The acute red eye

Question 1

What part of the eye is most likely to be affected if the patient describes a scratchy/gritty discomfort?

Answer 1

External or surface problem such as conjuntivitis or a foreign body (examine the lids, conjuntiva and cornea)

Question 2

What part of the eye is likely to be affected if the patient describes a severe deep aching pain?

Answer 2

Intra ocular or orbital problem such as irits, scleritis or angle closure glaucoma

Question 3

If there is circumcorneal injection what does this mean?

Answer 3

Redness is greatest around the cornea indicating the problem is most likely to be intra ocular

Question 4

If the redness is greater in the fornices then what is this likely to indicate?

Answer 4

Surface infection or lid disease

Question 5

What does fluorescein dye and blue light show up?

Answer 5

Epithelial defect wil fluoresce

Question 6

List 8 potential causes of a red eye

Answer 6

Infection
1. Conjunctivitis 
2. Corneal Ulcers
Trauma
3. Corneal Foreign body 
4. Chemical injury 
Inflammatory 
5. Episcleritis
6. Scleritis
7. Iritis
Pressure
8. Acute angle closure glaucoma

Question 7

What do you use to treat bacterial conjunctivitis?

Answer 7

Chloramphenicol

Question 8

What do you do to treat viral conjunctivitis?

Answer 8

Supportive treatment: Cool compresses/lubricants

Question 9

What is the treatment for a bacterial corneal ulcer?

Answer 9

Topical ofloxacin hourly

Question 10

How do you treat a dendritic ulcer?

Answer 10

Topical aciclovir for 7 - 10 days

Question 11

What virus causes a dendritic ulcer?

Answer 11

Herpes simplex

Question 12

Is episcleritis or scleritis more likely to be associated with connective tissue disease?

Answer 12

Scleritis

Question 13

What is the treatment for scleritis?

Answer 13

NSAIDS
Systemic steroids
Immunosupression may be needed if there is necrosis

Question 14

How can you tell the diffeence between episcleritis and scleritis?

Answer 14

1. Pain is worse with scleritis

2. Scleritis does not blanch with topical phenylephrine but episcleritis does.

Question 15

What kind of conditions is anterior uveitis associated with?

Answer 15

HLA B27 linked conditions such as ankylosing spondylitis/IBD/Psoriatic arthtisis

Question 16

What are the symptoms of anterior uveitis?

Answer 16

Ache
Photophobia
Lacrimation
Blurred vision

Question 17

What are the signs you see in a patient with anterior uveitis?

Answer 17

Circumcorneal redness
Cells in anterior chamber
Hypopyon
Posterior synechiae

Question 18

What is the treatment for anterior uveitis?

Answer 18

Topical steroids hourly with tapering down

Pupil dilating agent (mydratic) such as cyclopentolate

Question 19

Give three topical mydratics and the difference between them?

Answer 19

1. Tropicomide (quick half life)
2. Cyclopentolate (Medium half life)
3. Atropine (long half life)

Question 20

Unilateral painful red eye with severe loss of vision, a hazy cornea and a fixed, mid dilated pupil.

Answer 20

Acute angle closure glaucoma

Question 21

What is the immediate treatment for acute closed angle glaucoma?

Answer 21

IV Diamox (Acetazolamide)
Topical beta blockers
Topical steroids
Pilocarpine (Once IOP is less than 50mmHg)

Question 22

Give a surgical option for acute angle closure glaucoma?

Answer 22

YAG laser peripheral iridotomy which creates a alternative flow pathway for aqueous and reduces risk of recurrence