The red eye Flashcards
How does a subconjunctival haemorrhage present and what are its causes?
Presents with a harmless but alarming pool of blood behind the conjunctiva. Worth asking if they are on warfarin and what their INR is. Check BP.
How do you differentiate clinically between scleritis and episcleritis?
Episcera lies superficially and the vessels will move when probed with a cotton bud and will blanch with application of 10% phenylephrine. Deeper scleral vessels will do neither.
How does episcleritis present, causes and treatment?
70% of patients are women. Acute onset, the sclera may look blue underneath a cone shaped wedge of engorged vessels that will move over the area when probed with a cotton bud. Eye aches and is tender over area, usually no acuity change. There is often no cause found but in small number can be rheumatic fever or SLE.
Treatment is symptomatic relief through artificial tears and topical or systemic NSAIDs
How does scleritis present, what are causes and treatment?
Generalised inflammation of sclera itself with oedema of conjunctiva, scleral thinning and vasculitis changes. Can be anterior 90% or posterior. If necrosing can perforate globe and half of patients have systemic disease e.g. RA. Constant severe dull ache, ocular movements are painful from muscle insertion into sclera. May have headache and photophobia.
Treat with urgent referral:
-non necrosing may only require NSAIDS with high dose prednisolone. Posterior requires more aggressive therapy, sometimes immunosuppression typically cyclophosphamide and methylprednisolone. Surgical intervention required if globe perforation imminent.
What are the key questions to ask if an acute red eye presents?
is acuity affected? decreased suggests dangerous pathology
Is the globe painful? sinister with foreign body sensation
Does the pupil respond to light? Absent or sluggish sinister
Is the cornea intact? Use fluorescein eyedrops
What is uveitis?
Inflammation of the uvea which is the pigmented part of the eye (iris, ciliary body, choroid)
What are the causes of the different types of uveitis?
Anterior: -ank spond -Sarcoid, behcet's -IBD -Herpes, TB, Syphilis, HIV Posterior: -Herpes simpex + zoster, toxoplasmosis -Lymphoma -Behcet's
How does anterior uveitis typically present?
Pain, blurred vision and photophobia. Starts with conjunctival injection around the junction of the cornea and the sclera and increased lacrimation.
What is posterior synechiae?
This occurs in anterior uveitis and is the adherence of the iris to the lens
How is a diagnosis of anterior uveitis made?
This is made through slit lamp with dilated pupil to visualise the location of inflammatory cells (leukocytes in anterior chamber)
How is anterior uveitis treated?
Urgent eye clinic, MDT treatment guided by cause (often systemic)
Give prednisolone eye drops to decrease inflammation to help with pain and redness etc. Use a dilating agent cyclopentolate to prevent iris spasm and prevent synechiae.
What is acute closed angle glaucoma?
This is an increase in intraocular pressure due to blockage of the trabecular meshwork that allows atreous humour to drain. The angle of the anterior chamber is narrowed and this causes a fixed dilated pupil and axonal death occurs.
What is the difference between primary and secondary acute angle closure glaucoma?
Primary is where patients have an anatomical disposition and it causes an angle closure.
Secondary is where there is a pathological process such as traumatic haemorrhage pushing the posterior chamber forwards.
How do patients with acute angle closure glaucoma typically present?
They can present as generally unwell with nausea and vomiting with no eye complaints. Can also present with painful red eye and unilateral headache as well as halos around lights.
What should be avoided in acute angle closure glaucoma as can worsen it?
Dark rooms or patches because they cause pupil dilation which causes further angle closure
