The Red Eye Flashcards
most common cause of red eye?
conjuctivitis
when does subconjuctival haemorrhage most commonly occur?
in older patients with friable vessels or patients on warfarin. when they sneeze/cough/strain
how is a subconjuctival haemorrhage managed?
-usually left alone, it is self limiting
in what situation is orbital cellulitis often seen?
in a child with a sinus infection
what are the things that make the ocular defences?
- lids
- tears
- conjuctivae
- epithelium
what secretion is released from the lids?
meibomian
what lid is more important in protecting the eye?
the upper lid
what is an achey pain in the eye classic of?
intraocular infection
what is an itch in the eye normally caused by?
allergy
what type of discharge is associated with a bacterial infection?
purulent, sticky discharge
what is mucoid discharge classic of?
allergic type reaction
what does redness maximal at the limbus usually indicate?
an intra-ocular infection or keratitis
what is the term for inflamed eyelids?
blepharitis
what are the 2 different types of blepharitis?
anterior and posterior
what can be seen in anterior blepharitis?
seborrhoeic (sqamous) scales on the lashes
what pathogen often infects the lash follicle in anterior blepharitis?
staphlococcal
where is most of the redness seen in blepharitis?
at the lid margin
what is the problem in posterior blepharitis?
meibomian gland dysfunction
where is the reddness seen in posterior blepharitis?
in deeper part of lid
symptoms of blepharits?
- similar to conjuctivitis
- gritty eyes
- foreign body sensation
- mild discharge
in a seborrhoeic anterior bleparitis, what are the signs?
- lid margin red
- a lot of scales and dandruff on margin
what anterior blepharitis affects the lashes more?
a staphylococcal blepharitis
what are the signs in a staphylococcal blepharitis?
- lid margin red
- lashes distorted, loss of lashes, ingrowing lashes
- styes, ulcers of lid margin
- corneal staining, marginal ulcers
what is the correct term for ingrowing lashes?
trichiasis
what happens to the meibomian glands in posterior blepharitis?
the openings are pouting and swollen
what is around the gland openings in posterior blepharitis?
dried secretions
what is the result of dried secretions and swollen gland openings in posterior blephartis?
Meibomian Cysts
what is another name for meibomian cysts?
chalazia
what is associated (50%) with posterior blepharitis?
Acne Rosaecea
how can a meibomian cyst cause a stygmatism?
if it gets too big it can press on the eyeball
what is the treatment of blepharitis?
- lid hygiene- daily bathing/warm compresses
- supplementary tear drops
- oral doxycycline
how long should doxycycline be given for in blepharitis?
2-3 months
what are the infective causes of conjuctivitis?
viral, bacterial, chlamydial
what can cause a non-infective conjuctivitis?
- allergy
- chemicals/drugs
- skin diseases eg eczema
what is a viral conjuctivitis usually preceeded by?
a viral URTI
where is the redness more diffuse in conjuctivitis?
towards the fornices
what is the fornices?
space between the eyeball and eye socket
what is meant by chemosis?
oedema
what lymph glands are typically swollen in a viral conjuctivitis?
pre-auricular
how long does an acute bacterial conjuctivitis take to clear up without antibiotics?
about 14 days
most common organisms causing acute bacterial conjuctivitis?
- staph. aureus
- strep. pneumonia
- h.influenzae
what are papillae seen in?
bacterial conjuctivitis
what things can cause a follicular conjuctivitis?
- virus
- chlamydial infection
- drugs
what drugs can cause a follicular conjuctivitis?
propine, trusopt
what is the appearance and site of follicular conjuctivitis secondary to chlamydial infection?
raised white dots with redness around the base on the inner upper lip surface
what are the layers of the cornea from anterior to posterior?
- epithelium
- stroma
- endothelium
what is keratitis?
inflammation of the cornea
what are the causes of a central corneal ulcer?
- viral
- fungal
- bacterial
- acanthamoeba
what causes peripheral corneal ulcers?
Autoimmune conditions
- RA
- hypersensitivity
- rarely, GPA
In the UK, what kind of patients get a fungal corneal ulcer?
immunosuppressed patients
what is the pain like in a corneal ulcer?
severe- needle like pain
what virus can affect the corneal sensation?
herpes viruses
what are the symptoms of a corneal ulcer?
- pain
- photophobia
- profuse lacrimation
- may be reduced vision
- red eye
signs of corneal ulcers?
- redness
- corneal reflex abnormal
- corneal opacity
- hypopyon may be present
where is the redness seen in corneal ulcers?
circumcorneal - around the cornea
what is a hypopyon?
fluid level of white blood cells - inflammatory exudate
what kind of ulcer does H.simplex virus cause?
dendritic ulcer
what can happen to the edge of limbus in an auto-immune ulcer?
becomes obscured
in what conditions does a corneal ulcer form due to exposure keratitis?
- thyroid disease eg in proctosus in Graves
- VII palsy
what does keratoconjuctivitis sicca mean?
dry eye
how does Sjorgens manifest in the eyes?
dry eyes
what conditions can cause neurotrophic keratitis leading to a corneal ulcer?
H zoster in ophthalmic division of trigeminal
what vitimin defiency can cause a corneal ulcer?
vit A
how is the cause identified in a corneal ulcer?
‘corneal scrape’ for gram stain and culture
what is the treatment for a bacterial corneal ulcer?
ofloxacin hourly
what is the treatment fora herpetic corneal ulcer?
aciclovir ointment 5 times a day
what is given to treat autoimmune corneal ulcers?
oral/topical steroids
what are the autoimmune causes of anterior uveitis?
-reiter’s, UC, Ank Spon, Sarcoidosis
malignant causes of anterior uveitis?
leukemia
infective causes of anterior uveitis?
-TB, syphylis, herpes simplex, herpes zoster
what is anterior uveitis often mistreated as?
conjuctivitis
symtoms of anterior uveitis?
- pain
- vision may be reduced
- photophobia
- red eye
where is the redness most obvious in anterior uveitis?
circumcorneal - at the limbus
signs of anterior uveitis?
- ciliary injection
- cells and flare in anterior chamber
- keratic precipitates
- hypopyon
- small or irregular pupil
what is the term for an irregular pupil?
synechiae
where can the keratic precipitates be seen in anterior uveitus?
in inferior 1/3rd of cornea
treatment of anterior uveitis?
- topical steroids
- mydriatics
what topical steroid is given to treat anterior uveitis?
Pred Forte 1%
what mydriatic is used in anterior uveitis and how often is it given?
cyclopentolate 1% BD
what systemic disease is episcleritis associated with?
gout
what usually iniates episcleritis?
a late night, lack of sleep
how is episclertits managed?
it is self-limiting, no serious associations
what can occur in recurrent episcleritis?
nodules
how can you differentiate between episcleritis and scleritis?
- scleritis is painful
- apply vasoconstrictor drop to eye and the vessels will blaunche in episcleritis but they wont in scleritis
what is scleritits associated with?
serious systemic vasculitis eg RA, GPA
what is meant by the sign ‘violaceous hue’ in scleritis?
injection of deep vascular plexus
what would you expect in the phenylephrine test in scleritis?
vessels will not blaunche
what other feature in the eye often accompanies scleritis?
uveitis
treatment for scleritits?
oral NSAIDS, oral steroids, steroid sparing agents
what supportive treatment can be given in episcleritis?
lubricants, topical NSAIDS, possibly mild steroids
are hypermetropes or myotropes more likely to get acute closed angle glaucoma?
hypermetropes
where is the maximal redness in acute closed angle glaucoma?
at the limbus
why does IOP rise actutely in ACAG?
drainage angle is closed
what is the main symptom of ACAG?
severe pain, can make patient sick
where is the injected blood vessels most predominant in ACAG?
around cornea -limbus
what is the appearance of the cornea in ACAG?
cloudy (oedematous)
what state is the pupil in in ACAG?
mid dilated
how does the eye feel in ACAG?
stony hard
