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Ophthalmology > The Red Eye > Flashcards

The Red Eye Flashcards

1
Q

What is the most common cause of a red eye?

A

Conjunctivitis (blepharo-conjunctivitis)

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2
Q

What are some other causes of a red eye?

A

Keratitis, anterior uveitis, scleritis/episcleritis, acute closed angle glaucoma, subconjunctival haemorrhage, orbital disease (e.g cellulitis)

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3
Q

What are some of the defences of the eye?

A 
Lids = blinking, secretions (Meibomian)
Tears = mucous trapping, lysozyme, IgA/G, complement
Conjunctivae = mucous
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4
Q

What are some presenting complaints of the eye?

A

Pain = foreign body sensation, grittiness, dryness, ache

Itch, discharge, tearing, epiphora, photophobia, visual loss

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5
Q

What increases the risk of having a red eye?

A

Previous ocular disorders and contact lenses

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6
Q

What should be included in an examination of a patient with red eyes?

A

Facial appearance, lids (margins, lashes), conjunctivae (tarsal, bulbar), cornea, pupil/iris, anterior chamber, intra-ocular pressure

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7
Q

What is blepharitis?

A

Inflamed eyelid = may be anterior (lid margin) or posterior (Meibomian gland disease)

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8
Q

What are the kinds of anterior blepharitis?

A

Seborrhoeic (squamous) = scales on lashes

Staphylococcal = infection involving lash follicle

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9
Q

What part of the eye tends to be red in anterior blepharitis?

A

The lid margin is redder than the deeper part of the lid

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10
Q

What are the signs of seborrheic anterior blepharitis?

A

Red lid margin, scales, dandruff, no ulceration, lashes unaffected

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11
Q

What are the signs of staphylococcal anterior blepharitis?

A

Red lid margin, distorted lashes, loss of lashes, ingrowing lashes (trichiasis), styes, ulcers of margin, corneal staining

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12
Q

What causes ulceration of the lid margin in staphylococcal anterior blepharitis?

A

Exotoxin produced by the bacteria

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13
Q

What part of the eye is red in posterior blepharitis?

A

Redness is in the deeper part of the eye = lid margin is often normal looking

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14
Q

What is posterior blepharitis associated with?

A

Acne rosacea

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15
Q

What are the signs of posterior blepharitis?

A

Lid margin skin and lashes unaffected, Meibomian gland openings putting/swollen, dried secretion at gland openings, Meibomian cysts

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16
Q

What are the symptoms of blepharitis?

A

Similar to conjunctivitis = gritty eyes, foreign body sensation, mild discharge

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17
Q

What other eye diseases is blepharitis associated with?

A

Conjunctivitis, keratitis, episcleritis

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18
Q

How is blepharitis treated?

A

Lid hygiene = daily bathing, warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months

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19
Q

Is blepharitis easy to treat?

A

No = very difficult to eradicate

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20
Q

What are some causes of conjunctivitis?

A 
Infective = viral, bacterial, chlamydial
Non-infective = allergy, chemicals/drugs, skin disease (eczema)
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21
Q

What are the symptoms of conjunctivitis?

A

Red eye, foreign body sensation, gritty eyes, discharge (sticky eye), itch (allergy), vision unaffected

22
Q

What are the signs of conjunctivitis?

A

Redness diffuse towards fornicles, serous/mucopurulent discharge, papillae or follicles, subconjunctival haemorrhage, chemosis, pre-auricular glands (if viral)

23
Q

What is chemosis?

A

Oedema of the conjunctivae

24
Q

What are some features of acute bacterial conjunctivitis?

A

Red sticky eyes and papillae

25
Q

What organisms most commonly cause acute bacterial conjunctivitis?

A

Staph aureus, strep pneumoniae, haemophilus influenzae

26
Q

How long does acute bacterial conjunctivitis take to clear?

A

Self limiting = usually clears in about 14 days without treatment (topical antibiotics clear it faster)

27
Q

What are some causes of follicular conjunctivitis?

A

Adenovirus, herpes simplex/zoster, chlamydia, molluscum contagiosum, drugs (propine, trusopt)

28
Q

What may be some causes of chronic conjunctivitis?

A

Blepharitis, chlamydial infection, lacrimal disease (chronic dacrocystitis), keratoconjunctivitis sicca, sensitivity to topical glaucoma medication, subtarsal foreign bodies

29
Q

What are the layers of the cornea?

A

Epithelium, stroma, endothelium

30
Q

What are some features of a corneal examination?

A

Use of anaesthetics if photophobic, corneal reflex, use of fluorescein, vascularisation, opacity, oedema

31
Q

What are some causes of central (infective) corneal ulcers?

A

Viral, fungal, bacterial, acanthamoeba

32
Q

What are some peripheral (autoimmune) causes of corneal ulcers?

A

Rheumatoid arthritis, hypersensitivity (e.g marginal ulcers), rarely polyarteritis etc

33
Q

What are the symptoms of corneal ulcers?

A

Needle-like severe pain, photophobia, profuse lacrimation, reduced vision, circumcorneal red eye

34
Q

What are some signs of corneal ulcers?

A

Abnormal corneal reflex, corneal opacity, hypopyon, staining with fluorescein

35
Q

What are some special causes of corneal ulcers?

A

Exposure keratitis (e.g CN VII palsy), keratoconjunctivitis sicca (e.g Sjogren’s), neurotrophic keratitis (e.g herpes zoster), vitamin deficiency (e.g vit A)

36
Q

What is the management for corneal ulcers?

A

Corneal scrap for gram stain and culture
Hourly ofloxacin if bacterial
Aciclovir ointment 5x daily if viral
Oral or topical steroids if autoimmune

37
Q

What are some autoimmune causes of anterior uveitis?

A

Reiter’s, ulcerative colitis, ankylosing spondylitis, sarcoidosis

38
Q

What are some infective and random causes of anterior uveitis?

A 
Infective = TB, syphilis, herpes simplex/zoster
Others = malignancy (leukaemia), idiopathic, trauma, secondary to other eye disease
39
Q

What are the symptoms of anterior uveitis?

A

Pain, reduced vision, photophobia, circumcorneal red eye

40
Q

What are the signs of anterior uveitis?

A

Cells and flares in anterior chamber, keratic precipitates, hypopyon, synechiae (small/irregular pupil)

41
Q

What is the management for anterior uveitis?

A

1% topical prednisolone hourly tapering over 4-8 weeks

Mydriatics = cyclopentolate 1% twice daily

42
Q

When should anterior uveitis be investigated?

A

If recurrent or chronic

43
Q

What are some features of episcleritis?

A

Relatively common, no serious associations, recurrent and self-limiting, nodules may occur

44
Q

What is a condition associated with episcleritis?

A

Gout

45
Q

What is the treatment for episcleritis?

A

Lubricants, topical NSAIDs, mild steroids

46
Q

What are some features of scleritis?

A

Serious = associated with serious systemic vasculitides (e.g rheumatoid arthritis), very painful, associated uveitis common

47
Q

What are some investigations for scleritis?

A

Injection of deep vascular plexus = shows violaceous hue

Phenylephrine test

48
Q

What is the treatment of scleritis?

A

Oral steroids and NSAIDs, steroid sparing agent

49
Q

How common is acute closed angle glaucoma?

A

Rare = except in elderly with hypermetrophic sight

50
Q

What occurs in acute closed angle glaucoma?

A

Intra-ocular pressure rises acutely due to drainage angle being closed = precipitated by pupil dilation

51
Q

What are some symptoms of acute closed angle glaucoma?

A

Severe pain and nausea, cloudy cornea (oedematous), pupil mid-dilated, eye stony hard

Ophthalmology (20 decks)

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