Red Eyes Flashcards
What are the possible causes of an acute red eye?
Conjunctivitis (bacterial, viral or allergic) Subconjunctival haemorrhage Episcleritis Scleritis Anterior uveitis Keratitis Corneal abrasion Acute angle closure glaucoma
What questions need to be asked in a history of an acute red eye?
Onset and duration History of preceding trauma Visual acuity Pain? Foreign body sensation Discharge Photophobia Itching Recent illness Past ophthalmic history
What examination should be done in an acute red eye?
Visual acuity Pupil shape, reactivity Fluorescein Eye movements Visual fields
What is the commonest cause of red eye?
Conjunctivitis
What is conjunctivitis?
Inflammation of the conjunctiva covering the globe and lining the eyelids
What are the main types of conjunctivitis?
Viral
Bacterial (gonorrhoeae, chlamydial)
Allergic
What is the presentation of viral conjunctivitis?
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
What is the treatment for viral conjunctivitis?
Supportive - to ease discomfort
Topical lubricants
Cool compress
How long are conjunctivitis patients infectious for?
95% at 10 days after initial symptoms, 5% after 16 days
What measures should be taken to reduce spread?
Hand hygiene
Don’t share items such as towels
What is the presentation of bacterial conjunctivitis?
Sudden onset
Morning crusting
Difficulty opening eyes due to large amounts of mucopurulent yellow discharge
What is the treatment of bacterial conjunctivitis?
Chloramphenicol eye drops to hasten resolution
Don’t wear contact lenses
What should be suspected in hyper acute conjunctivitis?
Neisseria gonorrhoeae
How does neisseria gonorrhoeae cause conjunctivitis?
Ocular autoinnoculation - genital infection spread to eyes by e.g. rubbing them
What is the presentation of neisseria gonorrhoeae conjunctivitis?
Copious amounts of mucopurulent discharge
Lid swelling
Glibe tenderness
Conjunctival chemosis
What are the risks of neisseria gonorrhoeae conjunctivitis?
Can lead to corneal ulceration and perforation
What is the presentation of chlamydial conjunctivitis?
Mild unilateral or bilateral symptoms for many weeks
Small amounts of mucopurulent discharge
Pre-auricular discharge
What investigation should be done if chlamydial conjunctivitis is suspected?
Conjunctival swabs (taken before fluorescein applied) Refer to sexual health clinic, as co-infection with other STIs is common
What allergens can cause allergic conjunctivitis?
Pollen (if seasonal)
House dust mite
Animal dander
What is the presentation of allergic conjunctivitis?
Ocular itch Watery eyes Bilateral, symmetrical symptoms Global injection Chemosis
What is the treatment for allergic conjunctivitis?
Avoidance of triggers
Symptomatic relief with cool compress
Oral and topical anti-histamines
Maintenance with a mast cell stabiliser
What is sub-conjunctival haemorrhage?
Bleeding into the subconjunctival space
What are the possible aetiologies of sub-conjunctival haemorrhage?
Spontaneous
Following trauma
Underlying hypertension or bleeding disorder
What is the presentation of sub-conjunctival haemorrhage?
Bright red blood overlying the sclera
Well-defined borders
What is the treatment of sub-conjunctival haemorrhage?
None required - will heal within 2 weeks
Lubricants if large and causing significant local tissue swelling
What is the episclera?
The thin vascular sheet between the conjunctiva and the sclera
What are the possible aetiologies of episcleritis?
Idiopathic
Associated with a collagen-vascular disease (rheumatoid arthritis, sarcoidosis, IBD)
What is the presentation of episcleritis?
Hyperaemia
Mild foreign body discomfort
Globe tenderness
What is the treatment for episcleritis?
Topical lubricants for symptomatic relief
Oral NSAIDs
What is the sclera?
The tough, white layer below the episclera
What are the possible aetiologies for scleritis?
Immune mediated
Surgery
Infection (usually adjacent keratitis)
Collagen-vascular disorders (rheumatoid arthritis, Wegener’s granulomatosis)
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
What is the treatment of scleritis?
Urgent specialist referral
Systemic immunosuppresion
What is another name for anterior uveitis?
Iridocyclitis
What is anterior uveitis?
An intraocular inflammation that involves the iris and the ciliary body
What are the possible aetiologies of anterior uveitis?
Idiopathic
Associated with systemic disease (ank spon, psoriatic arthropathy, IBD) - HLA B27
Direct ocular trauma
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
What is a hypopyon?
Accumulation of leukocytes within the anterior chamber, occurs if intraocular inflammation is significant
What is the treatment for anterior uveitis?
Mydriatics and topical steroids
What is keratitis?
Inflammation of the cornea
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)
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
What is the treatment of non-infectious keratitis?
Systemic analgesics
Cool lid compress
Usually resolved in 24 hours
When should viral keratitis be considered?
Recurrent attacks
What can recurrent attacks of keratitis be triggered by?
Trauma
Emotional stress
Menstruation
UV exposure
What clinical feature is different in herpetic keratitis?
Corneal sensation is reduced
What is the treatment for viral keratitis?
Gancyclovir
What is the most common cause of bacterial keratitis?
High risk contact lens use - e.g. swimming or sleeping while wearing them
What is the presentation of bacterial keratitis?
White opacity (infiltrate) within the cornea Overlying epithelial defect Can be purulent discharge and hypopyon
What is the treatment for bacterial keratitis?
Corneal scrape and culture of contact lens to determine organism
Chloramphenicol
What is a corneal abrasion?
A defect in the corneal epithelium as a result of mechanical trauma
What are common causes of corneal abrasion?
Fingernails
Foreign bodies
Contact lenses
What is the presentation of a corneal abrasion?
Extremely painful
Fluorescein staining shows extent of abrasion
Ocular hyperaemia maximal at the limbus
What is the treatment for corneal abrasion?
Chloramphenicol
Mydriatic for symptomatic relief
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
What are the possible aetiologies of angle closure glaucoma?
Hypermetropic individuals
Precipitants: dim lighting, tricyclic antidepressants, anticholinergics, topical mydriatics
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
What is the treatment for angle closure glaucoma?
Ophthalmic emergency
Acetazolamide (dehydrates eye and reduced aqueous fluid production)
Laser treatment
