The red eye Flashcards
What is a subconjunctival hemorrhage?
Bleeding into the subconjunctival space - caused by trauma, anti-platelets, clotting problems or very high uncontrolled BP
How long does a subconjunctival haemorrhage take to heal?
1-2 week
What is orbital cellulitis?
Infection of soft tissue around the eye
Can track into the brain to cause an abscess
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)
What does a stony hard eye indicate?
Glaucoma
What is anterior blepharitis?
Seborrhoeic (scales on lashes)
Staphylococcal (involving lash follicle)
What is posterior blepharitis?
Meimomiain gland dysfunction
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
What are the symptoms of blepharitis?
Gritty eyes
Foreign body sensation
Mild discharge
What are the signs of seborrhoeic anterior blepharitis?
Lid margin red
Scales ++
Dandruf _
No ulceration, lashes unaffected
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
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)
What dermatological sign is posterior blepharitis associated with?
Acne rosacea
What is the treatment for blepharitis?
Lid hygiene - daily bathing/ warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months
What are the different types of conjunctivitis?
Viral Bacterial Chlamydial (low grade chronic conjunctivitis) Allergic Chemical/drugs Eczema
What are the symptoms of conjunctivitis?
Red eye Foreign body sensation - gritty Sticky discharge Itch = ALLERGY VISION UNAFFECTED
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
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)
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
RA
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
