The Red Eye Flashcards
common causes of a red eye
Conjunctivitis Keratitis Anterior uveitis Scleritis/epscleritis Acute angle closure glaucoma Subconjunctival haemorrhage Orbital disease
what is a subconjunctival haemorrhage
look v dramatic but just a blood blister
blood vessel bleeds under conjunctiva - has little or no consequence
what is orbital cellulitis
inflammation of the tissues behind the orbital septum
most commonly caused by infection from the sinuses
causes permanent vision loss and can spread to the brain
what immune defences does the eye have
eye lids
tears
conjunctivae (mucous)
epithelium (conjunctiva/corneal)
where are tears produced
lacrimal glands
what does an ache in the eye usually suggest
an intraocular problem
what does an itch in the eye usually suggest
allergy
what does dryness/grittiness/foreign body sensation suggest
problem with the surface of the eye
what examination can you do to quickly determine if there is raised IOP
Bllotting- eye feels ‘stony hard’
what is blepharitis
inflamed eyelids
what are the two types of anterior blepharitis
seborrhoeic (oily skin flakes causing irritation)
staphylococcal (infection involving lash follicle)
both give a v red lid margin
what is anterior blepharitis
Meibomian gland dysfunction
the redness is in the deeper part of the lid and the lid margin looks normal
symptoms of blepharitis
gritty eyes
foreign body sensation
mild discharge
signs of seborrhoeic blepharitis
red lid margin
scales ++
Dandruff +
(no ulceration, lashes unaffected)
signs of staphylococcal blepharitis
lid margin red
lashes distorted, loss of lashes, ingrowing lashes
styes, ulcers of lid margin
corneal staining, marginal ulcers
signs of posterior blepharitis
lid margin skin and lashes unaffected
meibomian glad openings pouting and swollen
dried secretion at gland
meibomian cysts
associated with acne rosacea
treatment for blepharitis
lid hygiene - daily bathing/warm compress
Supplementary tear drops
Oral doxycycline for 2-3 months
v difficult to irradiate
what are the types of infective conjunctivitis
viral
bacterial
chlamydial
what are the non-infective types of conjunctivitis
allergic
chemical/drugs
skin diseases - eczema
symptoms of conjunctivitis
red eye
foreign body sensation - gritty eye
discharge- sticky eye
itch (allergy)
signs of conjunctivitis
red eye (redness is diffuse more towards fornices (top and bottom)) discharge papillae or follicles sub conjunctival haemorrhage chemises (oedema) pre-auricular glands (if viral)
how long does it take for acute bacterial conjunctivitis to clear on its own
14 days
what are the most common causative organisms for bacterial conjunctivitis
staph azures
strep pneumoniae
h.influenza
what causes follicular conjunctivitis
chlamydia
what viruses can cause conjunctivitis
adenovirus
herpes simplex
herpes zoster
what is chemosis
conjunctival oedema
what are the layers of the cornea
epithelium
stroma
endothelium
where on the cornea do infective ulcers lie
centrally
what causes infective corneal ulcers
viral
fungal
bacterial
ancanthamoeba
where on the cornea do autoimmune ulcers lie
peripherally
causes of autoimmune corneal ulcers
rheumatoid arthritis
hypersensitivity eg. marginal ulcers
symptoms of corneal ulcers
pain (needle like and severe) photophobia produce lacrimation reduced vision circumcorneal redness
when might not you feel the pain of a corneal ulcer
if it is the herpes virus (this affects the corneal nerves)
signs of a corneal ulcer
Circumcorneal redness Abnormal corneal reflex Corneal opacity Staining with fluorescein Hypopyon
what can cause exposure keratitis
thyroid eye disease
VII palsy
(can’t close lid, this can lead to a corneal ulcer)
what can cause keratoconjunctivitis sicc
sjogrens
can lead to a corneal ulcer
what causes neurotrophic keratitis
Herpes zoster
what vitamin deficiency can cause a corneal ulcer
vitamin A
how do you treat a corneal ulcer
Corneal scrape for gram stain and culture to determine cause
antimicrobial if antibiotic (eg, hourly ofloxacin)
antiviral if herpetic (aciclovir ointment 5x day)
anti-inflammatory if autoimmune
(oral/topical steroids)
what can cause anterior uveitis
autoimmune disease
infections
malignancy (leukaemia)
other (idiopathic, trauma act)
what are some autoimmune causes of anterior uveitis
Reiter’s
Ulcerative Colitis
Ankylosing spondylitis
Sarcoidosis
what are some infective causes of anterior uveitis
TB
Syphylis
Herpes simplex
Herpes zoster
symptoms of anterior uveitis
pain
reduced vision
photophobia
red eye (circumcorneal)
signs of anterior uveitis
ciliary injection cells and flared in anterior chamber keratin precipitates hypopyon small or irregular pupil (synechiae)
treatment for anterior uveitis
topical steroids
mydriatics
investigate for systemic associations
what is episcleritis
superficial inflammation of the sclera - self limiting but recurrent
what is episcleritis commonly associated with
gout
what is scleritis
serious disease deeper in the sclera
symptoms/signs of scleritis
v painful
association with vasculitis (Rh arthritis, Wegners)
Injected deep vascular vessels
associated with uveitis
what is the phenylephrine test used for
to differentiate between episcleritis and scleritis
how do you treat episcleritis
it is self limiting
lubricant
topical NSAIDS
mild steroids
How do you treat scleritis
oral NSAIDS
oral steroids
Steroid sparing agents
signs/symptoms of acute closed angle glaucoma
severe pain acute onset nausea and vomiting Circumcorneal injection Cornea cloudy Pupil mid dilated Eye stony hard
