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Y2 - Ophthalmology > Red Eyes > Flashcards

Red Eyes Flashcards

1
Q

What are the possible causes of an acute red eye?

A 
Conjunctivitis (bacterial, viral or allergic)
Subconjunctival haemorrhage
Episcleritis
Scleritis
Anterior uveitis
Keratitis
Corneal abrasion
Acute angle closure glaucoma
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2
Q

What questions need to be asked in a history of an acute red eye?

A 
Onset and duration
History of preceding trauma
Visual acuity
Pain?
Foreign body sensation
Discharge
Photophobia
Itching 
Recent illness
Past ophthalmic history
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3
Q

What examination should be done in an acute red eye?

A 
Visual acuity
Pupil shape, reactivity
Fluorescein
Eye movements
Visual fields
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4
Q

What is the commonest cause of red eye?

A

Conjunctivitis

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5
Q

What is conjunctivitis?

A

Inflammation of the conjunctiva covering the globe and lining the eyelids

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6
Q

What are the main types of conjunctivitis?

A

Viral
Bacterial (gonorrhoeae, chlamydial)
Allergic

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7
Q

What is the presentation of viral conjunctivitis?

A 
Sudden onset and rapidly progressive
Typically bilateral
Watery discharge
Associated with upper respiratory infection
Vision not affected
Mild foreign body sensation
Tender pre-auricular lymphadenopathy
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8
Q

What is the treatment for viral conjunctivitis?

A

Supportive - to ease discomfort
Topical lubricants
Cool compress

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9
Q

How long are conjunctivitis patients infectious for?

A

95% at 10 days after initial symptoms, 5% after 16 days

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10
Q

What measures should be taken to reduce spread?

A

Hand hygiene

Don’t share items such as towels

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11
Q

What is the presentation of bacterial conjunctivitis?

A

Sudden onset
Morning crusting
Difficulty opening eyes due to large amounts of mucopurulent yellow discharge

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12
Q

What is the treatment of bacterial conjunctivitis?

A

Chloramphenicol eye drops to hasten resolution

Don’t wear contact lenses

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13
Q

What should be suspected in hyper acute conjunctivitis?

A

Neisseria gonorrhoeae

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14
Q

How does neisseria gonorrhoeae cause conjunctivitis?

A

Ocular autoinnoculation - genital infection spread to eyes by e.g. rubbing them

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15
Q

What is the presentation of neisseria gonorrhoeae conjunctivitis?

A

Copious amounts of mucopurulent discharge
Lid swelling
Glibe tenderness
Conjunctival chemosis

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16
Q

What are the risks of neisseria gonorrhoeae conjunctivitis?

A

Can lead to corneal ulceration and perforation

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17
Q

What is the presentation of chlamydial conjunctivitis?

A

Mild unilateral or bilateral symptoms for many weeks
Small amounts of mucopurulent discharge
Pre-auricular discharge

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18
Q

What investigation should be done if chlamydial conjunctivitis is suspected?

A 
Conjunctival swabs (taken before fluorescein applied)
Refer to sexual health clinic, as co-infection with other STIs is common
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19
Q

What allergens can cause allergic conjunctivitis?

A

Pollen (if seasonal)
House dust mite
Animal dander

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20
Q

What is the presentation of allergic conjunctivitis?

A 
Ocular itch
Watery eyes
Bilateral, symmetrical symptoms
Global injection
Chemosis
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21
Q

What is the treatment for allergic conjunctivitis?

A

Avoidance of triggers
Symptomatic relief with cool compress
Oral and topical anti-histamines
Maintenance with a mast cell stabiliser

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22
Q

What is sub-conjunctival haemorrhage?

A

Bleeding into the subconjunctival space

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23
Q

What are the possible aetiologies of sub-conjunctival haemorrhage?

A

Spontaneous
Following trauma
Underlying hypertension or bleeding disorder

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24
Q

What is the presentation of sub-conjunctival haemorrhage?

A

Bright red blood overlying the sclera

Well-defined borders

25
What is the treatment of sub-conjunctival haemorrhage?
None required - will heal within 2 weeks | Lubricants if large and causing significant local tissue swelling
26
What is the episclera?
The thin vascular sheet between the conjunctiva and the sclera
27
What are the possible aetiologies of episcleritis?
Idiopathic | Associated with a collagen-vascular disease (rheumatoid arthritis, sarcoidosis, IBD)
28
What is the presentation of episcleritis?
Hyperaemia Mild foreign body discomfort Globe tenderness
29
What is the treatment for episcleritis?
Topical lubricants for symptomatic relief | Oral NSAIDs
30
What is the sclera?
The tough, white layer below the episclera
31
What are the possible aetiologies for scleritis?
Immune mediated Surgery Infection (usually adjacent keratitis) Collagen-vascular disorders (rheumatoid arthritis, Wegener's granulomatosis)
32
What is the presentation of scleritis?
Severe eye pain (progresses over several days, wakes patient up at night) Deep vascular engorgement results in bluish-red hue) Tender eye
33
What is the treatment of scleritis?
Urgent specialist referral | Systemic immunosuppresion
34
What is another name for anterior uveitis?
Iridocyclitis
35
What is anterior uveitis?
An intraocular inflammation that involves the iris and the ciliary body
36
What are the possible aetiologies of anterior uveitis?
Idiopathic Associated with systemic disease (ank spon, psoriatic arthropathy, IBD) - HLA B27 Direct ocular trauma
37
What is the presentation of acute uveitis?
``` Sudden onset Red eye Deep, aching pain radiating up to the brow and exacerbated by accommodation Photophobia Conjunctival injection Blurred vision Constricted pupil Tender eye Hypopyon ```
38
What is a hypopyon?
Accumulation of leukocytes within the anterior chamber, occurs if intraocular inflammation is significant
39
What is the treatment for anterior uveitis?
Mydriatics and topical steroids
40
What is keratitis?
Inflammation of the cornea
41
What are the possible aetiologies of keratitis?
Infectious - viral (more common) or bacterial | UV light exposure (welders with inadequate eye protection, tanning salons sunlight reflected in snow)
42
What is the presentation of keratitis?
``` Photophobia Severe ocular pain Foreign body sensation Reduced visual acuity Hours after UV exposure Dendritic ulcer seen with fluorescein ```
43
What is the treatment of non-infectious keratitis?
Systemic analgesics Cool lid compress Usually resolved in 24 hours
44
When should viral keratitis be considered?
Recurrent attacks
45
What can recurrent attacks of keratitis be triggered by?
Trauma Emotional stress Menstruation UV exposure
46
What clinical feature is different in herpetic keratitis?
Corneal sensation is reduced
47
What is the treatment for viral keratitis?
Gancyclovir
48
What is the most common cause of bacterial keratitis?
High risk contact lens use - e.g. swimming or sleeping while wearing them
49
What is the presentation of bacterial keratitis?
``` White opacity (infiltrate) within the cornea Overlying epithelial defect Can be purulent discharge and hypopyon ```
50
What is the treatment for bacterial keratitis?
Corneal scrape and culture of contact lens to determine organism Chloramphenicol
51
What is a corneal abrasion?
A defect in the corneal epithelium as a result of mechanical trauma
52
What are common causes of corneal abrasion?
Fingernails Foreign bodies Contact lenses
53
What is the presentation of a corneal abrasion?
Extremely painful Fluorescein staining shows extent of abrasion Ocular hyperaemia maximal at the limbus
54
What is the treatment for corneal abrasion?
Chloramphenicol | Mydriatic for symptomatic relief
55
What is angle closure glaucoma?
Aqueous fluid accumulates behind the iris, blocking its drainage from the eye and leading to a rapid increase in intraocular pressure
56
What are the possible aetiologies of angle closure glaucoma?
Hypermetropic individuals | Precipitants: dim lighting, tricyclic antidepressants, anticholinergics, topical mydriatics
57
What is the presentation of angle closure glaucoma?
``` Severe monocular eye pain Blurred vision with haloes around lights Global hyperaemia Fixed mid-dilated pupil Shallow anterior chamber Increased pressure in eye ```
58
What is the treatment for angle closure glaucoma?
Ophthalmic emergency Acetazolamide (dehydrates eye and reduced aqueous fluid production) Laser treatment

Y2 - Ophthalmology (7 decks)

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