The red eye Flashcards by Shehnaz Hussain

What is a subconjunctival hemorrhage?

Bleeding into the subconjunctival space - caused by trauma, anti-platelets, clotting problems or very high uncontrolled BP

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How long does a subconjunctival haemorrhage take to heal?

1-2 week

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What is orbital cellulitis?

Infection of soft tissue around the eye

Can track into the brain to cause an abscess

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What should be included in a history of an ocular complaint?

Pain: foreign body sensation, grittiness, dryness. Ache
Itch
Discharge/treating/epiphora
Photophobia
Visual loss
Past ocular disorders
Contact lenses (acanthomoeba)

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What does a stony hard eye indicate?

Glaucoma

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What is anterior blepharitis?

Seborrhoeic (scales on lashes)

Staphylococcal (involving lash follicle)

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What is posterior blepharitis?

Meimomiain gland dysfunction

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How can anterior and posterior blepharitis be distinguished from examination?

Anterior: lid margin redder than deeper part of lid
Posterior: redness is in deeper part of lid, lid margin normal looking

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What are the symptoms of blepharitis?

Gritty eyes
Foreign body sensation
Mild discharge

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What are the signs of seborrhoeic anterior blepharitis?

Lid margin red
Scales ++
Dandruf _
No ulceration, lashes unaffected

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What are the signs of staphylococcal anterior blepharitis?

Lid margin red 
Lashes distorted, loss of lashes, ingrowing lashes (trichiasis) 
Styes
Ulcers of lid margin
Corneal staining, marginal ulcers

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What are the signs of posterior blepharitis?

Lid margin skin and lashes unaffected
MG openings pouting and swollen
Inspissated secretion at gland openings
Chalazia (meibomian cysts)

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What dermatological sign is posterior blepharitis associated with?

Acne rosacea

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What is the treatment for blepharitis?

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

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What are the different types of conjunctivitis?

Viral
Bacterial
Chlamydial (low grade chronic conjunctivitis)
Allergic
Chemical/drugs
Eczema

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What are the symptoms of conjunctivitis?

Red eye
Foreign body sensation - gritty
Sticky discharge
Itch = ALLERGY
VISION UNAFFECTED

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What are the signs of conjunctivitis?

Redness maximal towards the fornix 
Discharge serous or mucopurulent 
Papillae or follicles - chlamydia
Subconjunctival haemorrhage 
Chemosis 
Pre-auricular glands if viral

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What will be present in acute bacterial conjunctivitis?

Red sticky eye
Papillae
Self limiting - 14 days, but topical antibiotics will clear it faster (topical chloramphenicol for 5-7 days)

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What are the most common organisms in acute bacterial conjunctivitis?

S.aureus
Strep pneumoniae
H. influenzae

What will be present in viral conjunctivitis?

Follicular

What are the most common viral conjunctivitis?

Adenovirus
Herpes simplex
Herpes zoster

What sign is important in herpes zoster ophthalmicus?

Hutchinson’s sign (affects tip of nose and therefore nasociliary nerve)

What does chemosis commonly suggest?

Allergic conjunctivitis

What causes keratoconjunctivitis sicca?

Sjogrens

What can cause lacrimal disease?

Chronic dacryocystitis

What are the layers of the cornea?

Epithelium Stroma Endothelium

How should corneal disease be examined?

``` Anaesthetic if photophobic Corneal reflex Fluorescein - with cobalt blue light Vascularisation Opacity Oedema ```

What will cause central corneal ulcers?

Viral - dendritic Fungal Bacterial - contact lens Acanthamoeba

What will cause a peripheral (autoimmune) corneal ulcer?

RA Hypersensitivity (marginal ulcers) GPA

What are the symptoms of a corneal ulcer?

``` Severe pain Photophobia Profuse lacrimation Reduced vision Circumcorneal red eye ```

What are the signs of corneal ulcers?

``` Circumcorneal redness Corneal reflection abnormality Corneal opacity Staining with fluorescein Hypopyon ```

What type of ulcer will herpes simplex show?

Dendritic

What can lead to an exposure keratitis?

Thyroid eye disease | 7th nerve palsy - bells palsy

What vitamin deficiency can lead to a corneal ulcer?

Vitamin A

How are corneal ulcers treated?

Identify cause - corneal scrape Antimicrobial if bacterial - ofloxacin hourly Antiviral if herpetic - aciclovir ointment Anti-inflammatory in autoimmune

What can cause anterior uveitis?

``` Reiters Ulc colitis Ank spond Sarcoidosis Leukaemia TB Syphilis H. simplex H, zoster Traumatic ```

What are symptoms of anterior uveitis?

Pain Reduced vision Photophobia Red eye - cirumcorneal

What are the signs of anterior uveitis?

``` Ciliary injection Cells and flare in anterior chamber Keratic precipitates Hypopyon Synechiae (small or irregular pulis ```

What is the classic presentation of anterior uveitis?

``` Red eye Dull ache Photophobia Referred pain to eyebrow Synechiae ```

What is the management of anterior uveitis?

Topical steroids (prednisolone 1% hourly tapering over 4-8 weeks) Mydriatics - cyclopentolate Investigate for systemic associations

How can episcleritis and scleritis be distinguished?

Episcleritis - blood vessels blanch with use of phenylephrine Scleritis - blood vessels do not blanch

How is episcleritis treated?

Lubrication +/- topical NSAID or steroid

What is scleritis associated with?

Serious systemic vasculitides e.g. rheumatoid arthritis, wegener's

How will scleritis present?

Painful +++ Non Blanching Purple Associated uveitis common

How is scleritis treated?

Oral NSAIDs Oral steroids Steroid sparing agents

What is acute closed angle glaucoma?

IOP rises acutely due to the drainage angle being closed (pupil dilation precipitates it) Elderly hypermetropia Severe pain with N+V

What are the signs of acute closed angle glaucoma?

Circumcorneal injection Corneal cloudy Pupil mid-dilated Eye stony hard