The acute red eye Flashcards
What are the four ocular defences?
Lids
Tears
Conjunctivae
Epithelium
Why are tears important?
- tear flow/blinking
- mucous trapping
- lysozyme
- immunoglobulin -IgA, IgG
- complement
Describe anterior blepharitis?
Seborrheoic (squamous)= scales on lashes
Staphylococcal (infection involving the lash follicle)
Lid margin is redder than the deeper part of lid
Describe posterior blepharitis?
- meibomian gland dysfunction
- redness is in the deeper part of lid
- lid margin is often quite normal looking
Describe the symptoms of blepharitis
- gritty eyes
- foreign body sensation
- mild discharge
What are the signs of anterior seborrhoeic blepharitis?
- lid margin red
- scales ++
- dandruff +
- no ulceration
- lashes unaffected
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)
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%)
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
What are the infective causes of conjunctivitis?
Viral
Bacterial
Chlamydial
What are the non-infective causes of conjunctivitis?
Allergic
Chemical/drugs
Skin disease- eczema
What are the symptoms of conjunctivitis?
Red eye
Foreign body sensation
Discharge
Itch
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
Describe acute bacterial conjunctivitis
Red sticky eye
Self limiting, will clear in 14 days with no treatment (antibiotics will clear faster)
What are the most common organisms in bacterial conjunctivitis?
Staph aureus
Pneumonia
H. Influenza
What are the common causes of follicular conjunctivitis?
Viral (adenovirus, HS, HZ)
Chlamydial
Drugs e.g. propine, truspot
What is chemises?
Conjunctival oedema
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
