The Red Eye Flashcards
What are the main causes of red eye?
- Conjunctivitis
- Keratitis
- Anterior uveitis
- Scleritis/episcleritis
- Acute angle closure glaucoma
- Subconjunctival haemorrhage
- Orbital disease such as cellulitis
What is the most common cause of red eye?
Conjunctivitis
Damage to which glands will lead to eye film disruption?
Meibomian
In which two ways are lacrimal glands most commonly damaged?
- Sjogrens syndrome
- Radiotherapy
Where is deep pain within the eye sometimes referred?
- Head
- Brow
Mucoid stringy discharge from the eye is associated with which cause?
Allergic cause
The use of contact lenses predisposes the wearer to which type of infection at a much higher rate than non-wearers?
Acanthomeba
How can an acanthamoeba infection within the eye be treated?
Chlorhexidine ophthalmic drops (antiseptic)
Acanthamoeba causes which condition within the eye?
Keratitis
When balloting the upper conjunctival fornix how will it feel if the patient has glaucoma?
Stony hard
What is blepharitis?
Inflamed eyelids
What is the difference between anterior and posterior blepharitis?
Anterior - lid margin is redder then the deeper part of the lid
Posterior - Lid margin often looks quite normal yet the deep aspect is inflamed
What causes anterior blepharitis?
- Staphylococcal infection involving the lash follicle
- Seborrheic scales on the eyelashes
What causes posterior blepharitis?
Meibomian gland dysfunction
How does blepharitis often feel to the patient?
- Dry, gritty eyes
- Foreign body sensation
What are the signs for seborrheic blepharitis?
- Lid margin red
- Scales
- Dandruff
Why is dandruff a sign for seborrheic blepharitis?
There is an association with seborrheic dermatitis which causes oily flaky skin
What is the term given to eyelashes which are ingrowing?
Trichiasis
What are the main signs for a staphylococcal blepharitis?
- Lid margin red
- Distorted lashes and trichiasis
- Styes, ulcers of lid margin
- Corneal staining, margin ulcers (exotoxin induced)
Posterior blepharitis, or meibomian gland disease, has a strong association with which other condition?
Rosacea
How is meibomian gland disease generally treated?
Long term, low dose tetracycline
What happens if a meibomian cyst does not resolve itself after 3 months?
Incision and drainage
What are the causes for infective conjunctivitis?
- Viral
- Bacterial
- Chlamydial
If conjunctivitis is associated with an itch it is most likely to be due to what?
Allergy
Rice grain follicles are associated with which cause of conjunctivitis?
Chlamydial/viral
Small circular papillae which are red in the centre and found on the inside of the eyelids are associated with which cause of conjunctivitis?
Bacterial
What are the most common organisms to cause bacterial conjunctivitis in adults?
- S. aureus
- S. pneumoniae
- H. influenzae
A red sticky eye is most associated with which cause for conjunctivitis?
Bacterial
What often preceeds a viral conjunctivitis?
URTI
What can induce a follicular conjunctivitis?
- Viral causes
- Chlamydial
- Drugs (propine, trusopt)
Why should patients be encouraged not to rub their eyes with a viral conjunctivitis?
Corneal abraision is likely
Increases chances of dendritic ulcer formation
What can lead to chemosis?
- Allergy
- Aggressive viral conjunctivitis
If a cornea has an “ice rink” appearance, where is it important to look?
Underneath the eyelids for a foreign body
Where in the world are fungal corneal ulcers most common?
- Sub-Saharan Africa
- South-east asia
Why do many autoimmune reactions involve corneal inflammation?
Immune complexes can easily become trapped in the extracellula rmatric of the peripheral cornea causing an immune reaction
Which type of red eye is associated with corneal ulcers amongst other conditions?
Ciliary flush
How can a dendritic ulcer produced by herpes simplex be differentiated by one produced by herpes zoster?
Terminal bulbs are found at the end of branches for H.simplex
Which infective causes can cause corneal ulcers?
- Viral
- Bacterial
- Fungal
- Acanthomeba
Which other non-infective causes are there for corneal ulcers?
- Exposure keratitis
- Keratoconjunctivitis sicca
- Neurotrophic keratitis
- Vitamin A deficiency
A vitamin A deficiency may eventually lead to what?
Corneal perforation
Where in the world is vitamin A deficiency most common?
South east Asia
(high rice intake which has low vit A)
What are two major causes for exposure keratitis?
- Proptosis associated with thyroid eye disease
- Bell’s palsy (CN VII palsy, may causes eyes to remain open)
How is H. simplex keratitis treated?
Aciclovir
(5x daily, 7-10 days)
Which autoimmune conditions are associated with anterior uveitis, and which has the highest association?
- Ankylosing spondylitis (most common)
- Reiter’s
- Ulcerative colitis
- Sarcoidosis
What are four key causes for infective anterior uveitis?
- Tb
- Syphilis
- Herpes simplex
- Herpes zoster
Which type of pain is associated with anterior uveitis?
Dull ache
What are the main clinical signs for anterior uveitis?
- Ciliary injection
- Cells and flare
- Keratic precipitates
- Hypopyon
- Synechiae (small/irregular pupil)
How can anterior uveitis be treated?
Topical steroids
Episcleritis is associated with which other condition?
Gout
Which condition is more serious, episcleritis or scleritis?
Scleritis
Episcleritis is painful
True or false?
Not usually painful
Scleritis has associations with which other conditions?
Rheumatoid arthritis
Granulomatosis with polyangiitis
Anterior uveitis
Scleritis has which unique clinical sign?
Eyes have blueish/purple tinge best seen in daylight
(due to injection of deep vascular plexus)
How can episcleritis and scleritis quickly be differentiated?
Episcleritis will blanch, scleritis will not
How can episcleritis be treated?
- Topical NSAIDs
- Lubricants
- Mild steroids
How can scleritis be treated?
Oral NSAIDs
Oral steroids
Steroid sparing agents e.g. DMARDs
What precipitates acute closed angle glaucoma?
Pupil dilatation
How do patients with acute closed angle glaucoma present?
- Nausea
- Vomiting
- Eye stony hard
- Severe pain
