The Acute Red Eye Flashcards
what is a subconjunctival haemorrhage?
bleeding between conjunctiva and sclera
can be seen in clotting disorders or severe hypertension
usually disappears after 1-2 weeks
what is orbital cellulitis?
infection of the soft tissues around the orbit and globe of the eye
can track back to the brain
life threatening
name 4 defensive structures in the eye
lids (structure, function, blink, secretion of Meibomian)
tears
conjunctivae
epithelium-conjunctival/corneal
5 important features of tears
tear flow/blinking mucous trapping lysozyme immunoglobulin - IgA and IgG Complement
gritty, stingy pain vs achy pain in the eye?
gritty = ocular surface ache = inside
what does itch indicate?
allergy
what are contact lens wearers susceptible to?
acanthamoeba
what are the 2 locations in the conjunctiva?
tarsal = inside of eyelid which faces the eyeball/bulbar conjunctiva which cover upper portion of eyeball bulbar = sits overlying the upper eyeball, faces tarsal conjunctiva
what is blepharitis?
inflamed eyelids
causes of blepharitis in anterior lamella?
seborrheic (squamous) = scales on the lashes
staph = infection involving lash follicle (stye)
lid margin redder than deeper part of lid
causes of blepharitis in posterior lamella?
Meibomian gland dysfunction (MGD)
redness is in deeper part of lid
lid margin often quite normal looking
give 4 symptoms of blepharitis
similar to conjunctivitis
gritty eyes
foreign body sensation
mild discharge
blepharitis is associated with what 3 other eye conditions?
conjunctivitis
keratitis
episcleritis
signs of seborrheic anterior blepharitis?
lid margin red
scales
dandruff
no ulceration, lashes unaffected
signs of staphylococcal blepharitis?
lid margin red
lashes distorted, loss of lashes, ingrowing lashes - trichiasis
sytes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)
5 features of posterior blepharitis?
lid margin skin and lashes unaffected MG openings pouting and swollen inspissated (dried) secretion at gland openings Meibomian cysts (chalazia) associated with acne rosacea
how is blepharitis managed?
lid hygiene - daily bathing, warm compresses
supplementary eye drops
oral doxycycline for 2-3 months
2 groups of causes of conjunctivitis?
infective - bacterial - viral - chlamydial other - allergic - chemical/drugs - skin diseases (e.g eczema)
5 symptoms of conjunctivitis?
red eye foreign body sensation - gritty eye discharge - sticky eye itch (if allergic) normal vision
6 signs of conjunctivitis?
red eye discharge papillae or follicles sub-conjunctival haemorrhage chemosis (oedema) pre-auricular glands (if viral)
what usually causes bacterial conjunctivitis and how is it managed?
staph aureus, strep pneumoniae, haemophilus influenzae
usually self limiting within 14 days but topical antibiotics can clear faster
3 causes of follicular conjunctivitis?
viral (adenovirus, Herpes)
chalmydia
drugs (propine, trusopt)
what is chemosis?
conjunctival oedema
name 6 causes of chronic conjunctivitis
blepharitis chlamydial infection keratoconjunctivitis sicca lacrimal disease sensitivity to topical glaucoma medication sub-tarsal foreign body
what are the 3 layers of the cornea?
epithelium
stroma
endothelium
what usually causes a central corneal ulcer?
infection
- viral
- fungal
- bacterial
- acanthamoeba
what usually causes peripheral corneal ulcer?
autoimmune
- rheumatoid arthritis
hypersensitivity (e.g marginal ulcers)
5 symptoms of corneal ulcer?
severe pain (not as much if viral) photophobia profuse lacrimation may have reduced vision red eye - circumcorneal
5 signs of corneal ulcers?
redness corneal reflex (reflection abnormal) corneal opacity staining with fluorescein hypopyon
dendritic ulcers?
caused by herpes
stains with fluorescein
autoimmune vs infective corneal ulcer?
autoimmune = peripheral (immune destruction at the limbus) infective = central
name 4 special groups of corneal ulcers
exposure keratitis (thyroid, VII palsy) keratoconjunctivitis sicca (sjogrens) neurotrophic keratitis (H. zoster or V1 palsy) vitamin deficiency (Vit A)
how are corneal ulcers managed?
identify cause (corneal scrape for gram stain and culture)
antimicrobial if bacterial (ofloxacin)
antiviral if herpetic (acyclovir)
anti-inflammatory if autoimmune (steroids)
4 general causes of anterior uveitis?
autoimmune (reiters, UC, Ank Spondylitis, sarcoidosis)
infective (TB, syphilis, herpes)
malignancy (leukaemia)
other (idiopathic, trauma, secondary to eye disease)
4 symptoms of anterior uveitis?
dull achy pain (+ referred pain to brow)
may have reduced vision
photophobia
red eye (circumcorneal)
5 signs of anterior uveitis?
ciliary injection cells and flare in anterior chamber keratic precipitates (cells floating around get deposited behind cornea) hypopyon synechiae (small or irregular pupil)
how is anterior uveitis managed?
topical steroids (pred forte hourly for 4-8 weeks)
mydriatics (cyclopentolate)
investigate for systemic associations if chronic/recurrent
5 features of episcleritis?
associated with gout minor eye iritation recurrent nodules may occur self limiting
5 features of scleritis?
association with serious systemic vasculitides (RA, wegners granulomatosis)
extremely painful
injection of deep vascular plexus (violaceous hue)
associated uveitis is common
no blanching on phenylephrine test
how are scleritis and episcleritis differentiated?
phenylephrine causes blanching in episcleritis
scleritis = more painful
how is episcleritis managed?
self limiting
lubricants/topical NSAIDs/mild steroids
how is scleritis managed?
oral NSAIDs
oral steroids
steroid sparing agents
features of acute closed angle glaucoma?
severe pain nausea circumcorneal injection cloudy cornea pupil mid-dilated eye is stony hard
who is acute closed angle glaucoma most common in?
elderly
hypermetropic (can tell if they have thick/magnified glasses)
