The acute red eye Flashcards by Olivia McNee

What are the four ocular defences?

Lids
Tears
Conjunctivae
Epithelium

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Why are tears important?

tear flow/blinking
mucous trapping
lysozyme
immunoglobulin -IgA, IgG
complement

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Describe anterior blepharitis?

Seborrheoic (squamous)= scales on lashes

Staphylococcal (infection involving the lash follicle)

Lid margin is redder than the deeper part of lid

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Describe posterior blepharitis?

meibomian gland dysfunction
redness is in the deeper part of lid
lid margin is often quite normal looking

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Describe the symptoms of blepharitis

gritty eyes
foreign body sensation
mild discharge

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What are the signs of anterior seborrhoeic blepharitis?

lid margin red
scales ++
dandruff +
no ulceration
lashes unaffected

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What are the signs of anterior staphylococcal blepharitis?

lid margin red
lashes distorted, loss of lashes
ingrowing lashes- trichiasis
styes, ulcers of lid margin
corneal staining
marginal ulcers (due to exotoxin)

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What are the signs of posterior blepharitis?

lid margin and skin and lashes unaffected
MG openings pouting and swollen
inspissated (dried) secretion at gland openings
meibomian cysts (chalazia)
associated with acne rosacea (50%)

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What is the treatment of blepharitis?

lid hygiene- daily bathing/warm compresses
supplementary tear drops
oral doxyclyine for 2-3 months

very difficult to eradicate

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What are the infective causes of conjunctivitis?

Viral
Bacterial
Chlamydial

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What are the non-infective causes of conjunctivitis?

Allergic
Chemical/drugs
Skin disease- eczema

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What are the symptoms of conjunctivitis?

Red eye
Foreign body sensation
Discharge
Itch

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What are the signs of conjunctivitis?

redness focused to fornices

Discharge

Papillae or follicles

Sub conjunctival haemorrhage

Chemosis

Pre-auricular gland swelling if viral

Unaffected vision

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Describe acute bacterial conjunctivitis

Red sticky eye

Self limiting, will clear in 14 days with no treatment (antibiotics will clear faster)

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What are the most common organisms in bacterial conjunctivitis?

Staph aureus
Pneumonia
H. Influenza

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What are the common causes of follicular conjunctivitis?

Viral (adenovirus, HS, HZ)
Chlamydial
Drugs e.g. propine, truspot

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What is chemises?

Conjunctival oedema

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What are the causes of chronic conjunctivitis?

Blepharitis

Chlamydial infection

Keratoconjunctivitis Sicca

Lacrimal diseae

Sensitivity to glaucoma medication

Subtarsal foreign body

What are the causes of central corneal ulcers (infective)?

Viral
Fungal
Bacterial
Acanthamoeba

What are the causes of peripheral (autoimmune) corneal ulcers?

Rheumatoid arthritis

Hypersensitivity (marginal ulcers)

Wegener’s granulomatosis

Polyartertitis

What are the symptoms of corneal ulcers

Pain
-severe, needle like 
Photophobia 
Profuse lacrimation 
Reduced vision

What are the signs of corneal ulcers

Red eye (circumcorneal)
Corneal reflex abnormal
Corneal opacity
Hypopyon

What causes exposure keratitis?

Thyroid, VII palsy

What causes keratoconjunctivitis sicca?

sjogrens

What causes neurotrophic keratitis?

Herpes zoster or V1

Which vitamin deficiency can cause corneal ulcers?

Vitamin A

What is the treatment for corneal ulcers?

Corneal scrape for gram stain and culture Antimicrobial, antiviral, anti-inflammatory

Which antimicrobial is given in corneal ulcers?

Ofloxacin hourly

Which antiviral is given in corneal ulcers?

Aciclovir ointment 5x daily

What are the autoimmune causes of anterior uveitis?

Reiters, Ulcerative Colitis, Ankylosing spondylitis, sarcoidosis

Which malignancy can cause anterior uveitis?

Leukemia

Which infections can cause anterior uveitis?

Syphillis, herpes simplex, herpes zoster

What are the other non immune/malignant causes of anterior uveitis?

Trauma, secondary to other eye disorders, idiopathic

What are the symptoms of anterior uveitis?

Pain (+referred pain) Vision may be reduced Photophobia Red eye (circumcorneal)

What are the signs of anterior uveitis?

Ciliary injection Cells and floaters in anterior chamber Keratitis precipitated Hypopyon Synechiae -small or irregular pupil

What is the management of anterior uveitis?

Topical steroids (pred forte 1% hourly tapering over 4-8weeks) Mydriatics (cyclopentoate 1% BD)

What is episcleritis associated with?

Gout

What may occur in episcleritis?

Nodules

What is the treatment for episcleritis?

Self-limiting, lubricants, topical NSAIDs, mild steroids

What is scleritis associated with?

Rheumatoid arthritis, wegener's granulomatosis, uveitis

What are the symptoms of scleritis?

Pain

What can be observed in scleritis?

Injection of deep vascular plexus- violaceous hue

What is the phenylephrine test?

It can differentiate between episcleritis and scleritis- superficial inflammation in episcleritis (the vessels will blanch)

What is the treatment of scleritis?

Oral NSAIDs Oral steroids Steroid sparing agents