The Red Eye Flashcards
What is the most common cause of a red eye?
Conjunctivitis (blepharo-conjunctivitis)
What are some other causes of a red eye?
Keratitis, anterior uveitis, scleritis/episcleritis, acute closed angle glaucoma, subconjunctival haemorrhage, orbital disease (e.g cellulitis)
What are some of the defences of the eye?
Lids = blinking, secretions (Meibomian) Tears = mucous trapping, lysozyme, IgA/G, complement Conjunctivae = mucous
What are some presenting complaints of the eye?
Pain = foreign body sensation, grittiness, dryness, ache
Itch, discharge, tearing, epiphora, photophobia, visual loss
What increases the risk of having a red eye?
Previous ocular disorders and contact lenses
What should be included in an examination of a patient with red eyes?
Facial appearance, lids (margins, lashes), conjunctivae (tarsal, bulbar), cornea, pupil/iris, anterior chamber, intra-ocular pressure
What is blepharitis?
Inflamed eyelid = may be anterior (lid margin) or posterior (Meibomian gland disease)
What are the kinds of anterior blepharitis?
Seborrhoeic (squamous) = scales on lashes
Staphylococcal = infection involving lash follicle
What part of the eye tends to be red in anterior blepharitis?
The lid margin is redder than the deeper part of the lid
What are the signs of seborrheic anterior blepharitis?
Red lid margin, scales, dandruff, no ulceration, lashes unaffected
What are the signs of staphylococcal anterior blepharitis?
Red lid margin, distorted lashes, loss of lashes, ingrowing lashes (trichiasis), styes, ulcers of margin, corneal staining
What causes ulceration of the lid margin in staphylococcal anterior blepharitis?
Exotoxin produced by the bacteria
What part of the eye is red in posterior blepharitis?
Redness is in the deeper part of the eye = lid margin is often normal looking
What is posterior blepharitis associated with?
Acne rosacea
What are the signs of posterior blepharitis?
Lid margin skin and lashes unaffected, Meibomian gland openings putting/swollen, dried secretion at gland openings, Meibomian cysts
What are the symptoms of blepharitis?
Similar to conjunctivitis = gritty eyes, foreign body sensation, mild discharge
What other eye diseases is blepharitis associated with?
Conjunctivitis, keratitis, episcleritis
How is blepharitis treated?
Lid hygiene = daily bathing, warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
Is blepharitis easy to treat?
No = very difficult to eradicate
What are some causes of conjunctivitis?
Infective = viral, bacterial, chlamydial Non-infective = allergy, chemicals/drugs, skin disease (eczema)
What are the symptoms of conjunctivitis?
Red eye, foreign body sensation, gritty eyes, discharge (sticky eye), itch (allergy), vision unaffected
What are the signs of conjunctivitis?
Redness diffuse towards fornicles, serous/mucopurulent discharge, papillae or follicles, subconjunctival haemorrhage, chemosis, pre-auricular glands (if viral)
What is chemosis?
Oedema of the conjunctivae
What are some features of acute bacterial conjunctivitis?
Red sticky eyes and papillae
What organisms most commonly cause acute bacterial conjunctivitis?
Staph aureus, strep pneumoniae, haemophilus influenzae
How long does acute bacterial conjunctivitis take to clear?
Self limiting = usually clears in about 14 days without treatment (topical antibiotics clear it faster)
What are some causes of follicular conjunctivitis?
Adenovirus, herpes simplex/zoster, chlamydia, molluscum contagiosum, drugs (propine, trusopt)
What may be some causes of chronic conjunctivitis?
Blepharitis, chlamydial infection, lacrimal disease (chronic dacrocystitis), keratoconjunctivitis sicca, sensitivity to topical glaucoma medication, subtarsal foreign bodies
What are the layers of the cornea?
Epithelium, stroma, endothelium
What are some features of a corneal examination?
Use of anaesthetics if photophobic, corneal reflex, use of fluorescein, vascularisation, opacity, oedema
What are some causes of central (infective) corneal ulcers?
Viral, fungal, bacterial, acanthamoeba
What are some peripheral (autoimmune) causes of corneal ulcers?
Rheumatoid arthritis, hypersensitivity (e.g marginal ulcers), rarely polyarteritis etc
What are the symptoms of corneal ulcers?
Needle-like severe pain, photophobia, profuse lacrimation, reduced vision, circumcorneal red eye
What are some signs of corneal ulcers?
Abnormal corneal reflex, corneal opacity, hypopyon, staining with fluorescein
What are some special causes of corneal ulcers?
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)
What is the management for corneal ulcers?
Corneal scrap for gram stain and culture
Hourly ofloxacin if bacterial
Aciclovir ointment 5x daily if viral
Oral or topical steroids if autoimmune
What are some autoimmune causes of anterior uveitis?
Reiter’s, ulcerative colitis, ankylosing spondylitis, sarcoidosis
What are some infective and random causes of anterior uveitis?
Infective = TB, syphilis, herpes simplex/zoster Others = malignancy (leukaemia), idiopathic, trauma, secondary to other eye disease
What are the symptoms of anterior uveitis?
Pain, reduced vision, photophobia, circumcorneal red eye
What are the signs of anterior uveitis?
Cells and flares in anterior chamber, keratic precipitates, hypopyon, synechiae (small/irregular pupil)
What is the management for anterior uveitis?
1% topical prednisolone hourly tapering over 4-8 weeks
Mydriatics = cyclopentolate 1% twice daily
When should anterior uveitis be investigated?
If recurrent or chronic
What are some features of episcleritis?
Relatively common, no serious associations, recurrent and self-limiting, nodules may occur
What is a condition associated with episcleritis?
Gout
What is the treatment for episcleritis?
Lubricants, topical NSAIDs, mild steroids
What are some features of scleritis?
Serious = associated with serious systemic vasculitides (e.g rheumatoid arthritis), very painful, associated uveitis common
What are some investigations for scleritis?
Injection of deep vascular plexus = shows violaceous hue
Phenylephrine test
What is the treatment of scleritis?
Oral steroids and NSAIDs, steroid sparing agent
How common is acute closed angle glaucoma?
Rare = except in elderly with hypermetrophic sight
What occurs in acute closed angle glaucoma?
Intra-ocular pressure rises acutely due to drainage angle being closed = precipitated by pupil dilation
What are some symptoms of acute closed angle glaucoma?
Severe pain and nausea, cloudy cornea (oedematous), pupil mid-dilated, eye stony hard
