The acute red eye Flashcards
What are the broad categories of factors that can cause acute red eye?
anatomical structure of the eye or external factors
What is blepharitis?
chronic inflammation of the eyelid margins
What are the causes of blepharitis?
infection - usually staph aureus or epidermidis
associated skin disease (higher incidence in people with acne rosacea and seborrheic dermatitis)
What are the signs/symptoms of blepharitis?
sore, gritty, light sensitive eye that is occasionally red
What may be seen on examination of blepharitis?
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
How is blepharitis treated?
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
What is a stye and how is it differentiated from blepharitis?
infected hair follicle
differentiated from blepharitis as it will be very close to the eye at the lash follicle
What is entropion?
in turning of the lower lid causing the eyelashes to rub on the eye and cause irritation
What is ectropion?
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
What happens with herpes zoster ophthalmicus?
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
What is a key sign for herpes zoster ophthalmicus?
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
What usually causes bacterial conjunctivitis and what are the symptoms?
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
On examination of bacterial conjunctivitis what would you expect to see?
generalized conjunctival injection and eyelashes may be stuck together by exudate
How is bacterial conjunctivitis treated?
antibiotic eye drops, hourly for 24 hours and then QDS for one week - patient will be advised on general hygiene to reduce spread
What usually causes viral conjunctivitis and what are the symptoms?
adenovirus
- complain of red, gritty and watery eyes
What might be seen on examination of viral conjunctivitis?
enlargement of the pre-auricular lymph nodes (also seen in bacterial)m generalized conjunctival injection, petechial hemorrhage and there may be associated URTI
What can complicate viral conjunctivitis?
its highly contagious - complicated by keratoconjunctivitis (corneal involvement reducing vision)
How is viral conjunctivitis treated?
lubricating eye drops, the infection is self-limiting
What is chlamydial conjunctivitis and what are the symptoms?
generally unilateral - red, gritty, watery eyes, vision will be unaffected and there may be a chronic follicular reaction
Treatment = oral systemic ABX
What is the cause of allergic conjunctivitis and what are the symptoms and treatments?
type 1 hypersensitivity reaction which may be seasonal
red, itchy eyes and chemosis (conjunctival edema)- vision will be unaffected
Treat = sodium chromoglycate eye drops
What is cicatrising conjunctivitis?
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
What is bacterial keratitis?
bacterial infection of the cornea = ophthalmic emergency - can be caused by both gram +ve and -ve infections
What are the predisposing factors for bacterial keratitis?
corneal abrasion, contact lenses, topical steroids and corneal anaesthesia
What are the symptoms of bacterial keratitis?
red, sticky, painful eye with associated reduced vision and photophobia
What might be noted on examination of the eye in bacterial keratitis?
conjunctival injection with purulent discharge, corneal abscess and hypopyon (settled WBC in the anterior chamber)
What may further complicate bacterial keratitis?
corneal perforation, endopthalmitis and potential loss of the eye
What is the treatment for bacterial keratitis?
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
What usually causes viral keratitis and what are the symptoms?
herpes simplex - present with unilateral red and painful eye alongside photophobia and reduced vision
What is likely to be seen on examination of viral keratitis?
conjunctival injection, reduced corneal sensation, and dendritic ulceration of the cornea
What is the treatment of viral keratitis?
antiviral ointment alongside pupil dilatation
Steroids absolutely contraindicated as they may lead to global ulceration and bacterial infection
What can cause autoimmune keratitis?
idiopathic or related to systemic disease e.g. vasculitis, RA, SLE, and acne rosacea
What is scleritis?
inflammation of the outer coat of the eye - can be severe, sight threatening and destructive
What typically causes scleritis and what is the commonest type?
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
What are the symptoms of scleritis?
red eyes and a sever pain that can wake them from sleep
What is often seen on examination of scleritis?
deep red colouration of the sclera - diffuse or localized
Scleral thinning and normal visual acuity
What can scleritis be complicated by?
scleral thickening, perforation of the globe, visual loss and edema of the optic disc and macula
What is the treatment for scleritis?
oral NSAIDs for mild cases, which can be supplemented by topical steroids
In severe cases oral corticosteroids
What is acute anterior uveitis (iritis) and what are the symptoms?
inflammation of the iris
- unilateral red and painful eye which may be associated with blurred vision and photophobia
no discharge
What is likely to be seen on examination of acute anterior uveitis?
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)
How is iritis accurately diagnosed?
has to be done by a slit lamp
What is iritis commonly associated with and what can it be complicated by?
ankylosing spondylitis
complicated by increased iop, cataract formation and recurrence in the other eye
What is the treatment of iritis?
topical steroids and pupil dilating drugs e.g. mydricaine
What is AACG?
acute angle closure glaucoma - leads to sudden painful visual loss - lead to blindness if not treated
What is the commonest AACG?
primary AACG due to hypermetropia - can be secondary to hyper mature cataracts
What are the symptoms of AACG?
haloes around light, reduced vision, ocular pain, headache, nausea and vomiting
What can be seen on examination of aacg?
corneal edema and mild dilated unreactive pupil
What is the treatment of AACG?
initially medical = usually oral/IV acetazolamide, pilocarpine drops and IV mannitol
- if this isn’t effective, YAG later iridetomy or surgical iridectomy/lensectomy
What is orbital cellulitis?
life threatening condition
How does orbital cellulitis present?
red edematous conjunctiva, reduced eye movement, proptosis, reduced vision (optic nerve involvement) and adjacent sinusitis
pt will be very unwell
What are the complications of orbital cellulitis and how is it treated?
complicated by sepsis or venous sinus thrombosis - immediate treatment with IV abx, urgent CT scan and ENT referral
What do surface injuries of the eye generally present with?
sub-conjunctival hemorrhage - can indicate intraocular hemorrhage, a foreign body lodged in the tarsal surface of the eyelid and perforation
Other than surface injuries what other traumas can affect the eye?
corneal abrasion and foreign bodies
