The red eye Flashcards
Acute closed angle glaucoma mechanism
blockage of aqueous drainage through canal of schlemm due to contact of iris w. trabecular meshwork (closed angle)>raised IOP>neuronal death
RFs for acute closed angle glaucoma (4)
Hypermetropia-due to short eye elderly females mydriatric eyedrops drugs: -anticholinergics: oxybutynin, solifenacin -TCAs: due to raised adrenaline -ipratropium bromide
Presentation of acute closed angle glaucoma (7)
uniocular red, painful eye
nausea
headache
haloes/blurred vision may preceede symptoms
fixed medium-dilated pupil
Sx worse on pupil dilatation; worse at night
cloudy eye due to to corneal opacity from pressure.
DDx for acute closed angle glaucoma
Cluster headache: has constricted pupil whereas ACAG has fixed, medium-dilated pupil.
Ix for ACAG (4)
eye feels hard
tonometry for IOP
shallow anterior chamber measured w. split beam on slit lamp
goniometry: uses prisms to measure iridocorneal distance.
Mx of ACAG (5)
DON’T COVER EYE-causes pupil dilatation
pilocarpine drops (alpha blocker) for pupil constriction and acetozolamide (carb anhydrase inhib) to reduce aqueous production
analgesia and anti-emetics
may also need: mannitol, beta blockers and A-adrenergic antagonists
once IOP stabilised: peripheral iridectomy in BOTH eyes to promote aqueous drainage.
Presentation of anterior uveitis (7)
acute pain
decreased acuity/blurred vision
circumcorneal redness (differentiates from conjunctivitis)
photophobia
small, irregular, poorly constricted/oval pupil
hypopyon (inflamm. cells in ant. chamber) can> visible fluid lvl
lacrimation
Ix for anterior uveitis (2)
Talbot’s test: follow finger towards nose;pain increases w. convergence
slit lamp:
- white precipitates on the back of the cornea
- anterior chamber cells
Causes of uveitis (3)
anterior:
- ank spond
- still’s (juvenile arthritis)
- bechet’s
- reiter’s (chlamydia)
- sarcoid
- HSV, syphiis, TB, HIV
intermediate:
- MS
- lymphoma
- sarcoid
posterior:
- HSV, TB, toxoplasmosis, CMV, VZV
- lymphoma
- bechet’s
- sarcoid
Mx of anterior uveitis (4)
prevent inflammation w. prednisolone eye drops
dilate pupils w. cyclopentolate
(these aim to prevent adhesion between iris and lens which blocks posterior chamber>ACAG)
for AID: if HLA-B27 +ve (most recurrences are), give adalimumab (anti-TNF-alpha)
need regular followup due to high incidence of recurrence
Features of keratitis (7)
red eye photophobia hypopyon may be seen hazy cornea pupillary reflexes preserved mucopurulent discharge foreign body
Cause and common pathogens of keratitis (5)
contact lens most common source
pseudomonas
staphs
streps
acanthoemeba: particularly poor prognosis; from washing lens w. tap water.
Rx and consequence of keratitis (2)
Rx w. chloramphenicol eyedrops
if untreated can>blindness
Features of corneal abrasion (3)
breech of epithelium
commonly occurs in contact lens wearers or after trauma.
can occur w. or w/o keratitis.
Mx of corneal abrasion (2)
stain w. fluorescein eyedrops
if no keratitis, can give prophylactic chloramphenicol drops.
Features of corneal ulcers/ulcerative keratitis (6)
red, sore eye visible white opacity: ulcer hypopyon watering photophobia fluorescin staining may show epithelial ulcer
Causes of corneal ulcers (4)
bacterial
viral (HSV/VZV): dentritic ulcers=HSV, pseudodendritic ulcers=VZV
fungal
acanthoemeba
(acute corneal ulcers more likely to be bacterial)
Mx of corneal ulcers
smears and culture determine Rx.
Features of episcleritis (5)
younger pts.
no systemic upset
blanches under pressure/phenylephrine (topical vasoconstrictor)
can be: segmental (mainly), diffuse or nodular
not painful (can have dull ache)
Rx of episcleritis
topical NSAIDs or steroids.
Features of scleritis (8)
older, rheumatic pts.
doesn’t blanch
v. painful (worse on eye movement)
there is conjunctival oedema w. scleral thinning
CAN BE CONFINED TO PART OF THE EYE
risk of perforating
can become necrotising>scleromalacia perforans (seen in RA)
assoc. w. vaculiltides, connective tissue disorders and infection (HSP, IBD, RA, wegener’s, SLE, sarcoid).
Rx of scleritis (2)
oral steroids/immunosuppression
ciprofloxacin, amikacin, vancomycin if staph.
Presentation of conjunctivitis (6)
red, inflamed conjunctiva
purulent discharge-can stick eyelids together
red vessels which can be gently moved over sclera
reddened sclera-not around iris
itching, burning and lacrimation
often bilateral
Causes of conjunctivitis (3)
Adenovirus>tarsal follicles (white dots on conjunctiva)
bacteria:
- discharge more prominent
- staphs and streps
- think reiter’s in young, sexually active pt.
allergic:
- giant papillary conjunctivitis
- vernal keratoconjunctivitis
- chemical irritation
Rx of conjunctivitis (6)
advise not to share towels and keep eye clean and dry
infectious:
- should resolve spontaneously, don’t usually need Abx
- can give chloramphenicol/fusidic acid(pregnancy) though
- doxycycline/azithromycin for chlamydia
allergic:
- antihistamines: antalozine, emedastine or olopatadine
- sodium cromoglycate(NSAID) or steroid drops
Features of subconjunctival haemorrhage (3)
harmless, small haemorrhage behind conjunctiva
often Hx of coughing/sneezing/vomitting
can occur in newborn babies.
Red flags for subconjunctival haemorrhage (2)
check INR if on warfarin
skull base fractures.
