pupils
What investigations do you want to do for conjunctivitis?
- Bacterial swabs
- Viral swabs
- Chlamydial swabs
What is fluorescein?
Orange water-soluble dye - can be used IV or topically. The dye is visualised using a cobalt-blue filter which cause the dye to fluoresce a bright green colour. Fluorescein does not stain intact corneal epithelium but does stain the deeper corneal stroma, thus highlighting the area of epithelial loss.
What would you see in the ophthalmoscope for HSV?
Dendritic ulcer - caused by herpes simplex keratitis, this is a recurrent HSV infection in the cornea.
What are the types of herpes simplex viruses?
- HSV-1 causes infection above the waist (principally the face, lips and eyes)
- HSV-2 causes venerally-acquired infection (genital herpes). This may rarely be transmitted to the eye through infected secretions, either venereally or at birth (neonatal conjunctivitis).
- HSV is transmitted through conditions of crowding and poor hygiene.
How do you treat HSV conjunctivitis?
If necessary involves topical aciclovir ointment for the eye +/or cream for skin lesions.
What is anterior uveitis and what conditions is it associated with?
Uveitis is defined as inflammation of uveal tract (iris, ciliary body, retina and choroid). Anterior uveitis is inflammation primarily involving the iris (causes photophobia).
Associated conditions: ankylosing spondylitis, reactive arthritis, IBD, Behcet’s disease, sarcoidosis.
What are the signs for anterior uveitis?
- Signs of intra-ocular inflammation, such as cells in the anterior chamber and posterior synechiae
- Posterior synechiae is where the iris becomes stuck to the lens. This can cause an irregular pupil and raised IOP.
What are the symptoms of anterior uveitis?
- Acute pain, usually in 1 eye, associated with photophobia, redness and blurred vision
- Pupil may be small +/- irregular due to sphincteric contraction
- Lacrimation and ciliary flush
- Visual acuity initially normal»_space; impaired
- Hypopyon
- Pain is typically felt deeper than conjunctivitis
- May be background of HLA-B27 associated spondyloarthropathies, IBD, Reiter’s syndrome (reactive arthritis) +/or psoriasis.
What is the treatment for anterior uveitis?
Cycloplegiacs e.g.cyclopentolate for symptom relief and topical steroid to induce remission
What are the causes of bacterial conjunctivitis?
Acute bacterial conjunctivitis is usually a self-limiting condition caused by direct eye contact with infected secretions:
- S. pneumoniae
- S. aureus
- H. influenzae
- Moraxella Catarrhalis
- Neisseria gonorrhoeae - rare
- Meningococcal - rare, usually affects children
- PCR may be done for less severe cases failing to respond to medication to rule out possibility of chlamydial and viral infection
What is the treatment for bacterial conjunctivitis?
- Topical lubricants (e.g. chloramphenicol q.i.d. for up to 1 week) to speed recovery and prevent re-infection/transmission. Ointments and gels provide higher concentration for longer periods than drops but daytime use limited due to blurred vision
- Chloramphenicol eye drops (1st line) and cool compress
- Occasionally systemic antibiotics are needed: gonococcal infection (3rd gen cephalosporin e.g. ceftriaxone, or quinolones and macrolides), H. influenzae (oral amoxicillin with co-amoxiclav), meningococcal conjunctivitis (advice of paediatric ID specialist, IM benzylpenicillin, ceftriaxone or cefotaxime or PO ciprofloxacin)
- About 60% of cases should resolve within 5 days without treatment
What is the advise for someone with conjunctivitis?
- Irrigation to remove excessive discharge may be useful in purulent cases
- Contact lens wear should be discontinued until at least 48 hrs after complete resolution of symptoms - should not be worn whilst topical antibiotic continues
- Good hand-washing and avoid sharing of towels to reduce transmission
- Should be cautioned to see further advice in event of deterioration
- Statutory notification of public health authorities may be required locally in some cases.
How is viral conjunctivitis spread?
- Most frequently caused by an adenovirus, infection may be sporadic or occur in epidemics in workplaces (including hospitals), schools and swimming pools.
- Spread is facilitated by ability of viral particles to survive on dry surfaces for weeks and viral shedding may occur for many days before clinical features appear.
- Transmission is generally via contact with respiratory or ocular secretion and fomites e.g. contaminated towels.
