The acute red eye Flashcards by Louise Emerson

what can cause a red eye (acute)

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

How well did you know this?

Not at all

Perfectly

what is a subconjunctival haemorrhage

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

How well did you know this?

Not at all

Perfectly

what can orbital cellulitis cause

brain abscess
vision loss
death

How well did you know this?

Not at all

Perfectly

what usually causes orbital cellulitis

sinus infection, insect bite, eyelid trauma

How well did you know this?

Not at all

Perfectly

what lid secretions protect the eye

meibomian

How well did you know this?

Not at all

Perfectly

what can lid disease and shortening of the malar skin cause

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

How well did you know this?

Not at all

Perfectly

what are the anti-infection properties of tears

lysozyme
IgA, IgG
complement
mucous trapping

How well did you know this?

Not at all

Perfectly

what causes an itchy eye

allergic cause

How well did you know this?

Not at all

Perfectly

what is a stony hard eye suggestive of

acute glaucoma

How well did you know this?

Not at all

Perfectly

how is intracranial pressure check

blotting

How well did you know this?

Not at all

Perfectly

what are the types of anterior blepharitis

Seborrhoeic (squamous) scales on the lashes

Staphylococcal – infection involving the lash follicle

How well did you know this?

Not at all

Perfectly

what are the types of posterior blepharitis

Meibomian gland dysfunction

How well did you know this?

Not at all

Perfectly

how can you tell anterior from posterior blepharitis

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

How well did you know this?

Not at all

Perfectly

what are the symptoms of blepharitis

Gritty eyes
foreign body sensation
mild discharge

How well did you know this?

Not at all

Perfectly

what is blepharitis associated with

Conjunctivitis
Keratitis (marginal, SPK)
Episcleritis

How well did you know this?

Not at all

Perfectly

what are the signs of seborrhoeic anterior blepharitis

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

How well did you know this?

Not at all

Perfectly

what are the sign of staphylococcal anterior blepharitis

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

How well did you know this?

Not at all

Perfectly

what are the signs of posterior blepharitis

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

How well did you know this?

Not at all

Perfectly

what are the meinomian glands responsible for

the lipid component of tears

How well did you know this?

Not at all

Perfectly

what is the treatment for a meibomian cyst (chalazia)

2/3rds will spontaneously discharge

those that dont need surgery

How well did you know this?

Not at all

Perfectly

what is the treatment for blepharitis

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

How well did you know this?

Not at all

Perfectly

what can cause conjunctivitis

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

How well did you know this?

Not at all

Perfectly

what are the symptoms of conjunctivitis

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

How well did you know this?

Not at all

Perfectly

what are the signs of conjunctivitis

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)

How well did you know this?

Not at all

Perfectly

what are the common causes of bacterial conjunctivitis

Staph. aureus, Str. pneumoniae, H. infuenzae

tx for bacterial conjunctivitis

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

is chlamydial conjunctivitis uni or bi lateral

unilateral

is viral conjuncitivitis uni or bi lateral

bi lateral

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

if it spreads down to the side of the nose

what is chemosis

conjunctival oedema

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

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

what is keratitis

inflammation of the cornea

should the cornea have blood vessels

what are the layers of the cornea

epithelium stroma endothelium

what causes central corneal ulcers

``` (infective) viral (dendritic) fungal bacterial acanthamoeba (contact lenses) ```

what causes peripheral corneal ulcers

autoimmune RA hypersensitivity rarely- wegeners granulomatosis polyarteritis

what are the symptoms of a corneal ulcer

``` 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 ```

what are the signs of corneal ulcers

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

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

as where immune complexes are deposited

what causes exposure keratitis corneal ulcers

``` thyroid (proptosis) VII palsy (bells) skin cancer/deformity (pulling eyelid down) ```

what causes a keratoconjunctivitis sicca corneal ulcer

sicca symptoms- sjogrens

what cause a neurotrophic keratitis corneal ulcer

H zoster or V1

what causes a vit deficiency corneal ulcer

vit A

what is the treatment for a corneal ulcer

``` 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 ```

what causes anterior uveitis

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

what is uveitis

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

what are the symptoms of anterior uveitis

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

what are the signs of anterior uveitis

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

what is the management of anterior uveitis

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

what causes episcleritis

``` associated with gout quite common recurrent self limiting no serious associations ```

what can occur with episcleritis

nodules

what is the treatment for episcleritis

Self limiting | Lubricants / topical NSAIDs / mild steroids

how do you differentiate episcleritis from scleritis

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

what is scleritis associated with

RA, wegners

what are the features of scleritis

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

what is the treatment for scleritis

Oral NSAIDs Oral Steroids Steroid Sparing Agents

what causes acute closed angle glaucoma

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

who get acute closed angle glaucoma

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

what are the symptoms and signs of acute closed angle glaucoma

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

what red eyes need to be referred urgently

any with affected vision or marked photophobia

what is the treatment for acute closed angle glaucoma

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