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Ophthalmology > The Red Eye > Flashcards

The Red Eye Flashcards

1
Q

What causes a red eye

A 
Acute angle closure glaucoma
Anterior uveitis
Posterior uveitis 
Episcleritis 
Scleritis
Conjunctivitis 
Subconjunctival haemorrhage
Endophthalmitis 
Keratitis 
Thyroid eye 
Cellulitis
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2
Q

What are easily treated conditions

A

Conjunctivitis
Subconjunctival haemorrhage
Episcleritis

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3
Q

What requires urgent treatment or sight threatening

A

Glaucoma
Anterior uveitis
Sclertiis
Keratits / corneal ulcer

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4
Q

What are important initial questions when someone presents with red eye

A 
Is vision affected / double vision 
Floaters in vision 
Halo in vision
Any pain / photophobia / pain on eye movement 
Any headache 
Any discharge
Any itch 
Any surgery or trauma 
Contact lens use 
Hx sinusitis
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5
Q

What do you ask about pain

A 
SOCRATES 
Type of pain - gritty / dull / sharp 
Pain on eye movement 
What makes it better - drops ? 
Makes worse - light or movement
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6
Q

What do you ask about contact lenses

A 
Type of lenses
How it is cleaned
How long in eye
How often they were
When was light assessment
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7
Q

If vision affected what does this suggest

A 
Sight threatening
Glaucoma
Keratits / ulcer
Uveitis
Scleritis
Trauma
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8
Q

What does halo + eye pain / headache suggest

A

Acute angle closure glaucoma

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9
Q

If halo / glare only

A

Suggests early cataract

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10
Q

If red eye + pain on movement

A

Optic neuritis

Posterior scleritis

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11
Q

What can cause floaters + red eye

A

Uveitis
Endothalmitis
Post-trauma

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12
Q

What do all floaters in eye require

A

Urgent assessment to exclude vitreous detachment/retinal tear

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13
Q

What causes unilateral Sx

A

Galucoma
Scleritis
Ulcer
Bacterial conjunctivitis but spreads

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14
Q

What is typical bilateral

A

Dry eyes
Viral conjunctivitis
Allergy

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15
Q

If discharge + normal vision

A

Conjunctivitis

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16
Q

What do you ask about discharge

A

Watery
Mucous = viral
Purulent = bacterial

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17
Q

What if abnormal vision + discharge

A

Keratitis

Neonatal from maternal birth canal

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18
Q

What does itch suggest

A

Allergy
Dry eyes
Blepharitis

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19
Q

What does painful WHITE eye suggest

A

Vitreous detachment
Vitreous haemorrhage
Retinal detachment

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20
Q

What is anterior uveitis (iritis)

A

Inflammation of anterior portion of eye - iris + ciliary body

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21
Q

What causes anterior uveitis

Inflammation 
Autoimmnue
Infectious
Malignancy
Local
A

Idiopathic = 80%

Inflammation

  • AS xxx
  • RA xxx
  • Reactive arthritis
  • IBD

Autoimmune

  • SLE
  • Sarcoid
  • Vasculitis
  • Bechet’s (mouth ulcer) xxx

Infections

  • Syphillis
  • HSV
  • TB
  • CMV
  • Lyme’s
  • Toxo

Malignancy
- Intra-ocualr lymphoma

Local

  • Cataract
  • Retinal detachment
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22
Q

How does anterior uveitis present

A 
Acute onset
Red painful eye
Intense photophobia  
Marked around cornea
No blanching 
Increased lacrimation
Minimal discharge 
Iris vessel injected 
Macular oedema 
Blurred vision 
Floaters if ciliary body involved 
Ciliary flush
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23
Q

What happens to pupil

A

Small

Irregular due to adhesions (synchiae - lens sticks to iris)

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24
Q

What happens to vision

A

Blurred

Floaters if ciliary body involved

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25
Q

What is a ciliary flush

A

Hue at limbus (junction between cornea and sclera)

Signifies dilation of vessels

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26
Q

What is normal in uveitis

A

Pressure in eye
Cornea
Posterior section
NO HALO - would suggest raised IOP

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27
Q

What gene associated

A

HLA-B27

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28
Q

How do you Dx

A

Urgent opthamology

Slit lamp

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29
Q

What does slit lamp show

A

Leakage of cells into AH

  • Hypopyon
  • Plasma
  • WBC
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30
Q

How do you Rx

A

Steroid eye drop + mydriatic eye drop to relieve pain as dilates = 1st line
Systemic steroid if recurrent
Immunosuppression

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31
Q

What can you get on top

A

Bacterial infection so treat that

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32
Q

What is posterior uveitis

A

Inflammation of choroid

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33
Q

What happens in posterior

A

Frequent spread to retina causing blurred vision / visual loss

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34
Q

What is scleritis

A

Inflammation of sclera of the eye

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35
Q

What causes

A

Autoimmune / inflammation

  • RA
  • SLE
  • Vasculitis

Local due to corneal ulceration / trauma

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36
Q

What infection 2 to local causes

A

S.pneumonia
Pseudomona
VZV

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37
Q

How does scleritis present

A 
Diffuse redness
Severe boring pain
Photophobia
Lacrimation 
No discharge 
Similar to uveitis but no involvement of papillary / anterior chamber
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38
Q

What is normal

A

Vision

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39
Q

How do you treat

A

NSAID
Systemic steroid if severe
Immunosuppression

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40
Q

What is episcleritis

A

Inflammation of space between sclera and conjunctiva

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41
Q

How does it present

A 
Red eye
Not painful or mild discomforty
Mild photophobia 
Watery discharge
Normal vision
42
Q

How do you differentiate from scleritis

A

Give phenylephrine which blanches conjunctival and episclera vessel
NOT sclera vessel
If redness improves = episcleritis

43
Q

How do you Rx

A

Conservative
Artifical tears
Topical NSAID / steroid

44
Q

What causes conjunctivitis

A

Bacterial
Viral
- Adenovirus
Allergic

45
Q

What bacteria

A

S.aureus
S.pyogenes
S.pneumonia
Haemophilus

46
Q

What are Sx

A 
Diffuse redness
BLANCH on pressure
Gritty eye 
Itch 
Often bilateral
Conjunctival vessel injected
Mobile over sclera
47
Q

What is normal

A 
Vision
Iris
Pupil 
Cornea (no staining or defect in epithelium) 
Pressure 
NO pain
48
Q

How does bacteria present

A

Yellow discharge
Eyes stuck together
Usually begins in one eye and spreads

49
Q

How does viral present

A

Watery / serous discharge
Hx URTI
Tends to be bilateral
Lymphocytes on scrape

50
Q

How does allergic present

A

Mucous discharge
Often with hayfever
PROMINENT ITCH

51
Q

When do you swab

A

ALWAYS IF NEONATE due to risk of C+G
If suspect C+G
If not responding

52
Q

How do you Rx

A 
Chloramphenicol Ax eye drop if likely bacterial 
Topical fusidic if pregannt
Anti-histamine if allergic 
Lubricant for symptomatic 
Avoid contact lenses
Good hygiene
Can use steroids under expert
53
Q

How do you Rx neonatal C+G

A 
C = erythromycin 
G = ceftriaxone
54
Q

What is subconjunctival haemorrhage

A

Haemorrhage into the space between conjunctiva and sclera

55
Q

What causes

A 
Increased IOP precipitated cough / vomit / sneeze
High BP
Bleeding disorder
Trauma
Leptospirosis 
Haemorrhagic fever
Snake venom
56
Q

How does it present

A

Bright red sclera with white rim around

57
Q

How do you treat / investigate

A

Should resolve spontaneously
Check BP in elderly
Check clotting if suspect disorder

58
Q

What is keratitis

A

Inflammation of cornea including corneal ulcer

59
Q

What causes

A 
Idiopathic 
Trauma 
Contact lenses
Foreign body 
Degeneration 
Corneal dystrophy 
Steroid eye drop increase risk of fungal infection 
HSV keratitis 
Bacterial / fungal
60
Q

What are RF for developing

A 
Contact lense use
Corneal abrasion
Keratoconjunctivitis sicca
Immunocompromised
Ectropion
Entropion
61
Q

How does it present

A 
Red eye 
Severe pain on closure of eye
Photophobia 
Discharge can occur
Loss of vision
62
Q

What do you do if suspect

A

Refer opthamology

Evert lid to look for FB

63
Q

What is 1st line and what does it show

A

Fluroscein angiography

  • Shows corneal opacity / ulcer
  • May show hypophyon which suggests uveitis
64
Q

What must you also do

A

Exclude infection

  • Corneal scrape and sent gram stain + PCR
  • Send contact lenses for culture
65
Q

What do you do to see if posterior involvement

A

Fundoscopy

May need ocular USS as corneal haze will blur

66
Q

How do you Rx

A

Analgesia
Lubricant eye drop
Ax if infection
Bring back after 1 week to check infection has cleared

67
Q

What Ax

A

Ceftriaxone / gent = 1st line

Chloramphenicol / penicillin = 2nd line

68
Q

What may be required after

A

Corneal transplant due to stromal scarring

69
Q

What are complications

A

Corneal epithelium lost
Scarring if stoma involved = opacification
Endothalmitis

70
Q

What is CI

A

Topical steroid as impairs healing

71
Q

How does HSV keratitis present

A

Red painful eye
Photophobia
Decreased acuity
Decreased corneal sensation

72
Q

What is seen on fluroscenin

A

Dendritic ulcer

73
Q

How do you Rx

A

Topical acyclovir

74
Q

What is endophathalmitis

A

Infection of interior of eye including AH and VH

75
Q

What causes

A

Intra-ocular surgery e.g. cataract
Commonly bacterial
Can occur following keratitis

76
Q

How do patient present

A

Red painful eye
Visual loss
Hx surgery

77
Q

How do you Rx

A

Ax

Vitrectomy

78
Q

What does thyroid eye disease cause

A 
Red eye
Proptosis 
Lid retraction 
Conjunctivitis 
Horizontal or vertical diplopia
79
Q

How do you Rx

A

Artificial tears
Steroid
Immunosuppression
Surgical decompression

80
Q

What are the complications

A

Optic nerve can be damaged due to muscle enlargement

81
Q

What is pre-septal cellulitis

A

Infection around the eye anterior to orbital septum
Includes eyelid, skin and soft tissue
NO orbital involvement

82
Q

What bacteria

A

S.aureus
S.epidermidits
Strep

83
Q

What are RF

A

Sinusitis
Insert bite
Chalazion
Children

84
Q

How does it present

A 
Pain
Redness around eye
Swelling of lid 
Discharge
Fever
Can have ptosis 
Eye remains white
NORMAL vision
85
Q

How do you investigate

A

Bloods
Swab of eye
Contrast CT if suspect orbital

86
Q

How do you Rx

A

Refer 2 care

Oral Ax

87
Q

What is Ddx

A

Shingles if redness dermatomal
Allergy
Conjunctivitis

88
Q

What is Ddx of peri-orbital swelling

A 
Cellulitis
Sinusitis
Sarcoid / SLE / dermatomyositis 
Cavernous sinus thrombosis
Thyroid eye
Trauma
Lymphoma
89
Q

What is orbital cellulitis

A

Inflammation of orbit of eye

MEDICAL EMERGENCY

90
Q

What commonly causes

A

Sinus infection - maxillary

Dental or haemotagenous spread

91
Q

What are common organisms

A 
S.pyogene
S.pneumonia
S.aureus
Hib
Fungal if immunocompromised or DM
92
Q

What are RF

A 
Child
Previous Sinus 
Recent peri-orbital
Ear or facial infection 
No Hib vaccine
93
Q

How does it present

A 
Red eye
Swelling 
Discharge
Conjunctivitis 
Double or blurred vision
Afferent pupil defect 
Severe peri-ocular pain
Limited movement 
Exohthamos
Proptosis
94
Q

What can severe proptosis cause

A

Diplopia due to deviation of eye ball

95
Q

How do you Dx

A

Bloods
Blood culture and swab
Vital signs
CT with contrast of sinus / brain and orbit to look for complications

96
Q

When do you CT

A 
Central signs
Unable to assess vision
Gross proptosis 
Bilateral oedema
Deteriorating visual acuity 
No improvement after 24 hours
97
Q

How do you Rx

A

Admit for urgent ENT / ophthalmology review as may need drainage
IV Ax

98
Q

How do you differentiate from pre-septal

A

Reduced acuity
Proptosis
Pain on movmenet
Afferent pupil defect

99
Q

What are complications

A 
Central retinal vein or artery occlusion
Optic neuropathy
Raised IOP
Meningism
Brain abscess
Cavernous sinus thrombosis
100
Q

Contact lens + red eye

A

Refer to exclude keratitis

Ophthalmology (10 decks)

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