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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
Q

What is the treatment of sub-conjunctival haemorrhage?

A

None required - will heal within 2 weeks

Lubricants if large and causing significant local tissue swelling

26
Q

What is the episclera?

A

The thin vascular sheet between the conjunctiva and the sclera

27
Q

What are the possible aetiologies of episcleritis?

A

Idiopathic

Associated with a collagen-vascular disease (rheumatoid arthritis, sarcoidosis, IBD)

28
Q

What is the presentation of episcleritis?

A

Hyperaemia
Mild foreign body discomfort
Globe tenderness

29
Q

What is the treatment for episcleritis?

A

Topical lubricants for symptomatic relief

Oral NSAIDs

30
Q

What is the sclera?

A

The tough, white layer below the episclera

31
Q

What are the possible aetiologies for scleritis?

A

Immune mediated
Surgery
Infection (usually adjacent keratitis)
Collagen-vascular disorders (rheumatoid arthritis, Wegener’s granulomatosis)

32
Q

What is the presentation of scleritis?

A

Severe eye pain (progresses over several days, wakes patient up at night)
Deep vascular engorgement results in bluish-red hue)
Tender eye

33
Q

What is the treatment of scleritis?

A

Urgent specialist referral

Systemic immunosuppresion

34
Q

What is another name for anterior uveitis?

A

Iridocyclitis

35
Q

What is anterior uveitis?

A

An intraocular inflammation that involves the iris and the ciliary body

36
Q

What are the possible aetiologies of anterior uveitis?

A

Idiopathic
Associated with systemic disease (ank spon, psoriatic arthropathy, IBD) - HLA B27
Direct ocular trauma

37
Q

What is the presentation of acute uveitis?

A 
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
Q

What is a hypopyon?

A

Accumulation of leukocytes within the anterior chamber, occurs if intraocular inflammation is significant

39
Q

What is the treatment for anterior uveitis?

A

Mydriatics and topical steroids

40
Q

What is keratitis?

A

Inflammation of the cornea

41
Q

What are the possible aetiologies of keratitis?

A

Infectious - viral (more common) or bacterial

UV light exposure (welders with inadequate eye protection, tanning salons sunlight reflected in snow)

42
Q

What is the presentation of keratitis?

A 
Photophobia
Severe ocular pain
Foreign body sensation
Reduced visual acuity
Hours after UV exposure
Dendritic ulcer seen with fluorescein
43
Q

What is the treatment of non-infectious keratitis?

A

Systemic analgesics
Cool lid compress
Usually resolved in 24 hours

44
Q

When should viral keratitis be considered?

A

Recurrent attacks

45
Q

What can recurrent attacks of keratitis be triggered by?

A

Trauma
Emotional stress
Menstruation
UV exposure

46
Q

What clinical feature is different in herpetic keratitis?

A

Corneal sensation is reduced

47
Q

What is the treatment for viral keratitis?

A

Gancyclovir

48
Q

What is the most common cause of bacterial keratitis?

A

High risk contact lens use - e.g. swimming or sleeping while wearing them

49
Q

What is the presentation of bacterial keratitis?

A 
White opacity (infiltrate) within the cornea
Overlying epithelial defect
Can be purulent discharge and hypopyon
50
Q

What is the treatment for bacterial keratitis?

A

Corneal scrape and culture of contact lens to determine organism
Chloramphenicol

51
Q

What is a corneal abrasion?

A

A defect in the corneal epithelium as a result of mechanical trauma

52
Q

What are common causes of corneal abrasion?

A

Fingernails
Foreign bodies
Contact lenses

53
Q

What is the presentation of a corneal abrasion?

A

Extremely painful
Fluorescein staining shows extent of abrasion
Ocular hyperaemia maximal at the limbus

54
Q

What is the treatment for corneal abrasion?

A

Chloramphenicol

Mydriatic for symptomatic relief

55
Q

What is angle closure glaucoma?

A

Aqueous fluid accumulates behind the iris, blocking its drainage from the eye and leading to a rapid increase in intraocular pressure

56
Q

What are the possible aetiologies of angle closure glaucoma?

A

Hypermetropic individuals

Precipitants: dim lighting, tricyclic antidepressants, anticholinergics, topical mydriatics

57
Q

What is the presentation of angle closure glaucoma?

A 
Severe monocular eye pain
Blurred vision with haloes around lights
Global hyperaemia
Fixed mid-dilated pupil
Shallow anterior chamber
Increased pressure in eye
58
Q

What is the treatment for angle closure glaucoma?

A

Ophthalmic emergency
Acetazolamide (dehydrates eye and reduced aqueous fluid production)
Laser treatment

Y2 - Ophthalmology (7 decks)

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