The Acute Red Eye

Question 1

What is it important to ascertain with an acute red eye

Answer 1

Whether it is urgent or not

And the cause

Question 2

Causes of eye lid problems

Answer 2

Blepharitis 
Melbornian cyst 
Stye 
Herpes simplex 
Molluscum contagiosum 
Herpes zoster ophthamiscus 
Entropian

Question 3

What is blepharitis

Answer 3

Chronic inflammation of the eyelid margins

Question 4

Causes of blepharitis

Answer 4

Usually staph aureus or epidermidis
Associated with skin disease
- acne Rosales
- seborrhoea can dermatitis

Question 5

Symptoms of blepharitis

Answer 5

Sore
Gritty
Occasionally red eyes

Question 6

findings on examination for blepharitis

Answer 6

Hyperaemic lid margins
Crusts on lashes
Blocked meibomian gland orifices
Meibomiancysts

Question 7

Complications of blepharitis

Answer 7

Conjunctivitis
Marginal keratitis
Meibomian cysts

Question 8

what is a stye

Answer 8

infected hair follicle

more superficial at the base of the eyelash rather than in the gland

Question 9

what is the treatment of blepharitis

Answer 9

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

Question 10

what is entropian

Answer 10

in turning of the lower lid

Question 11

what is ectropian

Answer 11

eversion of the lower lid

Question 12

what is herpes zoster opthalmiscus

Answer 12

shingles affect on the eye

Question 13

causes of conjunctivitis

Answer 13

Cicatrising
bacterial
viral
allergic
chlamydial

Question 14

causes of bacterial conjunctivitis

Answer 14

Usually staphylococcus, streptococcus or haemophilus species

Question 15

symptoms of bacterial conjunctivitis

Answer 15

slight discomfort
red sticky eyes
Visual acuity is not affected although slight blurring due to purulent exudation, which clears when discharge is blinked away

Question 16

findings on examination of bacterial conjunctivitis

Answer 16

Generalised conjunctival injection with purulent discharge

lashes may stick together

Question 17

complications of bacterial conjunctivitis

Answer 17

usually nil

Question 18

treatment of bacterial conjunctivitis

Answer 18

frequent antibiotic drops
-­‐ instil hourly for 24 hours then qds for a week
general hygiene by not sharing towels etc

Question 19

causes of viral conjunctivitis

Answer 19

Usually adenovirus (self-­‐limiting, but can also affect cornea -­‐keratoconjunctivitis

Question 20

symptoms of viral conjunctivitis

Answer 20

red watery eye

gritty uncomfortable feeling

Question 21

examination of viral conjunctivitis

Answer 21

• 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

Question 22

complications of viral conjunctivitis

Answer 22

Highly contagious
• Risk of epidemics
• Nosocomial transfer (Audited by Infection Control)
May last several weeks
Small corneal opacities leading to photophobia and reduced vision

Question 23

treatment of viral conjunctivitis

Answer 23

none
antibiotics can be given to prevent bacterial secondary infection
general hygiene and not sharing towels

Question 24

typical chlamydial conjunctivitis

Answer 24

unilateral red eye in a young male

Question 25

symptoms of chlamydial conjunctivitis

Answer 25

Red, watery eye(s)-> Vision

unaffected -> Gritty, foreign body sensation -> Chronic -> Follicular reaction

Question 26

epidemiology of chlamydial conjunctivitis

Answer 26

Usually
young
adults
Sexually
acquired

Question 27

treatment of chlamydial conjunctivitis

Answer 27

systemic antibiotics

Question 28

symptoms of allergic conjunctivitis

Answer 28

acute onset
red itchy eyes
chemosis - conjunctival oedema
vision unaffected

Question 29

how does allergic conjunctivitis occur

Answer 29

Type 1 hypersensitivity reaction
• Seasonal
• Perennial
often settles spontaneously

Question 30

what is cicatrising conjunctivitis

Answer 30

conjunctivitis that causes scarring

Question 31

causes of cicatrising conjunctivitis

Answer 31

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

Question 32

types of keratitis

Answer 32

autoimmune
bacterial
viral

Question 33

what is bacterial keratitis

Answer 33

bacterial infection of the cornea

it is an ophthalmic emergency

Question 34

what are the causes of bacterial keratitis

Answer 34

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)

Question 35

symptoms of bacterial keratitis

Answer 35

red sticky eye
pain
reduced vision
photophobia

Question 36

examination of bacterial keratitis

Answer 36

Conjunctival injection with purulent discharge
Corneal abscess(yellow/white area on cornea)
May be activity (cells) in anterior chamber

Question 37

complications of bacterial keratitis

Answer 37

Severe sight-­‐threatening intraocular infection (endophthalmitis)
Corneal perforation
Loss of eye

Question 38

treatment of bacterial keratitis

Answer 38

Admit
• Scrape cornea
• Gram stain
• Culture and sensitivities