The Acute Red Eye And Age Related Macular Degeneration

Question 1

What are the main causes of acute red eye?

Answer 1

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

Question 2

What is blepharitis?

Answer 2

Chronic inflammation of the eyelid margins, can have an infective cause such as staph aureus

Question 3

What is the treatment of blepharitis?

Answer 3

It is treated with lid hygiene and warm compresses

Antibiotic ointments can be used

Question 4

What are entropion and ectropion?

Answer 4

Turning in and turning out of the eyelid

Both tend to be treated surgically

Question 5

What are the main bacterial causes of conjunctivitis?

Answer 5

Staphylococcal and streptococcal bacteria

Question 6

What is the treatment of bacterial conjunctivitis?

Answer 6

Antibiotic eye drops such as chloramphenicol, hourly for 24 hours then QDS for one week

Question 7

What are the possible associated symptoms with viral conjunctivitis?

Answer 7

Pre-auricular lymphadenopathy and occasionally URTI

Question 8

How is allergic conjunctivitis treated?

Answer 8

With sodium chromoglycate

Question 9

How does bacterial keratitis present?

Answer 9

With a red, sticky eye, associated reduced vision and photophobia

Question 10

What are the possible complications of bacterial keratitis?

Answer 10

Loss of vision, corneal perforation and potentially loss of the eye

Question 11

How should bacterial keratitis be treated?

Answer 11

The patient should be admitted and bacteria identified with a corneal scrape
Should be given hourly topical antibiotics (usually dual therapy)

Question 12

How is viral keratitis treated?

Answer 12

With antiviral ointment alongside pupil dilation

Steroids are contraindicated as they may lead to global ulceration and bacterial infection

Question 13

How do you decrease the risk of infection in corneal abrasion?

Answer 13

Prophylactic antibiotics and eye patching

Question 14

How does scleritis present?

Answer 14

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

Question 15

How is scleritis treated?

Answer 15

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

Question 16

What is uveitis? How does it present?

Answer 16

Inflammation of the iris, presents with unilateral red, painful, photophobic eye

Question 17

How is anterior uveitis treated?

Answer 17

Topical steroids or oral steroids if severe

Question 18

What is acute angle closure glaucoma?

Answer 18

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.

Question 19

What are the main causes of acute angle closure glaucoma?

Answer 19

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.

Question 20

What are the symptoms of AACG?

Answer 20

Haloes around light
reduced vision
extreme ocular pain
headache
nausea
vomiting

Question 21

What are the examination findings of AACG?

Answer 21

redeye
corneal oedema
Mid-dilated unreactive pupil

Question 22

What are the investigations of AACG?

Answer 22

Measure ocular pressure using Goldmann application tonometry

Question 23

What is the treatment of AACG?

Answer 23

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

Question 24

What normally causes orbital cellulitis?

Answer 24

Infection behind orbital septum usually caused by spread from the air sinuses
complications such as blindness and intracranial abscess

Question 25

What is the treatment of orbital cellulitis?

Answer 25

IV antibiotics and ENT opinion, CT scan and blood cultures are essential

Question 26

What is the pathogenesis of age related macula degeneration?

Answer 26

It is the accumulation of drusen within the macula. Drusen start off hard and progress to soft

Question 27

What is the difference between hard drusen and soft drusen?

Answer 27

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

Question 28

What is the difference between dry and wet AMD?

Answer 28

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

Question 29

What is the name of the blood vessel formation in wet AMD? How does it damage the retina?

Answer 29

Choroidal neurovascularisation

The vessels are prone to bleeding which leads to macular scarring

Question 30

How is wet AMD treated?

Answer 30

With non-selective VEGF inhibitors such as ranibizumab

Photocoagulation

Question 31

What is the treatment for dry AMD?

Answer 31

Vitamins can help

There is no definitive treatment for dry AMD so they should be offered support