SS2 Flashcards
What can cause a red eye?
Conjunctivitis
Subtarsal or conjunctival foreign body
Corneal abrasion
Episcleritis.
Dry eye -
Blepharitis
Ectropion (outward rotation of the eyelid margin).
Entropion (inward rotation of the eyelid margin).
Trichiasis (misdirection of the eyelashes towards the cornea).
Acute glaucoma. corneal ulcer (bacterial, viral or fungal), contact lens-related red eye corneal foreign body. Anterior uveitis. Scleritis. Trauma. Chemical injuries. Neonatal conjunctivitis.
What is conjunctivitis?
inflammation of the conjunctiva - infective or allergic
What are the key symptoms of conjunctivitis
Red eye - generalised, often bilateral.
Irritation, grittiness and discomfort are typical.
Discharge, which may be watery, mucoid, sticky or purulent depending on the cause.
What are the key signs of conjunctivitis
Conjunctival injection with dilated conjunctival vessels.
Conjunctival oedema
Follicles or papillae:
Conjunctival follicles = round collections of lymphocytes, most prominent in the inferior fornix, which appear as small, dome-shaped nodules - caused by viruses, atypical bacteria and toxins
Papillae = cobblestone appearance of flattened nodules with central vascular cores, appearing red on the surface and pale at the base on the tarsal surface of upper eyelid - caused by allergic immune response, response to a foreign body such as a contact lens.
What can be used in the management of allergic conjunctivitis
Topical mast cell stabilisers - Sodium cromoglycate
Topical antihistamines
What can be used in the management of infective conjunctivitis
bacterial - most cases of bacterial conjunctivitis are self-limiting and management is usually supportive. Conjunctivitis caused by gonococcal or chlamydial infection should be treated with antibiotics - chloramphenicol
What is the difference between scleritis and episcleritis
Episcleritis = inflammation of the superficial, episcleral layer of the eye. It is relatively common, benign and self-limiting.
Scleritis = inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment.
In which patients is scleritis more common
rheumatoid arthritis Wegener's granulomatosis, SLE reactive arthritis, polyarteritis nodosa ankylosing spondylitis. gout, Churg-Strauss syndrome syphilis.
What are the symptoms of episcleritis
Acute onset of redness with discomfort
Discomfort, grittiness, aching in or around the eye
Watering and occasional mild photophobia.
No other associated ocular symptoms.
No discharge other than watering.
Visual acuity normal
What are the symptoms of scleritis
Subacute or gradual onset
Presents early, as symptoms are severe.
Boring eye pain, often radiating to the forehead, brow and jaw and usually severe.
Pain worse with movement of the eye and at night (may wake the patient).
Associated watering, photophobia.
Gradual decrease in vision.
Diplopia.
Occasional associated systemic symptoms (fever, vomiting, headache).
What are the signs of episcleritis
Sectoral/diffuse redness.
Engorged episcleral vessels extending radially.
Translucent white nodule may be present within the inflamed area.
Visual acuity is normal.
What are the signs of scleritis
Visual acuity may be reduced or normal.
Anterior:
Sectoral or diffuse redness.
Scleral, episcleral and conjunctival vessels all involved.
Sclera may take on a bluish tinge ± may be thin and oedematous.
The globe is tender.
Posterior: Lid oedema. Proptosis. Optic disc swelling. Retinal detachment can occur.
Which diseases are associated with episcleritis
UC
Crohn’s
RA
SLE
Wegener’s
hyperuricaemia
What is the treatment for episcleritis
Artificial tears
topical NSAIDs
Where the episode is more severe, a short course of topical steroids may be required (under the supervision of an ophthalmologist).
What is used in the treatment of scleritis
oral NSAIDs or steroids
immunosuppressive therapy such as methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or ciclosporin
