Red eyes and red flags part 2 Flashcards
allergic conjunctivitis Hx
intermittent/seasonal, itchiness, redness and watering
rhinitis, atopy
chemosis/conjunctival swelling
management of allergic conjunctivitis
lubricating eye drops
oral antihistamines
ophthalmology
PRN (for use my ophthalmologists): topical antihistamines, mast cell stabilisers, steroids
blephoritis
common
middle aged to elderly patients
oil glands on the eyelid margins
chronic, bilateral, grittiness, burning, watering, intermittant blurring
glands that make eye oil
meibomian glands
examination of blephoritis
lid erythema, conjunctival injection, punctate staining
dandruff like flakes on eyelashes, blocked meibomian glands
management of blephorits
lid hygiene, warm compress, lubricating eye drops
oral omega-3 fatty acids
ophthalmology PRN: topical antibiotic/steroid, oral doxy/minocycline, thermal pulsation
lid hygiene
uses a cotton tip dipped in boiled water to scrub eye lashes every day
either bicarb sod or johnson johnson baby shampoo
use a flannel in a warm shower to massage the eye lid to mechanically push out the blockages
lubricating eye drops
chalazion
trapped meibomian gland secretion that has enlarged over time
inflammatory condition
stye
staph infection of eyelash follicle
management of chalazion
warm compress, fish oil supplements
management of stye
remove infected lash
warm compress
topical antibiotic ointment eg. clorsig
what is the difference between scleritis and episcleritis
both sectoral redness but scleritis is more painful
scleritis Hx
sub acute
sectoral reddness
severe pain boring into their head
among most painful eye conditions
visual disturbance
wakes patient at night
scleritis aetiology
idiopathic, collagen vascular / rheumatological conditions
gout
infection (HZO, syphilis)
management of scleritis
oral NSAIDs
urgent referral to ophthalmology
may need systemic immunosupression, manage with opthal and rheum
diagnostic test for scleritis
drop of phenylephirine
conjunctival vessels constrict causing conjunctival redness to go away
if the eye becomes completely white, it must be either episcleritis or conjunctivitis
if the redness remains, it must be scleritis
pre-septal cellulitis
also called periorbital cellulitis
infection or inflammation of contents in front of the orbital septum
can become post-septal
subacute (hours to days)
unilateral
young
examination of pre septal cellulitis
white eye
peri orbital erythema
normal eye movements
eye isnt proptosed
systemically well
management of pre septal cellulitits
opthalmology consult
oral ABs
daily follow up
CT head and orbits if unable to examine eye,
red tender swelling near the nose
acute in onset
dacrocystitis
dacrocystitis Hx
acute onset
painful red swelling at medial canthus
patient unwell
blocked nasolacrimal sac causing infection
may be discharging - you can swab this
common in kids and >40yo
management of dacrocystitis
ophthalmology consult
swab for culture
FBC and CT if febrile or severe
start ABs
can become orbital cellulitis
definitive management is often surgury
beware extension to orbital cellulitis
admission
red flags for orbital cellulitis
displaced eyeball
extra occular muscle involvement
red eye
reduced VA
management for orbital cellulitis
urgent CT head and orbits
IVABx
opthalmology and ENT consults, admission +/- theatre
FBC, blood cultures, wound swab
risks in orbital cellulitis
risk of subperiosteal/orbital/intracranial abscess, meningitis
hypopion
pus fluid level in the anterior chamber
either infective or inflammatory
endophthalmitis Hx
sub acute
severe pain
recent injection, surgery, contact lens wearer
hypopion
same day opthalmology referral
most common cause of endopthalmitis
injections into the eyes
where to the antibiotics need to go for endopthalmitis
injected into the eye
endophthalmitis examination
reduced VA, severe injection, peri-orbital erythema, hypopyan
cloudy cornea and anterior chamber
management of endophthalmitis
urgent ophthalmology consult
fast
+/- systemic antibiotics
vitrous tap and injection of ABs
+/- vitrectomy surgery (remove vitreous gel, to remove bacterial load)
pterygium
chronic growth over years
red eye
discomfort
management of pterygiums
lubricating eye drops
beware rapid growths (may be SCC)
referral to ophthalmology for surgery
when to refer for surgery for pterigiums
rapid growth
threatening vision
astigmatism (by exterting traction of the cornea)
discomfort
cosmesis
shallow anterior chamber indicates, dated non reactive pupil, elevated IOP
acute angle glaucoma
normal pressure
10-21
checking pressure
anesthetise the eye
measure intraoccular pressure
pressure in acute angle glaucoma
50+ or not recordaable
management of acute angle closure
urgent opthal consult
topical pressure lowering drops, use at least 3 classes
systemic acetazolamide
definitive management = laser peripheral iridotomy (makes a hole through the iris
definitive treatment for acute angle closure glaucoma
laser peripheral iridotomy
makes a hole in the iris using the laser
creates a bypass, gives immediate relief
have to wait until corneal swelling is reduced
sometimes they do one prophylactically in the other eye
classes of pressure lowering drops
beta blockers eg. timolol
carbonic anhydrase inhibitors
alpha-2 agonists
prostaglandins
