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Ophthalmology > The Red Eye > Flashcards

The Red Eye Flashcards

1
Q

What can cause infective keratitis?

A

For infection to occur - disruption to epithelial surface

Triggers: contact lenses, trauma, dry eyes, pre existing corneal disease, immune compromised state

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2
Q

What symptoms are associated with infective keratitis?

A

Pain - loss of epithelium exposes free nerve endings
Red eye - inflammation leads to increased vascularity redness
Watery discharge or muco- purulent
Epiphora
Drop in visual acuity - corneal surface and tear film disruption, also corneal oedema
Photophobia
Gritty sensation

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3
Q

On examining the eye, what may been seen in infective keratitis?

A

White deposit in cornea (corneal infiltrate)

Collection of pus behind cornea in anterior chamber (hypopyon)

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4
Q

Corneal abrasion occurs when…

A

Surface of epithelium sloughed off

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5
Q

What symptoms and signs are associated with corneal abrasion?

A 
Pain
Foreign body sensation
Tearing 
Red eye 
Variable reduction in vision
Photophobia
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6
Q

How do you aid the diagnosis of corneal abrasion?

A

Use fluorescein drops and blue light on a slit lamp - abrasion will typically appear green

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7
Q

How should corneal abrasions be managed?

A

Analgaesia - paracetamol or ibuprofen
Prevent secondary infection with tetanus prophylaxis and a topical antibiotic for 7 days (chloramphenicol)
Exclude foreign body trapped under upper eyelid - invert upper lid
Ask contact wearers if they sleep with contacts in and ask when they are changed

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8
Q

What can cause corneal ulcers?

A

Bacterial: chlamydia, pseudomonas (may progress rapidly)
Viral: herpes simplex, herpes zoster
Fungal: candida, aspergillus
Protozoan: acanthamoeba (in contact lens wearers)

Steroid eye drops can lead to fungal infections which in turn can cause corneal ulcers

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8
Q

Why should ulceration with keratitis (ulcerative keratitis) be treated as an emergency?

A

To prevent permanent scaring or vision loss

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9
Q

How should corneal ulcers be managed?

A 
Refer 
Remove contacts 
Test CN V 
Until cultures known, alternative chloramphenicol drops (for gram positive bacteria) and ofloxacin (gram neg) 
Admit if diabetes or immunosuppression
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10
Q

What is another name for herpes simplex corneal ulcers?

A

Dendritic ulcer

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11
Q

If considering dendritic ulcers, what should be asked in the history?

A

Past eye, mouth or genital ulcers

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12
Q

How are dendritic ulcers diagnosed?

A

Slit lamp and apply fluorescein staining - look for green ulcers (suggests active viral replication)

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13
Q

What drug should be given for dendritic ulcers?

A

Aciclovir eye ointment 5x day

Corneal transplant if significant visual impairment due to scarring

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14
Q

HSV-1 generally infects…

A

Above the waist - lips, face, eyes
Primary infection in childhood usually, lies dormant it trigeminal ganglion, when reactivates it travels along branches to cause infection e.g cold sores, herpes keratitis

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15
Q

HSV-2 generally infects…

A

Below the waist and usually sexually acquired, but may be a cause of herpetic keratitis

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16
Q

What is the leading cause of corneal blindness in UK?

A

Herpes simplex keratitis

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17
Q

Uveitis can be anatomically classified into…

A

Anterior uveitis
Intermediate uveitis
Posterior uveitis
Panuveitis

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18
Q

Which is the most common type of uveitis?

A

Anterior uveitis

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19
Q

Anterior uveitis is inflammation where?

A

Affecting iris +/- ciliary body

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20
Q

Intermediate uveitis is inflammation of…

A

Posterior part of ciliary body and nearby peripheral retina and choroid

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21
Q

Posterior uveitis is inflammation of…

A

Choroid and retina

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22
Q

Panuveitis is inflammation of..

A

Whole uveal tract

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23
Q

Which type of uveitis is likely to present with red eye?

A

Anterior uveitis

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24
Q

Which group of people does anterior uveitis usually affect?

A

Adults of working age

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25
Q

How does a patient usually present with anterior uveitis?

A

Photophobia
Pain
Reduced vision (especially peripheral)
Watery eye that may overflow (not sticky like in conjunctivitis)
Injection around junction of cornea and sclera
Smaller pupil (iris spasm) or irregular due to adhesions between lens and iris (synaechiae)

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26
Q

In anterior uveitis, what can be found on examination?

A

Circum-corneal injection
Anterior chamber - leucocytes and flare (protein), hypopyon
Posterior synaechiae (in subacute or recurrent cases) which can obstruct passage of aqueous humour

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27
Q

What are posterior synaechiae?

A

Adhesions between inflamed iris and anterior lens capsule

  • may obstruct aqueous humour passage
  • may change shape of pupil
28
Q

Anterior uveitis is also called…

A

Iritis

29
Q

Anterior uveitis is associated with Human Leucocyte Antigen …

A 
B27 
Diseases associated with HLA B27:
PAIR
Psoriasis
Ankylosing spondylitis 
IBD
Reactive arthritis
30
Q

Anterior uveitis is associated with systemic diseases e.g….

A

Seronegative arthropathies: AS, IBD, psoriatic arthritis, Reiter’s syndrome
Infection: TB, syphilis, herpes zoster, toxoplasmosis
Autoimmune: sarcoidosis, Behcets
Malignancy: NHL, leukaemia

31
Q

Describe the onset of anterior uveitis

A

Acute, over hours to days

32
Q

How do you diagnose anterior uveitis?

A

Slit lamp with dilated pupil to visualise location of inflammatory cells (in anterior uveitis in anterior chamber) if no cells visualised consider posterior uveitis
Ocular imaging e.g fundus fluorescein to examine for retinal and choroid disease

33
Q

How is anterior uveitis treated?

A

Depends on cause
Urgent review by ophthalmologist
Steroid eye drops
To prevent synechiae, relive spasms of ciliary body and keep pupil dilated! Cycloplegics e.g cyclophentolate, atropine

34
Q

What is the most frequent cause of all conjunctivitis types?

A

Allergic conjunctivitis

35
Q

Other than allergic conjunctivitis, what other non infectious causes of conjunctivitis are there?

A

Toxic
Autoimmune
Neoplastic
Contact lens wearers may develop reaction to foreign substance

36
Q

Allergic conjunctivitis may occur alone, but is often seen in the context of…

A

Hay fever

37
Q

What features are associated with allergic conjunctivitis?

A 
Bilateral symptoms
Conjunctival erythema 
Conjunctival swelling (chemosis)
Itch
Swollen eyelids
History of atopy
May be seasonal - due to pollen or perennial due to dust mites, washing powder or other allergens
38
Q

How is allergic conjunctivitis managed?

A

Avoid source
Cold compress
Avoid rubbing eyes

Topical or systemic antihistamines
Topical mast cell stabilisers - do not work straight away, but can prevent symptoms

39
Q

What is the difference between the discharge in bacterial and viral conjunctivitis?

A 
Bacterial = purulent, eyes may be stuck together in the morning 
Viral = serous
40
Q

What is the most common eye problem presenting to primary care?

A

Conjunctivitis

41
Q

What features are associated with bacterial conjunctivitis?

A 
Purulent discharge - may be yellow or green 
Pinkness or redness of eye 
Burning or itching sensation 
Grittiness 
Mild pain in eye 
Swollen and/ or red eyelids
42
Q

Who is most at risk of bacterial conjunctivitis?

A

Children
Elderly
Immunocompromised e.g diabetes
Not washing hands before removing or inserting contacts

43
Q

What features are associated with viral conjunctivitis?

A

Watery discharge
Often follows a recent cold or sore throat
Pink or often intense redness of eye
Burning sensation, grittiness, mild pain
Swollen/ red eyelids
Preauricular lymph nodes

44
Q

How should infective conjunctivitis be managed?

A

Normal gets better on own, around 1-2 weeks
Bathing eyelids with sterile pads and clean water
Antibiotic drops or ointment if bacterial - chloramphenicol drops 2-3 hourly initially whereas the ointment given QDS initially
- topical fusidic acid as alternative for pregnant women BD
If viral: artificial tears, topical anti histamines (topical anti virals do not help)
Avoid contact lenses
Don’t share towels

45
Q

What should be considered in prolonged conjunctivitis especially in young adults or those with sexual diseases?

A

Chlamydial infection

46
Q

In cases of conjunctivitis, when should cultures be done?

A

If you suspect gonoccocal or chlamydial infection, neonatal conjunctivitis or recurrent disease not responding to therapy

47
Q

Describe a Subconjunctival haemorrhage

A

Bleeding from a small blood vessel in the outer layer of the eye (the conjunctiva) into the space between the conjunctiva and the sclera
Results in a red spot in the white of the eye

48
Q

What can cause a subconjunctival haemorrhage?

A 
Sneezing, vomiting or coughing 
Heavy lifting 
Straining 
High BP
Blood thinners - aspirin or warfarin 
Rubbing eye too vigorously 
Eye trauma 
Atmospheric changes
49
Q

How is subconjunctival haemorrhage managed?

A

Resolves spontaneously in 2 weeks

Artificial tears if discomfort

50
Q

How is a subconjunctival haemorrhage diagnosed?

A

Visual inspection - bright red discolouration confined to the white part of the eye (sclera)

51
Q

What is the episclera?

A

A thin layer of tissue that lies between the conjunctiva and the sclera

52
Q

What are the two types of Episcleritis?

A

Nodular - lesions have raised surface

Simple - which can be diffuse or sectoral

53
Q

What symptoms are associated with episcleritis?

A

Painless (or mild pain)
May be tender to palpate
Redness of eye - focal, cone shaped wedge of engorged vessels that can be moved over the area
Sclera may look blue below the inflammation
Watery eye
Acuity usually normal

54
Q

Is vision affected in episcleritis?

A

No

55
Q

What causes episcleritis?

A

70% unknown
RA, IBD, SLE, psoriatic arthritis, AS
Vasculitides
Metabolic disorders

56
Q

Is episcleritis more common in men or women?

A

Women

57
Q

How is episcleritis treated?

A

Self limiting
Artificial tears to help with discomfort
Topical steroids or NSAIDS if more severe

58
Q

What drops can be used to differentiate between episcleritis and scleritis?

A

Phenylephrine
It blanches the conjunctival and episcleral vessels but not the scleral vessels. If the redness improves after phenylephrine = episcleritis

59
Q

What is scleritis?

A

Generalised inflammation of the sclera, with oedema of the conjunctiva, scleral thinning and vasculitic changes

60
Q

How can scleritis be classified?

A

Anterior 90%
Posterior
Non- necrotising - diffuse or nodular
Necrotising

61
Q

What symptoms and signs are associated with scleritis?

A

Redness of sclera and conjunctiva - can change to a purple hue (does not move with pressure)
Severe ocular pain - deep, boring and constant
May radiate to temple or jaw
Ocular movements painful
Photophobia
Tearing
Headache
Decreased visual acuity possibly leading to blindness

62
Q

What can the necrotising type of scleritis cause?

A

Globe perforation

63
Q

Approximately what percentage of people with scleritis have systemic disease?

A

50% - typically RA or granulomatosis with polyangitis

Also: IBD, SLE, TB, sarcoidosis

64
Q

How is scleritis managed?

A

Depends on type
Non necrotising anterior: may only require NSAIDS, oral high dose prednisolone
Posterior or signs of necrotising: systemic immunosuppression
Imminent globe perforation: surgery

65
Q

Is an urgent referral required for suspected scleritis?

A

Yes

66
Q

Does scleritis blanch with vasoconstrictors?

A

No

67
Q

Can scleritis spread to different layers of eye?

A

Yes - to episclera or cornea

68
Q

What can occur in necrotising scleritis?

A

Severe pain
Extreme scleral tenderness
Vasculitis
Infarction and necrosis with exposure of choroid may result

Ophthalmology (25 decks)

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