The Red Eye Lecture Powerpoint

Question 1

Red eye

Answer 1

Cardinal sign of ocular inflammation that is caused by many conditions, most cases are benign and can be effectively managed by primary care provider but key to management is recognizing cases with underlying disease that require opthalmologic consultation

Question 2

Conjunctivitis

Answer 2

Most common cause of red eye with purulent discharge, does not cause visual changes or ocular pain, can be due to allergic, viral (most contagious), or bacterial origin and typically treat with antibiotics just in case, can refer if no improvement in 3-5 days

Question 3

Dacrocystitis

Answer 3

Nasolacrimal duct obstruction and infection characterized by local pain, edema, and erythema over lacrimal sac usually unilateral, does not typically cause visual defect or pain in globe of eye, often causes purulent discharge from puncta, refer to IV abx if pt is febrile or no improvement

Question 4

Preseptal (periorbital cellulitis)

Answer 4

Infection from eyelid from trauma, infection, may be mild to moderate edema and tenderness of eyelid, no pain with eye movement or limitation, no swelling behind eye or redness of eye, visual acuity not affected, can be treated outpatient with antibiotics

Question 5

Episcleritis

Answer 5

Inflammation of connective tissue btwn sclera and conjunctiva, patient usually presents with discomfort and irritation (not pain) that upon slit lamp eval usually localizes edema to the area that overlies the sclera, can be recurrent, vision rnot affected

Question 6

Keratoconjunctivits sicca

Answer 6

Dry eye syndrome, presents with foreign body sensation, blurred vision and burning, no change in visual acuity, caused by environmental exposures, lacrimal gland disease, eyelid disorders, connective tissue disease, mainstay of treatment is lubrication from artificial tears and cyclosporine

Question 7

Subconjunctival hemorrhage

Answer 7

Bright red patch appearing in the white of the eye, most often caused when small blood vessel breaks open and bleeds near the surface of the bulbar conjunctiva, can occur spontaneously often noticed upon awakening or straining, does not affect vision and is not painful, changes colors as it recedes and is similar to a bruise of the eye

Question 8

Pterygium vs pingueculas

Answer 8

Pterygium is a triangular mass of thickened conjunctiva shaped like a wedge that can extend over the cornea while a pinguecula is a small yellowish elevation situated near the outer margin of the cornea

Question 9

Medial canthus and lateral canthus

Answer 9

The inner fold of the eyelid and the outer fold of the eyelid

Question 10

Pinguecula do NOT progress into…

Answer 10

….anything larger or pterygium

Question 11

Hordeolum/stye

Answer 11

Localized, painful, sting or itchy infection of eyelid margin involving hair follicles of eyelashes (external) or meibomian glands (internal). caused often in obstructed glands, failure to remove eye makeup, poor heigeine

Question 12

Treatment of hordeolum/stye (4)

Answer 12

• Warm compress

- only antibiotics in extreme cases if suspected MRSA including dicloxacillin, bactrim, or linezolid

Question 13

Chalazion

Answer 13

Painless** granuloma of eyelid resulting from obstruction of a sebaceous gland (meibomian or other), slow growing nodule can be quite large and last many months, rarely interfere with vision or causes pain, usually resolves spontaneously, can be from seborrhea

Question 14

Blepharitis

Answer 14

Inflammatory condition of the eyelid caused by infection or obstruction of eyelid glands (may be assoc with conjunctivitis) patients generally do not experience visual changes or ocular pain, either staph or seborrheic in origin, treated with no tears baby shampoo 2-3 times a day, or erythromycin ointment in staph infection

Question 15

Keratitis

Answer 15

Inflammation of cornea that can be bacterial, fungal, or parasitic in origins, patient complains of severe pain and decreased visual acuity and photophobia, requires immediate treatment, bacterial often associated with contact lens and mucopurulent discharge, viral usually with watery discharge and grey corneal opacity

Question 16

Scleritis

Answer 16

Inflammation of the sclera, may be associated with uveitis, can be unilateral, bilateral, or alternate eye to eye, conjunctival vessels are engorged with rough appearance*** (diff from episcleritis), usually accompanied by pain especially with pressure, gradual onset with insidious decrease in vision, recurrent episodes common

Question 17

Rheumatoid arthritis is most frequently associated with…

Answer 17

…Scleritis

Question 18

3 differentiating symptoms of scleritis compared to conjunctivitis

Answer 18

• lack of discharge
• ocular pain
• loss of visual acuity

Question 19

Corneal injury

Answer 19

Patient presents with pain, tearing, photophobia, may or may not have decreased visual acuity, detected with fluorescein to detect evidence, eyelid should be everted to exclude retained material, can be dealt with in primary care but sometimes require referral if no improvement from antibiotic treatment

Question 20

Iritis

Answer 20

Inflammation of the iris often due to blunt trauma, nontraumatic is associated with certain diseases, symptoms include pain in eye or brow region, unilateral worsened eye pain in bright light, reddened eye especially adjacent to iris, blurred vision, headache, perilimbal flush

Question 21

Iritis is closely associated with…

Answer 21

…inflammatory bowel disease

Question 22

Hyphema

Answer 22

Blood layering in anterior chamber often due to trauma, can affect vision and patients may also experience pain and sensitivity to light, treat with protective shield over injured eye, limit physical activity and elevate head to help drainage, NSAIDS MAY be used according to who you ask, may cause dangerous elevation of eye pressure requiring surgical drainage

Question 23

Orbital cellulitis

Answer 23

Medical emergency that sees inflammation of tissues of the orbit with proptosis, pain and limitation of movement of eye, edema of conjunctiva with mean age being 7 years old, appear very sick, potentially decreased visual acuity, requires CT scan of orbits and hospitalization

Question 24

Most common cause of exopthalmos and proptosis in children

Answer 24

Orbital cellulitis caused by S aureus, strep, and H influenzae

Question 25

Herpes simplex conjunctivitis

Answer 25

Frequently occurs at the lid margin, disease occurs in children and may include fever, respiratory system involvement, present with painful red eye with watery discharge and preauricular lymphadenopathy, vision can be affected if not treated, small ecchymoses seen on conjunctiva, within 2 weeks of onset 50% of patients develop corneal epithelial manifestations, require referral to ophthalmology

Question 26

Herpes zoster ophthalmicus

Answer 26

Shingles infection in elderly very painful that can affect vision if left untreated, commonly effects eyelids, does not cross midline

Question 27

Herpes zoster ophthalmicus treatment

Answer 27

• Valcyclovir best

- burrows solution, cool compress (relief)

Question 28

Summary of findings that require prompt referral visually

Answer 28

• proptosis
• decreased vision
• ocular pain
• severe photophobia
• corneal ulcers/dendrites
• abnormal pupils