The Red Eye and Adnexal Oncology Flashcards
Presentation of acute closed angle glaucoma
Extreme, deep, dull pain Red eye Sudden onset Visual loss - visual field changes Fixed dilated pupil Systemically very unwell and vomiting Hard eye Cloudy / steamy cornea
Possible symptoms along with a red eye
Blurred vision / affected vision Pain Itching Discharge Watery / excess tear production
Who is at a higher risk of closed angle glaucoma?
Inuits
Older age
Which of a constricted or dilated pupil would result in a smaller angle and therefore lead to CAG?
A dilated pupil
What should be done if an older patient presents with vomiting?
Check the eyes
Who is rubiotic glaucoma seen in?
DM
What is glaucoma?
Damage to the optic nerve due to with or without raised IOP
What does IOP stand for?
Intraocular pressure
How is normal IOP maintained? What would increased IOP do to this?
Pump in the cornea is on the endothelium of the eye
Pumps water out and maintains arrangement of collagen / proteins
Raised IOP would displace them and cause hazy vision
What prodromal symptoms are seen in someone with threatening glaucoma?
Halos and lights in the evening
Intermittent evening headaches
What is the conjunctiva?
A translucent membrane that carries blood vessels
How can conjunctivitis be passed onto a baby from mum?
Vaginally
Why is it important to diagnose congenital conjunctivis?
Can penetrate through the cornea and can result in bilateral blindness
Types of conjunctivis
Viral
Bacterial
Allergic
How can someone get conjunctivitis?
Direct contact
Newborns; vaginally
Chlamydia infection
Flies
What causative organism causes newborn conjunctivis?
Gonococcus bacteria
What presentation would indicate conjunctivitis caused by chlamydia?
UNILATERAL conjunctivitis > 2 weeks
What virus usually causes conjunctivitis?
Adenovirus
How long does a corneal abrasion take to heal?
48 hours
Pathology of a corneal abrasion
Removal of corneal epithelium
Has not gone through to stroma
NO infiltrates
Presentation of corneal abrasion
Very painful - stingy pain
Feeling of something in eye
What should always be checked for in a corneal abrasion?
Under the eyelid for a foreign body
Causes of corneal ulcer / keratitis
Autoimmune Bacterial Viral Fungal Amoeba Irritant
Pathology of keratitis / corneal ulcer
Penetration of stroma
White infiltrates
Causative organisms of viral corneal ulcers
HSV
HZV
Who gets fungal corneal ulcers?
Immunosuppressed
Hot tropical countries
Pathology of irritant corneal ulcers
Oil not being produced so bacteria build up and production of by products by them causing the irritation
Is there infiltrates in corneal ulcers?
Yes, white infiltrates
What is a lesion near the outside of the cornea called?
Near the limbus
What is the lesion near the middle of the cornea called?
Visual access
In shingles what comes first, the pain or the rash?
Pain
What happens if have shingles in V1?
Usually starts on the scalp then moves to the eye, so check them then look at the cornea for microdendrites
What is a feature of a viral corneal ulcer?
Dendrites
Where is the blood supply to the deeper part of the eye found?
Limbus
What do floaters indicate?
The back of the eye
Are all blephritis red eyes?
No, it is a spectrum
What is blephritis?
Inflammation of the ridges of the eyelids
What does the uvea consist of?
Iris
Ciliary body
Choroid
Presentation of iritis / anterior uveitis
Acute
Red eye ; centrally around cornea at limbus
Deeper pain
Small and irregular pupil; lens and iris getting stuck as iris gets stuck when inflamed
Hazy vision / floaters
Photosensitivity / photophobia
Accommodative pain e.g. looking up close, at light etc
What may patients get with a corneal problem?
Light sensitivities
Presentation of a subconjunctival haemorrhage
Red eye
Stingy
A lot of coughing
Can look very serious
How long does a subconjunctival haemorrhage take to resolve? Does it need treatment?
2 - 3 weeks
Not usually requiring Tx
Is a subconjunctival haemorrhage serious?
No it is fine but can look very serious
What is a retrobulbar haemorrhage?
Haemorrhage at the back of the eye in the retrobulbar space which tracks forward
Can lead to compartment syndrome at back of eye
Causes of retrobulbar haemorrhage
Anticoagulation e.g. warfarin
Trauma
Complication of eye / orbital surgery
AV malformations
Presentation / pathology of retrobulbar haemorrhage
Increased IOP -> damage to optic nerve Diplopia - muscles dying - optic nerve dying - no room for the eyeball to move
Function of the sclera
Attachment to muscles
Structural
Pathology of scleritis
Sclera melts
Loss of structure of the eye
Is scleritis serious?
Yes
What condition is scleritis associated with?
RA
Does scleritis always have a red eye?
Not if happens at the back of the eye
Presentation of scleritis
Extreme pain, wakes up from sleep Deep pain Pain on movement Redness - purple/funny coloured Vision fine
What colour would a very bad case of scleritis be at what would this be at risk of?
Black
Perforation
Where does episcleritis effect?
Top of sclera
Is episcleritis serious?
No
Presentation of episcleritis
Sectorial red - bright red
Mild pain / no pain
Comes and goes
What does phenylafferen do?
Constricts blood vessels
Treatment of a chemical in the eye
Wash out very quickly
If there is dust in the eye, what also needs to be done?
Wash on and under eyelid
If an eye is burnt by a chemical, can It heal? Why?
No
As dont have the limbus rehealing pattern
What is a hiphemia?
Layers of blood in the anterior chamber
Types of trauma to the eye
Blunt force
Penetrating
What is endoptholmitis?
An infected eye - inflammation of the intraocular fluids due to infection
Causes of endoptholmitis?
Recent operations eg. glaucoma surgery, cataracts
Presentation of endoptholmitis
Red eye
White pussy layer
Hipopiem
Pathology of orbital cellulitis
Pus collecting and pushing forward
Presentation of orbital cellulitis
Diplopia
Red eye
Systematically unwell
Meningitis
What can occur secondary to the pus in orbital cellulitis?
Compartment syndrome
What is looked at with optic disc changes?
- Visual acuity
- Pupils - RAPD
- Colour vision
- Visual fields
- Look at the disc
What should the optic disc look like?
Pink / orange colour
Donut shaped - thick outer layer
What does cupping of the optic disc indicate?
Glaucoma
Over time what can chronic glaucoma cause damage to?
Optic nerve
What visual defect can glaucoma lead to?
Arcing defects in visual fields
- tunnel vision
Where is your blind spot?
On the optic nerve
What is the normal pressure of the eye?
10 - 21 mmHg
Most common cause of conjunctivitis? What does this often have a relevant history of?
Viral
Goes along often with URTI or sore throat
Presentation of bacterial conjunctivitis
Thick profuse green discharge
Eye stuck together in morning
Causes / associations of uveitis
Syphillis Lyme Sarcoidosis HLA - B27 conditions Connective tissue diseases
What can happen to uveitis in someone with JIA? What is done due to this?
May have a very white eye
Screening is carried out as may have chronic uveitis
In uveitis, what is found on the corneal epithelium?
Inflammatory cells
Presentation of a dendritic ulcer
Pain
Red eye
Watery eye
Vision may be affected
Cause of dendritic ulcer in the eye
HSV
What is Hutchisons sign? What does it mean?
The tip of the nose is involved in shingles, then there is an increased chance the cornea is involved as they have a common innervation
What is Marcus gunns pupil?
Relative afferent pupillary defect due to lesion before the optic chiasm
How is Marcus gunns pupil diagnosed?
Swinging light test
Findings of Marcus gunns pupil
Affected and normal eye appears to dilate when the light is shown on the affected eye
Causes of Marcus gunns pupil
Retinal detachment
Optic neuritis
