The Acute Red Eye Flashcards
What is it important to ascertain with an acute red eye
Whether it is urgent or not
And the cause
Causes of eye lid problems
Blepharitis Melbornian cyst Stye Herpes simplex Molluscum contagiosum Herpes zoster ophthamiscus Entropian
What is blepharitis
Chronic inflammation of the eyelid margins
Causes of blepharitis
Usually staph aureus or epidermidis
Associated with skin disease
- acne Rosales
- seborrhoea can dermatitis
Symptoms of blepharitis
Sore
Gritty
Occasionally red eyes
findings on examination for blepharitis
Hyperaemic lid margins
Crusts on lashes
Blocked meibomian gland orifices
Meibomiancysts
Complications of blepharitis
Conjunctivitis
Marginal keratitis
Meibomian cysts
what is a stye
infected hair follicle
more superficial at the base of the eyelash rather than in the gland
what is the treatment of blepharitis
Lid hygiene Warm compresses - Gentle expression of lipids with a cotton tipped applicator - Gentle lid cleaning with a solution of sodium bicarbonate Antibiotic Ointment Lubricants Low Dose tetracyclines -Antibiotics -Lipid soluble -Protease inhibitors
what is entropian
in turning of the lower lid
what is ectropian
eversion of the lower lid
what is herpes zoster opthalmiscus
shingles affect on the eye
causes of conjunctivitis
Cicatrising bacterial viral allergic chlamydial
causes of bacterial conjunctivitis
Usually staphylococcus, streptococcus or haemophilus species
symptoms of bacterial conjunctivitis
slight discomfort
red sticky eyes
Visual acuity is not affected although slight blurring due to purulent exudation, which clears when discharge is blinked away
findings on examination of bacterial conjunctivitis
Generalised conjunctival injection with purulent discharge
lashes may stick together
complications of bacterial conjunctivitis
usually nil
treatment of bacterial conjunctivitis
frequent antibiotic drops
-‐ instil hourly for 24 hours then qds for a week
general hygiene by not sharing towels etc
causes of viral conjunctivitis
Usually adenovirus (self-‐limiting, but can also affect cornea -‐keratoconjunctivitis
symptoms of viral conjunctivitis
red watery eye
gritty uncomfortable feeling
examination of viral conjunctivitis
- Vision unaffected unless the cornea is involved
- Generalised conjunctival injection with watery discharge
- Follicles (lymphoid aggregates) in the tarsal conjunctiva
- Petechial conjunctival haemorrhages
- Enlarged pre-auricular lymph node
- Associated URTI
complications of viral conjunctivitis
Highly contagious
• Risk of epidemics
• Nosocomial transfer (Audited by Infection Control)
May last several weeks
Small corneal opacities leading to photophobia and reduced vision
treatment of viral conjunctivitis
none
antibiotics can be given to prevent bacterial secondary infection
general hygiene and not sharing towels
typical chlamydial conjunctivitis
unilateral red eye in a young male
symptoms of chlamydial conjunctivitis
Red, watery eye(s)-> Vision
unaffected -> Gritty, foreign body sensation -> Chronic -> Follicular reaction
epidemiology of chlamydial conjunctivitis
Usually young adults Sexually acquired
treatment of chlamydial conjunctivitis
systemic antibiotics
symptoms of allergic conjunctivitis
acute onset
red itchy eyes
chemosis - conjunctival oedema
vision unaffected
how does allergic conjunctivitis occur
Type 1 hypersensitivity reaction
• Seasonal
• Perennial
often settles spontaneously
what is cicatrising conjunctivitis
conjunctivitis that causes scarring
causes of cicatrising conjunctivitis
Physical • Heat • Ionising radiation • Chemical injury Infection • Trachoma, nMembranous conjunctivitis (bacterial and viral) Drug induced • Systemic • Topical Oculocutaneous Disorders • Stevens-‐Johnson syndrome • Toxic epidermal necrosis • Mucous membrane pemphigoid • Chronic atopic keratoconjunctivitis Other associated systemic disorders • Acne rosacea • Sjögren’s syndrome • Inflammatory bowel disease • Immune complex diseases Tumours • Squamous and sebaceous cell carcinomas
types of keratitis
autoimmune
bacterial
viral
what is bacterial keratitis
bacterial infection of the cornea
it is an ophthalmic emergency
what are the causes of bacterial keratitis
Large range of gram positive or negative organisms
corneal abrasion
Contact lenses (usually soft extended wear)
topical steroids
Corneal anaesthesia (e.g. previous herpes zoster ophthalmicus)
symptoms of bacterial keratitis
red sticky eye
pain
reduced vision
photophobia
examination of bacterial keratitis
Conjunctival injection with purulent discharge Corneal abscess(yellow/white area on cornea) May be activity (cells) in anterior chamber
complications of bacterial keratitis
Severe sight-‐threatening intraocular infection (endophthalmitis)
Corneal perforation
Loss of eye
treatment of bacterial keratitis
Admit
• Scrape cornea
• Gram stain
• Culture and sensitivities
