The acute red eye Flashcards
what can cause a red eye (acute)
conjunctivitis blepharitis keratitis anterior uvetitis scleritis episcleritis acute angle closure glaucoma subconjunctival haemorrhage orbital disease (cellulitis)
what is a subconjunctival haemorrhage
bleeding into the subconjunctival space (can happen in trauma, anticoagulants, hptx) takes 1-2 weeks to go away
what can orbital cellulitis cause
brain abscess
vision loss
death
what usually causes orbital cellulitis
sinus infection, insect bite, eyelid trauma
what lid secretions protect the eye
meibomian
what can lid disease and shortening of the malar skin cause
corneal ulcer (as conjunctiva exposed when cheek skin pulled down)
what are the anti-infection properties of tears
lysozyme
IgA, IgG
complement
mucous trapping
what causes an itchy eye
allergic cause
what is a stony hard eye suggestive of
acute glaucoma
how is intracranial pressure check
blotting
what are the types of anterior blepharitis
Seborrhoeic (squamous) scales on the lashes
Staphylococcal – infection involving the lash follicle
what are the types of posterior blepharitis
Meibomian gland dysfunction
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
what are the symptoms of blepharitis
Gritty eyes
foreign body sensation
mild discharge
what is blepharitis associated with
Conjunctivitis
Keratitis (marginal, SPK)
Episcleritis
what are the signs of seborrhoeic anterior blepharitis
Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)
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)
what are the signs of posterior blepharitis
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%)
what are the meinomian glands responsible for
the lipid component of tears
what is the treatment for a meibomian cyst (chalazia)
2/3rds will spontaneously discharge
those that dont need surgery
what is the treatment for blepharitis
Lid hygiene – daily bathing / warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months (acne rosacea)
what can cause conjunctivitis
viral bacterial chlamydial allergic chemical/ drugs skin diseases (eczema)
what are the symptoms of conjunctivitis
red eye
foreign body sensation – gritty eye
discharge – sticky eye
Itch = allergy
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)
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
no
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
