The Acute Red Eye And Age Related Macular Degeneration Flashcards
What are the main causes of acute red eye?
Eyelid causes such as blepharitis
Bacterial, viral or allergic conjunctivitis
Bacterial, viral or autoimmune keratitis (Inflammation of cornea)
Scleritis via infection, vasculitis, connective tissue disease or idiopathic
Uveitis (inflammation of the iris)
Acute angle closure glaucoma
Orbital cellulitis
What is blepharitis?
Chronic inflammation of the eyelid margins, can have an infective cause such as staph aureus
What is the treatment of blepharitis?
It is treated with lid hygiene and warm compresses
Antibiotic ointments can be used
What are entropion and ectropion?
Turning in and turning out of the eyelid
Both tend to be treated surgically
What are the main bacterial causes of conjunctivitis?
Staphylococcal and streptococcal bacteria
What is the treatment of bacterial conjunctivitis?
Antibiotic eye drops such as chloramphenicol, hourly for 24 hours then QDS for one week
What are the possible associated symptoms with viral conjunctivitis?
Pre-auricular lymphadenopathy and occasionally URTI
How is allergic conjunctivitis treated?
With sodium chromoglycate
How does bacterial keratitis present?
With a red, sticky eye, associated reduced vision and photophobia
What are the possible complications of bacterial keratitis?
Loss of vision, corneal perforation and potentially loss of the eye
How should bacterial keratitis be treated?
The patient should be admitted and bacteria identified with a corneal scrape
Should be given hourly topical antibiotics (usually dual therapy)
How is viral keratitis treated?
With antiviral ointment alongside pupil dilation
Steroids are contraindicated as they may lead to global ulceration and bacterial infection
How do you decrease the risk of infection in corneal abrasion?
Prophylactic antibiotics and eye patching
How does scleritis present?
Severe pain with a red eye (if anterior) but no visual loss
There will be painful eye movements as the muscles insert into the sclera
How is scleritis treated?
Shoukd be referred in 24 hours as can be necrosing and cause globe perforation
Oral NSAIDs for mild cases and can be supplemented with topical steroids
In severe cases then give oral corticosteroids
What is uveitis? How does it present?
Inflammation of the iris, presents with unilateral red, painful, photophobic eye
How is anterior uveitis treated?
Topical steroids or oral steroids if severe
What is acute angle closure glaucoma?
When there is a blockage of the trabecular meshwork that drains the eye in the acute angle in the anterior chamber. Fluid is continuously produced in the posterior chamber so there is a build up of pressure.
What are the main causes of acute angle closure glaucoma?
Most commonly caused by hypermetropia (long sightedness) as the eyeball is short therefore the drainage angle is narrowed. AACG can be secondary to hyper-mature cataracts as thickness of lens increases narrowing angle, angle closes when pupil dilates as iris bunches up.
What are the symptoms of AACG?
Haloes around light reduced vision extreme ocular pain headache nausea vomiting
What are the examination findings of AACG?
redeye
corneal oedema
Mid-dilated unreactive pupil
What are the investigations of AACG?
Measure ocular pressure using Goldmann application tonometry
What is the treatment of AACG?
Constrict pupil using motifs e.g. pilocarpine drops
If pupil doesn’t constrict then iris ischaemic so bring down IOP with acetazolamide oral/IV or mannitol IV
Surgical iridotomy last line to create drainage outflow from posterior to anterior chamber
What normally causes orbital cellulitis?
Infection behind orbital septum usually caused by spread from the air sinuses
complications such as blindness and intracranial abscess
What is the treatment of orbital cellulitis?
IV antibiotics and ENT opinion, CT scan and blood cultures are essential
What is the pathogenesis of age related macula degeneration?
It is the accumulation of drusen within the macula. Drusen start off hard and progress to soft
What is the difference between hard drusen and soft drusen?
Hard drusen are round, yellow and well defined and are not nessesarily associated with AMD
Soft drusen are poorly defined and large and when they increase in number can lead to AMD
What is the difference between dry and wet AMD?
In dry AMD the soft drusen lift up the pigment epithelium of the retina causing atrophy of the photoreceptors
In wet AMD there is growth of blood vessels in the region of the soft drusen
What is the name of the blood vessel formation in wet AMD? How does it damage the retina?
Choroidal neurovascularisation
The vessels are prone to bleeding which leads to macular scarring
How is wet AMD treated?
With non-selective VEGF inhibitors such as ranibizumab
Photocoagulation
What is the treatment for dry AMD?
Vitamins can help
There is no definitive treatment for dry AMD so they should be offered support
