The Red Eye Flashcards
How should you approach a patient with a red eye?
Where?
Where is the redness
What?
What structures can be found in this location
How?
Hoe can this structure become red
What can ocular redness be divided into?
Ocular coats/ adnexa
Iris hyperaemia
Intraocular bleed
What structures can become red?
Eyelids Conjunctiva Third eyelid Cornea Anterior chamber Interior uvea Posterior uvea/retina Retrobulbar area
What is the anterior uvea?
Iris and ciliary body
What is the posterior uvea?
Choroid
Describe your approach to red eyelids and what you might note?
Where: red periocular tissue
What: skin, Meibomian glands, conjunctiva
How : Hyperaemia, swelling, ulcers, crusts, hairloss
What are key differentials for eyelid redness?
Periocular dermatitis
Meibomian gland infection/inflammation/neoplasia
What other stuctures can be affected by eyelid irritation?
Cornea and tear film production, abnormal contact to ocular surface (hair, mass lesions etc)
Irratation of sclera - conjunctival hyperaemia
Corneal irritation - corneal neovascularisation and ulceration
What would you consider for third eyelid redness? What might you note?
Where: red ocular coats
What: Cartilage, lymphoid tissue, accessory lacrimal gland
How:
T-shape cartilage - can can curl and cause outward fold
Lymphoid tissue: large amount - prominent in young, allergies, some cat infections
AL gland - can prolapse + inflammation
What DDx should be considered for TEL hyperaemia and swelling?
Ocular surface disease
Orbital disease
TEL neoplasia
There are multiple small lumps on the inner side of the TEL. What is your main DDx ? What patients would you expect this in?
What other CS may accompany this ?
TEL Follicular proliferation
Young, allergies, some cat infections
Hyperaemia may be present
What is the colloquial term for a prolapsed nicitants gland?
Cherry eye
What presents very similarly to cherry eye?
how can you differentiate between the two?
Scrolled cartilage
Manipulate under topical anaesthesia
What would you consider for conjunctival redness? What might you note?
Where: red ocular coats
What: mm lining eyelids, third eyeling and sclera
- epithelium, goblet cells, lymphoid tissue
- BVs
How : hyperaemia, swelling, ulcers, lymphoid follicles
What can conjunctival hyperaemia be a sign of?
Ocular surface disease
What would you consider for episcleral/scleral redness? What might you note?
Where: red ocular coats
What: fibrous tunic of globe
- collagen
- BVs
How: hyperaemia and swelling
What might scleral/episcleral hyperaemia indicate?
Deeper ocular tissue disease including intraocular
How can you differentiate between conjunctival and episcleral hyperaemia?
Conjunctival - tortuous branching bright red Thinner most evident at FORNICES
- MOVE with conjunctiva
Episcleral - straight deep red thick
- STATIONARY
Most evident at limbus
What are the four layers of the cornea?
Epithelium
Stroma
Descemet’s membrane
Endothelium
When might you see conjunctival hyperaemia due to superficial corneal neovascularisation?
Ulcerative keratitis
Keratoconjunctivitis sicca (dry eye)
What STT reading would you expect for dry eye?
LOW
Compare the appearances of superficial and deep corneal neovascularisation
Superficial - long and branching like a tree
Deep - short, straight, usually stay close to the limbus - like a bush
When might you see deep corneal neovascularisation?
Uveitis
Gaucoma
What clinical signs are associated with uveitis?
Episcleral hyperaemia
Deep corneal neovascularisation
MIOSIS
LOW IOP
What clinical signs are associated with glaucoma?
Episcleral hyperaemia
Deep corneal neovascularisation
MYDRIASIS
HIGH IOP
What are the anatomical limits of the anterior chamber?
Cornea
Iris
Iridocorneal angle
What causes iris hyperaemia?
Uveal bleed Uveal tumour Engorgement of normal vascularisation - usually 2ry to uveitis Iridal neovascularisation
How would you investigate a red eye?
Complete op tho exam
- Hands off
- Hands on - outside to inside, diagnostics
- BOTH eyes
What diagnostics be used for red eye work up?
STT
Fluorescein
IOP measurement
When are some diagnostics contraindicated?
Corneal or scleral rupture - FRAGILE EYE
