The Red Eye Flashcards
List the eyelid causes of red eye
-Trichiasis
-Entropion
-Ectropion
-Blepharitis
-Periorbital cellulitis
-Stye (infection of oil gland)
-Chalazion (blocked oil gland)
List the conjunctiva causes of red eye
-Conjunctivitis
-Dry eye syndrome
-Pterygium (eye web)
-Subconjunctival Hemorrhage
-Trauma
What is the antidote for heparin overdose?
Protamine sulphate
List the sclera causes of red eye
-Episcleritis
-Scleritis
List the cornea causes of red eye
-Abrasion
-Foreign body
-Laceration
-Corneal ulcer
-Keratitis
-Contact lens wearing
List the uvea causes of red eye
-Iritis (anterior uveitis)
-Iridocyclitis (inflammation of the iris and ciliary body)
List other cause of red eye
-Acute angle closure glaucoma
-Orbital cellulitis
-Acute dacryocystitis (inflammation and of the lacrimal sac)
-Hypopyon (pus) in the anterior chamber
-Trauma
What are the symptoms associated with red eye?
•Pain, Blurred vision
•Eye discharge
- Purulent –> bacterial conjunctivitis
- Clear – viral or allergic cause
•Gritty sensation – common in conjunctivitis
•Itching – common in allergic eye disease, blepharitis and topical medication hypersensitivity
•Photophobia -keratits,Iritis
•Halos around light: indicating corneal oedema
What are the signs of red eyes?
•±Reduced visual acuity
•Ciliary flush
•Conjuctival hyperemia
•Chemosis
•Papillary/follicular reactions
•Corneal haze/ opacification
•Corneal epithelial disruption
•Hypopyon: pus in anterior chamber
•Pupillary abnormalities
•Shallow anterior chamber depth: In acute angle closure glaucoma
•Elevated intraocular pressure [Normal: 10-21mmHg]
•Hyphaema; Blood in AC
•Proptosis: protrution of the eyeball
•Preauricular lymph node enlargement
What type of epithelial
Stractified, non-keratinizing cuboid-columnar epithelium + goblet cells
Bacterial conjunctivitis is usually unilateral.
True or False
True
It can also be bilateral
What is the management protocol for bacterial conjunctivitis?
•General measures:
–Swab discharge for M/C/S
–Regular cleaning of discharge & not sharing towel/handkerchief (prevent spread of infection)
•Specific:
–1)Antibiotic drops to hasten resolution (used day time, broad spectrum e.g chloramphenicol & floroquinolones, gentamicin for Gram -ve)
–2)Antibiotic ointment (used at night,).
What is the commonest cause of conjunctivitis?
Viral cause
What are the spectrum of presentation for viral conjunctivitis
1) Mild self limiting
2) Severe inflammation
- Non-specific acute follicular
conjunctivitis
- Pharyngoconjuctival fever
- Epidermic Keratoconjuctivitis
- Chronic relapsing Adeno viral
conjunctivitis
- Acute hemorrhagic conjunctivitis
Which virus is responsible for Pharyngoconjuctival fever?
Adeno virus 1,3,7
Which virus is responsible for Epidermic Keratoconjuctivitis
Adenovirus 8,19,37.
What is the causative agent for APOLLO and what is the management protocol?
Enterovirus 70. Highly contagious 1) Self limiting
2) Supportive treatment;
- Pain relief
- Antibiotic for secondary bacterial.
infection.
NB:- For other viral causes of viral conjunctivitis, you can give them NSAID.
What are the common features of allergic conjunctivitis?
- Usually both eyes
- Itchiness (main feature)
- Lid swell
- Conjunctival injection
- Chemosis
- Previous episode around same season.
What are the management options for allergic conjunctivitis
• Topical antihistamine (levocabastine, ketotifen)
• Systemic antihistamine (levocetririzine, Loratidine)
• Mast cell stabilizers (e.g. sodium cromoglycate, iodoxamide)
• Topical Agents with both properties [antihistamine & mast cell stabilizer] e.g olopatadine
• Topical steroids in severe cases [with caution]
• Discontinue contact lens use while on treatment
What is OPHTHALMIA NEONATORUM
This is neonatal conjunctivitis of any type that occurs in the 1st 28 days of life.
What are the 2 important causative agents for ophthalmia neonatorum.
List the differential diagnosis.
– Neisseria gonorrhoea (corneal perforation)
– Chlamydia trachomatis (chronic corneal scarring)
Other possible causes are
- Bacterial conjunctivitis (gram +ve)
- Herpes Simplex Virus (corneal scarring)
Differentials include;
- Congenital glaucoma
- Congenital blocked nasolacrimal gland
What is the management protocol for ophthalmia neonatorum
Management:
–Referral to Ophthalmologist
–Swab and send for culture test (mandatory)
–N.gonorrhoeae cefuroxime topically (local disease) and systemically (systemic disease)
–Chlamydia topical tetracycline ointment (local disease) and systemic erythromycin (systemic disease)
–HSV topical antivirals
What are the predisposing factors for pterygium and its management
– Hot climates
– Chronic dryness
– Exposure to sun
Management
Antihistamines
Vasoconstrictors
Tears substitutes
Surgical excision with antimetabolite
Conjuctival graft
— Surgical excision is the definitive treatment and can also be followed by beta radiation or amniotic membrane attachment.
Causes of dry eye syndrome
•Poor TEARS quality
– Meibomian gland disease, Acne
rosacea
– Eyelid disease related
– Vitamin A deficiency
•Poor TEARS quantity
– Keratoconjunctivitis sicca
•Sjogren Syndrome
•Rheumatoid Arthritis
•SLE
– Lacrimal gland disease ie, Sarcoidosis
– Paralytic ie, VII CN palsy
– Medications – Antihypertensives
[beta blocker] , antihistamines,
antidepressants ,Antipsychotic,
analgesics, chemotherapy
What investigation is done to test for dry eye
-Tear breakup time [< 10 seconds] = Positive
-Schimers test [>10mm in 5 mins] = Positive
What are the signs and symptoms of acute angle glaucoma
Symptoms:
Onset of severe ocular pain
Nausea and vomiting
Headache
Blurred vision is sudden.
Signs:
Reduced vision
Haloes around light
Raised IOP up to >40mmhg
Narrow angles
What is the treatment option for acute angle closure glaucoma
Treatment:
- Immediate supine position
- IV acetazolamide, topical steroid, beta blockers.
- Topical pilocarpine or other ocular hypotensives
- Definitive treatment is Laser Iridectomy or surgical iridectomy
What is the treatment protocol for chemical injuries and burns
• Copious irrigation
• Double-eversion of eyelids
• Debridement if indicated
• Topical Steroids with caution
• Ascorbic acid to promote healing
• Tetracycline/ chloramphenicol ointment
• Surgery if indicated to release adhesions
