The Red Eye Flashcards
1
Q
what makes a tissue pathologically red?
A
- inflammation (-itis): more blood to area/vasodilation or new vessels
- hemorrhage: blood out of vessels, into tissue
- congestion: blood can’t leave
2
Q
what are your differentials for a red eye?
A
GO SHUCK
Glaucoma
Orbital Disease and proptosis
Scleritis- very uncommon, episcleritis is more common
Hemorrhage: subconjunctival, corneal, stromal, hyphema, vitreal
Uveitis
Conjunctivitis
Keratitis
AND ALSO eyelids!!-blepharitis, prolapsed gland of nictitating membrane (TEL)
rule these in or out via ophthalmic exam!
3
Q
describe eyelid disease
A
usually obvious, more of a derm workup
4
Q
describe conjunctivits
A
- diagnosis of exclusion with normal globe
-conjunctiva is often affected as an extension/reaction of other ocular diseases
-hyperemia, chemosis, discharge, follicular response, etc. - is NOT conjunctivitis unless other ddx ruled out!!
- ddx:
-infection (cats esp): bacterial, viral, parasitic
-KCS
-other immune-mediated: allergic (dogs!), eosinophilic (cats, horses), drug reaction (neomycin)
-foreign body
-neoplasia - workup:
-general PE
-ophthalmic exam including STT, bulbar TEL evaluation
-response to empiric therapy
-conjunctival scrape cytology, culture, and/or biopsy if refractory or worsens
5
Q
describe keratitis
A
- corneal disease/inflammation with MANY potential underlying causes and types (ulcerative and non-ulcerative)
-non-ulcerative when in a dog most likely immune mediated! - may also be confounded by involvement by extension of eyelid, intraocular, and/or orbital disease
-may be tip of iceberg or red herring
6
Q
describe ulcerative keratitis
A
- clinical signs:
-blepharospasm (squinting)
-ocular discharge
-ocular/corneal redness (vascularization)
-HALLMARK: fluorescein uptake
-corneal edema
-corneal infiltrate, malace, and/or stromal loss
-reflex uveitis (miosis, flare, +/- hypopyon) - diagnosis:
-ophthalmic exam: FLUORESCEIN UPTAKE
-corneal cytology and culture - treatment:
-topical antibiotic: prevent or treat secondary infection
-mydriatic/cycloplegic: NOT with KCS or glaucoma
-oral anti-inflammatory and/or pain meds
-E-collar
-SHOULD heal within a week!
7
Q
describe non-ulcerative keratitis
A
- clinical signs:
-+/- blepharospasm
-ocular discharge
-ocular/corneal redness
-corneal edema
-corneal infiltrate: much less than ulcerative
-NEGATIVE fluorescein uptake - ddx:
-usually immune-mediated inflammation!: pannus, EK, sheltie dystrophy, shih tzus, cockers, dachshunds
-post-ulcerative (healing)
-infection/stromal abscess - diagnosis:
-signalment (esp breed), history (chronic, insidious)
-ophthalmic exam: frequently bilateral, STT, fluorescein negative!!
-+/- cytology: low to no yield bc non-ulcerated
-response to empiric therapy - treatment:
-topical anti-inflammatory: steroids (CAREFUL), tear stimulants (anti-inflam)
-hit hard to achieve remission then slowly taper to lowest amount that keeps things in check
-expect control with long term to life-long therapy, NOT cure
8
Q
describe uveitis
A
- inflammation of the uveal tract
- clinical signs for anterior uveitis:
-+/- blepharospasm/photophobia
-+/- ocular discharge (tearing)
-ocular redness
-corneal redness and edema
-HALLMARK: AH FLARE!!!!
-MIOSIS!!!
-DECREASED IOP!! - ddx:
-primary ocular:
–reflex (secondary to corneal disease, can help indicate severity and progression)
–traumatic
–lens-induced (cataract)
–immune-mediated
–neoplastic
–secondary to retinal disease
-associated with underlying systemic diseases too so systemic screening workup indicated!!
- diagnosis:
-thorough history
-careful general PE
-ophth exam: BOTH eyes! look for flare, IOPs, dilated pupils, fundic exam
-+/- ocular ultrasound
-guided systemic screening! - treatment:
-address underlying causes if possible; treat inflammation, acoind secondary glaucoma
-topical anti-inflammatory: steroidal or non
-topical mydriatic/cycloplegic: stabilize BAB, reduces pain of ciliary spasm, reduce visually significant posterior synechia formation
-oral anti-inflammatory
9
Q
describe hyphema
A
- uveitis with RBCs = slight different/expanded ddx list
- ddx:
-primary ocular: traumatic, foreign body, retinal detach/tear, uveitis, neoplastic, congenital anomaly (CEA, MOA)
-associated with underlying systemic disease too
-systemic causes: DONT memorize!!
-vasculitis: infectious (RMSF, FIP), sepsis, endotoxemia
-systemic hypertension
-hyperviscosity syndrome: MM, leukemia, ehrlichiosis, HGE, PCV
-neoplasia
-severe anemia
-bleeding disorder: thrombocytopenia, thrombocytopathy, coagulopathy
10
Q
describe diagnosis and treatment of hyphema
A
- history
- general PR
- ophth exam; BOTH eyes, assess IOPs, dilated fundic exam, ocular ultrasound, guided systemic screening
- +/- ocular ultrasound, skull rads
- guided systemic screening: add in BP, coag profiles, then rest same as uveitis
treatment is same as uveitis
11
Q
describe glaucoma
A
- elevated IOP induced optic neuropathy
- acute clinical signs:
-pain
-blepharospasm, TEL elevation
-ocular redness: congestion, injection
-CORNEAL EDEMA
-MYDRIASIS
-optic nerve damage
-INCREASED IOP - ddx:
-primary: abnormal drainage angle
-secondary: underlying ocular (uveitis, lens luxation, neoplasia), +/- systemic disease - diagnosis:
-ophth exam: assess potential for vision! - treatment: primary versus secondary, treated differently, review lecture
12
Q
describe episcleritis
A
- diagnosis of exclusion with normal globe
-often affected (injection, as extension of/reaction to other ocular disease)
-NOT episcleritis unless other ddx ruled out - ddx:
-immune-mediated inflammation
-neoplasia
-infection
-foreign body
-sometimes associated with underlying systemic disease
13
Q
describe diagnosis of episcleritis
A
- general PE
- ophth exam: rule out other red eye ddx!!
-diagnosis of exclusion!! - appearance
- response to empiric therapy
- cytology (or biopsy) if refractory or worsens
14
Q
describe treatment of episcleritis
A
- address underlying disease if possible
- trial empiric topic and/or oral anti-inflammatory
-steroid
-tetracycline/niacinimide
-cyclosporine - surgery: debulk with adjunct cryo
15
Q
describe orbital disease
A
- red eye due to space-occupying orbital mass effect causing congestion +/- actual inflammation and/or ocular surface inflammation
- diagnosis by ophthalmic exam, especially ocular motility, and retropulsion results
