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September lectures yr 3 (2018) > The acute red eye > Flashcards

The acute red eye Flashcards

1
Q

What are the broad categories of factors that can cause acute red eye?

A

anatomical structure of the eye or external factors

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2
Q

What is blepharitis?

A

chronic inflammation of the eyelid margins

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3
Q

What are the causes of blepharitis?

A

infection - usually staph aureus or epidermidis

associated skin disease (higher incidence in people with acne rosacea and seborrheic dermatitis)

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4
Q

What are the signs/symptoms of blepharitis?

A

sore, gritty, light sensitive eye that is occasionally red

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5
Q

What may be seen on examination of blepharitis?

A

hyperemia of the lid margins, crusts on the eyelashes and blocked meibomian gland orifices leading to meibomian cysts - this can be complicated by conjunctivitis, chalazion formation and marginal keratosis

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6
Q

How is blepharitis treated?

A

improving lid hygiene using warm compresses on the eye
ABX ointments and topical lubricants
Low dose oral tetracyclines as these will also inhibit MMPs, decreasing inflammation of the eye

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7
Q

What is a stye and how is it differentiated from blepharitis?

A

infected hair follicle

differentiated from blepharitis as it will be very close to the eye at the lash follicle

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8
Q

What is entropion?

A

in turning of the lower lid causing the eyelashes to rub on the eye and cause irritation

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9
Q

What is ectropion?

A

an eversion of the lower lid commonly in older people meaning that the tear film is not held on the eye causing it to dry out - treated with a lateral tarsal strip operation

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10
Q

What happens with herpes zoster ophthalmicus?

A

is hinges that activates the trigeminal nerve affecting the face - often pain will precede the appearance of a rash

treated with antibiotic ointment to prevent associated bacterial infection and lubricant eye drops

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11
Q

What is a key sign for herpes zoster ophthalmicus?

A

hutchinson’s sign - positive when the tip of the nose is involved in the rash - indicates involvement of the naso-ciliary nerve and therefore a heightened risk of eye involvement

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12
Q

What usually causes bacterial conjunctivitis and what are the symptoms?

A

staphylococcal and streptococcal infections but can also be due to haemophilus
presents with slight eye discomfort, red and sticky eyes and reduced visual acuity due to accumulation of purulent exudate

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13
Q

On examination of bacterial conjunctivitis what would you expect to see?

A

generalized conjunctival injection and eyelashes may be stuck together by exudate

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14
Q

How is bacterial conjunctivitis treated?

A

antibiotic eye drops, hourly for 24 hours and then QDS for one week - patient will be advised on general hygiene to reduce spread

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15
Q

What usually causes viral conjunctivitis and what are the symptoms?

A

adenovirus

- complain of red, gritty and watery eyes

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16
Q

What might be seen on examination of viral conjunctivitis?

A

enlargement of the pre-auricular lymph nodes (also seen in bacterial)m generalized conjunctival injection, petechial hemorrhage and there may be associated URTI

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17
Q

What can complicate viral conjunctivitis?

A

its highly contagious - complicated by keratoconjunctivitis (corneal involvement reducing vision)

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18
Q

How is viral conjunctivitis treated?

A

lubricating eye drops, the infection is self-limiting

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19
Q

What is chlamydial conjunctivitis and what are the symptoms?

A

generally unilateral - red, gritty, watery eyes, vision will be unaffected and there may be a chronic follicular reaction
Treatment = oral systemic ABX

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20
Q

What is the cause of allergic conjunctivitis and what are the symptoms and treatments?

A

type 1 hypersensitivity reaction which may be seasonal
red, itchy eyes and chemosis (conjunctival edema)- vision will be unaffected
Treat = sodium chromoglycate eye drops

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21
Q

What is cicatrising conjunctivitis?

A

causes scarring - due to physical or infective factors or it can be drug induced
may be related to formation of tumors e.g. squamous and sebaceous cell carcinomas
Can be associated with oculocutaneous and systemic disorders

22
Q

What is bacterial keratitis?

A

bacterial infection of the cornea = ophthalmic emergency - can be caused by both gram +ve and -ve infections

23
Q

What are the predisposing factors for bacterial keratitis?

A

corneal abrasion, contact lenses, topical steroids and corneal anaesthesia

24
Q

What are the symptoms of bacterial keratitis?

A

red, sticky, painful eye with associated reduced vision and photophobia

25
Q

What might be noted on examination of the eye in bacterial keratitis?

A

conjunctival injection with purulent discharge, corneal abscess and hypopyon (settled WBC in the anterior chamber)

26
Q

What may further complicate bacterial keratitis?

A

corneal perforation, endopthalmitis and potential loss of the eye

27
Q

What is the treatment for bacterial keratitis?

A

takes place in hospital

  • firstly bacteria should be identified and tested for sensitivity following corneal scrape
    1) sterilization phase - hourly ABX for 3 days given alongside cycloplegics to dilate the pupil, intraoculr hypotensive and avoidance of eye injections
    2) healing phase - careful use of topical glucocorticoids, treatment of underlying cause
28
Q

What usually causes viral keratitis and what are the symptoms?

A

herpes simplex - present with unilateral red and painful eye alongside photophobia and reduced vision

29
Q

What is likely to be seen on examination of viral keratitis?

A

conjunctival injection, reduced corneal sensation, and dendritic ulceration of the cornea

30
Q

What is the treatment of viral keratitis?

A

antiviral ointment alongside pupil dilatation

Steroids absolutely contraindicated as they may lead to global ulceration and bacterial infection

31
Q

What can cause autoimmune keratitis?

A

idiopathic or related to systemic disease e.g. vasculitis, RA, SLE, and acne rosacea

32
Q

What is scleritis?

A

inflammation of the outer coat of the eye - can be severe, sight threatening and destructive

33
Q

What typically causes scleritis and what is the commonest type?

A

idiopathic but can be due to infection or associated connective tissue disease
- anterior scleritis is commonest but posterior does also occur
Anterior = diffuse, nodular and necrotising

34
Q

What are the symptoms of scleritis?

A

red eyes and a sever pain that can wake them from sleep

35
Q

What is often seen on examination of scleritis?

A

deep red colouration of the sclera - diffuse or localized

Scleral thinning and normal visual acuity

36
Q

What can scleritis be complicated by?

A

scleral thickening, perforation of the globe, visual loss and edema of the optic disc and macula

37
Q

What is the treatment for scleritis?

A

oral NSAIDs for mild cases, which can be supplemented by topical steroids
In severe cases oral corticosteroids

38
Q

What is acute anterior uveitis (iritis) and what are the symptoms?

A

inflammation of the iris
- unilateral red and painful eye which may be associated with blurred vision and photophobia
no discharge

39
Q

What is likely to be seen on examination of acute anterior uveitis?

A

circumcorneal conjunctival injection, keratitis precipitates of the cornea, flare (albumin leakage from vessels), hypopynon, posterior synechiae (adhesion between iris and lens giving clover shaped pupil)

40
Q

How is iritis accurately diagnosed?

A

has to be done by a slit lamp

41
Q

What is iritis commonly associated with and what can it be complicated by?

A

ankylosing spondylitis

complicated by increased iop, cataract formation and recurrence in the other eye

42
Q

What is the treatment of iritis?

A

topical steroids and pupil dilating drugs e.g. mydricaine

43
Q

What is AACG?

A

acute angle closure glaucoma - leads to sudden painful visual loss - lead to blindness if not treated

44
Q

What is the commonest AACG?

A

primary AACG due to hypermetropia - can be secondary to hyper mature cataracts

45
Q

What are the symptoms of AACG?

A

haloes around light, reduced vision, ocular pain, headache, nausea and vomiting

46
Q

What can be seen on examination of aacg?

A

corneal edema and mild dilated unreactive pupil

47
Q

What is the treatment of AACG?

A

initially medical = usually oral/IV acetazolamide, pilocarpine drops and IV mannitol
- if this isn’t effective, YAG later iridetomy or surgical iridectomy/lensectomy

48
Q

What is orbital cellulitis?

A

life threatening condition

49
Q

How does orbital cellulitis present?

A

red edematous conjunctiva, reduced eye movement, proptosis, reduced vision (optic nerve involvement) and adjacent sinusitis
pt will be very unwell

50
Q

What are the complications of orbital cellulitis and how is it treated?

A

complicated by sepsis or venous sinus thrombosis - immediate treatment with IV abx, urgent CT scan and ENT referral

51
Q

What do surface injuries of the eye generally present with?

A

sub-conjunctival hemorrhage - can indicate intraocular hemorrhage, a foreign body lodged in the tarsal surface of the eyelid and perforation

52
Q

Other than surface injuries what other traumas can affect the eye?

A

corneal abrasion and foreign bodies

September lectures yr 3 (2018) (56 decks)

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