The red eye

Question 1

What is blepharitis?

Answer 1

• inflamed eyelids

- can be anterior or posterior

Question 2

What is anterior blepharitis? how does this affect the conjunctiva? what else can this involve?

Answer 2

• Inflammation of the lid margin is concentrated in the lash line can accompanied by squamous debris around the eyelashes
• Conjunctiva becomes injected
• In severe disease cornea is affected
(Blepharokeratitis)
• Small infiltrates or ulcers may form in the peripheral cornea
(marginal keratitis)

Question 3

What causes anterior blepharitis?

Answer 3

Seborrhoeic (squamous) scales on the lashes
Staphylococcal – infection involving the lash follicle
Lid margin redder than deeper part of lid

Question 4

What are the clinical signs seen in seberrhoeic blepharitis?

Answer 4

Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)

Question 5

What are the clinical signs seen in staphylococcal blepharitis?

Answer 5

• lid margin red
• Lashes distorted, loss of lashes, ingrowing lashes - trichiasis
• Styes, ulcers of lid margin
• corneal staining, marginal ulcers (due to exotoxin)

Question 6

What is posterior blepharitis ? what is it also known as?

Answer 6

• This is also known as meibomian gland dysfunction

Meibomian glands are usually obstructed by squamous debris

Question 7

How is posterior blepharitis different from anterior blepharitis?

Answer 7

redness is in deeper part of lid

lid margin often quite normal looking

Question 8

What are the signs seen in posterior blepharitis? what is this also assoc. with?

Answer 8

• Lid margin skin and lashes unaffected
• M.G. openings pouting & swollen
• Inspissated (dried) secretion at gland openings
• Meibomian Cysts (chalazia)

–Associated with Acne Rosacea (50%)

Question 9

How is anterior and posterior blepharitis managed?

Answer 9

Lid hygiene – daily bathing / warm compresses

Supplementary tear drops

Oral doxycycline for 2-3 months

Very difficult to eradicate

Question 10

What is anterior uveitis also known as?

Answer 10

iritis

Question 11

What are the different:
-autoimmune
-infective
-malignant
-other
causes of anterior uveitis

Answer 11

Autoimmune:
-Reiter’s, ulcerative colitis, ankylosing spondylitis, sarcoidosis

Infective:
-T.B, syphilis, herpes simplex, herpes zoster

Malignancy:
-Leukaemia

Other:
-Idiopathic, traumatic, secondary to other eye disorders

Question 12

What are the symptoms of anterior uveitis?

Answer 12

Pain (+ referred pain)
	Vision may be reduced
	Photophobia
	Red eye (circumcorneal)
nb often missed and treated as conjunctivitis

Question 13

What are the signs seen in anterior uveitis

Answer 13

Ciliary injection (i.e. circum-corneal )
	Cells & flare in anterior chamber
	Keratic precipitates
	Hypopyon
	Synechiae – causes irregular pupil iris adheres to cornea or lens
	Small or irregular pupil

Question 14

What is the treatment of anterior uveitis?

Answer 14

topical steroids
Pred Forte 1% Hourly tapering over 4-8 weeks
Mydriatics eg
Cyclopentolate 1% BD
investigate for systemic associations if recurrent or chronic

Question 15

What is episcleritis? is this common? what is this assoc. with? What is the treatment?

Answer 15

inflamation of the episclera

• Relatively common / no serious associations
• Association with gout
• Recurrent
• Nodules may occur
• Self limiting
• Lubricants / topical NSAIDs / mild steroids

Question 16

What is scleritis?
what is this assoc. with?
what symptoms/signs seen?
what is the treatment?

Answer 16

• Association with serious systemic vasculitides e.g. Rh arthritis, Wegener’s
• PAINFUL +
• Injection of deep vascular plexus – ‘violaceous hue’
• Phenylephrine test
• Associated uveitis common

Treatment:

• Oral NSAIDs
• Oral Steroids
• Steroid Sparing Agents

Question 17

Acute closed angle glaucoma:

• what is this?
• what are the clinical features?

Answer 17

• IOP rises acutely due to the drainage angle being closed (pupil dilatation precipitates it)
• Elderly* hypermetropic – thick glasses
• Severe pain + nausea
• Circumcorneal injection
• Cornea cloudy (oedematous)
• Pupil mid dilated
• Eye stony hard

Question 18

How does subacute closed angle glaucoma present?

Answer 18

Subacute closed angle presents with intermittent attacks typically lasting 1-2 hours and are associated with blurring of vision and haloes around light sources