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Opthalmology > The acute red eye > Flashcards

The acute red eye Flashcards

1
Q

what can cause a red eye (acute)

A 
conjunctivitis 
blepharitis 
keratitis 
anterior uvetitis 
scleritis
episcleritis 
acute angle closure glaucoma
subconjunctival haemorrhage 
orbital disease (cellulitis)
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2
Q

what is a subconjunctival haemorrhage

A

bleeding into the subconjunctival space (can happen in trauma, anticoagulants, hptx) takes 1-2 weeks to go away

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3
Q

what can orbital cellulitis cause

A

brain abscess
vision loss
death

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4
Q

what usually causes orbital cellulitis

A

sinus infection, insect bite, eyelid trauma

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5
Q

what lid secretions protect the eye

A

meibomian

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6
Q

what can lid disease and shortening of the malar skin cause

A

corneal ulcer (as conjunctiva exposed when cheek skin pulled down)

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7
Q

what are the anti-infection properties of tears

A

lysozyme
IgA, IgG
complement
mucous trapping

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8
Q

what causes an itchy eye

A

allergic cause

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9
Q

what is a stony hard eye suggestive of

A

acute glaucoma

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10
Q

how is intracranial pressure check

A

blotting

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11
Q

what are the types of anterior blepharitis

A

Seborrhoeic (squamous) scales on the lashes

Staphylococcal – infection involving the lash follicle

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12
Q

what are the types of posterior blepharitis

A

Meibomian gland dysfunction

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13
Q

how can you tell anterior from posterior blepharitis

A

anterior- Lid margin redder than deeper part of lid, dandruff on lashes

posterior- redness is in deeper part of lid
lid margin often quite normal looking

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14
Q

what are the symptoms of blepharitis

A

Gritty eyes
foreign body sensation
mild discharge

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15
Q

what is blepharitis associated with

A

Conjunctivitis
Keratitis (marginal, SPK)
Episcleritis

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16
Q

what are the signs of seborrhoeic anterior blepharitis

A

Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)

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17
Q

what are the sign of staphylococcal anterior blepharitis

A

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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18
Q

what are the signs of posterior blepharitis

A 
Lid margin skin and lashes unaffected
M.G. openings pouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian Cysts (chalazia)
Associated with Acne Rosacea (50%)
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19
Q

what are the meinomian glands responsible for

A

the lipid component of tears

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20
Q

what is the treatment for a meibomian cyst (chalazia)

A

2/3rds will spontaneously discharge

those that dont need surgery

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21
Q

what is the treatment for blepharitis

A

Lid hygiene – daily bathing / warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months (acne rosacea)

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22
Q

what can cause conjunctivitis

A 
viral 
bacterial 
chlamydial 
allergic 
chemical/ drugs 
skin diseases (eczema)
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23
Q

what are the symptoms of conjunctivitis

A

red eye
foreign body sensation – gritty eye
discharge – sticky eye
Itch = allergy

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24
Q

what are the signs of conjunctivitis

A

Chemosis = oedema
Pre-auricular glands (if viral)
Sub conj. Haemorrhage (if infection v virulent)
discharge (watery if viral, purulent is bacterial)
red eye
papillae in bacterial and allergic
follicles in viruses and chlaymdia and drugs (propine, truspot)

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25
Q

what are the common causes of bacterial conjunctivitis

A

Staph. aureus, Str. pneumoniae, H. infuenzae

26
Q

tx for bacterial conjunctivitis

A

is self limiting - will clear up in about 14 days without treatment
topical antibiotics clear it faster (5-7 day course)

27
Q

is chlamydial conjunctivitis uni or bi lateral

A

unilateral

28
Q

is viral conjuncitivitis uni or bi lateral

A

bi lateral

29
Q

is herpes zoster opthalmicus how do you know is the eye will be affected

A

if it spreads down to the side of the nose

30
Q

what is chemosis

A

conjunctival oedema

31
Q

chronic conjuctivitis is not a real thing- what can it be caused by

A

Blepharitis
Chlamydial infection
Keratoconjunctivitis sicca- sjorgens
Lacrimal disease (chr. dacryocystitis)
Sensitivity to topical glaucoma medication
Sub-tarsal foreign body- something stuck underneath upper lid

32
Q

what is keratitis

A

inflammation of the cornea

33
Q

should the cornea have blood vessels

A

no

34
Q

what are the layers of the cornea

A

epithelium
stroma
endothelium

35
Q

what causes central corneal ulcers

A 
(infective) 
viral (dendritic)
fungal 
bacterial 
acanthamoeba (contact lenses)
36
Q

what causes peripheral corneal ulcers

A

autoimmune
RA
hypersensitivity
rarely- wegeners granulomatosis polyarteritis

37
Q

what are the symptoms of a corneal ulcer

A 
Pain+ (needle like severe -note corneal sensation is affected by herpes viruses so wont be as painful)
Photophobia
Profuse lacrimation
Vision may be reduced
Red eye - circumcorneal
38
Q

what are the signs of corneal ulcers

A 
Redness – circumcorneal
Corneal reflex (reflection abnormal)
Corneal opacity
Staining with fluorescein
Hypopyon- pus fluid line within the eye
39
Q

why do you get auto-immune corneal ulcers at the limbus

A

as where immune complexes are deposited

40
Q

what causes exposure keratitis corneal ulcers

A 
thyroid (proptosis)
VII palsy (bells) 
skin cancer/deformity (pulling eyelid down)
41
Q

what causes a keratoconjunctivitis sicca corneal ulcer

A

sicca symptoms- sjogrens

42
Q

what cause a neurotrophic keratitis corneal ulcer

A

H zoster or V1

43
Q

what causes a vit deficiency corneal ulcer

A

vit A

44
Q

what is the treatment for a corneal ulcer

A 
Identify cause – ‘corneal scrape’ for gram stain and culture
Antimicrobial if bacterial infection
Eg ofloxacin hourly
Antiviral if herpetic
Aciclovir ointment 5 x day
Anti-inflammatory if autoimmune
Oral / topical steroids
45
Q

what causes anterior uveitis

A

autoimmune (HLA-B27 gene): Reiter’s, Ulc colitis, Ank Spondylitis, Sarcoidosis

malignancy: leukemia
infective: TB, syphillis, H simplex and zoster

idiopathic
trauma
secondary to other eye disorders

46
Q

what is uveitis

A

inflammation of the uvea (can be iris, cilliary body, choroid)

47
Q

what are the symptoms of anterior uveitis

A 
Pain- boring (+ referred pain to forehead, jaw and brow)
Vision may be reduced
Photophobia
Red eye (circumcorneal)
dull ache
48
Q

what are the signs of anterior uveitis

A 
Ciliary injection (i.e. circum-corneal )
Cells & flare in anterior chamber
Keratic precipitates (cell deposits on corneal epithelium)
Hypopyon
Synechiae
Small or irregular pupil
49
Q

what is the management of anterior uveitis

A

topical
steroids over 4-8 weeks
Mydriatics eg
Cyclopentolate 1% BD (dilate eye break up synechiae)
investigate for systemic associations if recurrent or chronic

50
Q

what causes episcleritis

A 
associated with gout
quite common 
recurrent
self limiting
no serious associations
51
Q

what can occur with episcleritis

A

nodules

52
Q

what is the treatment for episcleritis

A

Self limiting

Lubricants / topical NSAIDs / mild steroids

53
Q

how do you differentiate episcleritis from scleritis

A

vasoconstrictors and if doesn’t blanche then deeper inflammation = scleritis
episcleritis will blanch

54
Q

what is scleritis associated with

A

RA, wegners

55
Q

what are the features of scleritis

A

PAINFUL + (will wake up patients)
Injection of deep vascular plexus – ‘violaceous hue’
Phenylephrine test (will no blanche after a vasoconstrictor)
Associated uveitis common

56
Q

what is the treatment for scleritis

A

Oral NSAIDs
Oral Steroids
Steroid Sparing Agents

57
Q

what causes acute closed angle glaucoma

A

IOP rises acutely due to the drainage angle being closed (pupil dilatation precipitates it)

58
Q

who get acute closed angle glaucoma

A

Elderly hypermetropic – thick glasses (far sighted, smaller eyes)

59
Q

what are the symptoms and signs of acute closed angle glaucoma

A 
Severe pain + nausea
Circumcorneal injection
Cornea cloudy (oedematous)
Pupil mid dilated 
Eye stony hard
60
Q

what red eyes need to be referred urgently

A

any with affected vision or marked photophobia

61
Q

what is the treatment for acute closed angle glaucoma

A

IV acetazolamide (glaucoma)
Pilocarpine drops (constricts pupil)
Analgesia, antiemetics
Referral to ophthalmologist

Opthalmology (16 decks)

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