The Red Eye - PS Flashcards by Rebecca Davies

What tissues make up the eyelids?

Skin, meibominan glands and conjunctiva

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Where can you see redness in the eye?

Eyelids, conjunctiva, episclera, sclera, third eyelid, cornea, anterior chamber, anterior uvea, posterior uvea, retina, retrobulbar area

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How could you get red eyelids?

Hyperaemia, swelling, ulcers, crusts, loss of hair
Dermatitis of various causes
Meibomian glands have a problem such as infection, neoplasia, granuloma

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What are the eyelids intimately associated with?

Cornea and tear film

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What knock on effects could be seen with red eyelids?

Loss of protective effect
Loss of oily part of tear film
Contact problem with eyelid hairs/masses and the cornea

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What secondary pathologies could be seen as a result of eyelid pathology?

Corneal ulceration
Corneal vascularisation
Excessive tear production

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What is the conjunctiva?

Mucus membrane lining of the sclera, 3rd eyelid and underside of eyelid that ends at the limbus (where the white meets the cornea)

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What makes up the conjunctiva?

Epithelial cells
Mucus cells (goblet cells)
Lymphoid tissue
Blood vessels

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What are the characteristics of conjunctival blood vessels?

Dichotomous branching

Very sensitive to surface irritation

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How can conjunctival blood vessels cause redness?

Dilation of vessels and separation of endothelial cells leads to hyperaemia and oedema

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What is the episclera?

Connective tissue under conjunctiva up to the limbs

Different looking blood vessels

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What are the characteristics of episcleral blood vessels?

No dichotomous branching

Larger, meadner

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What does the presence of episcleral blood vessels indicate?

Intra-ocular disease such as uveitis and glaucoma

Severe/chronic surface irritation in some cases

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What is the sclera?

True white of the eye
Fibrous tunic continuous with the cornea via the limbus
Collagen fibres and fibroblasts
Emisaria are the holes in the sclera for blood vessels and nerves

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What is the structure of the third eyelid?

Lots of lymphoid follicles in the bulbar side and palpebral side
T shaped cartilage core holds the third eyelid up against the eye
Contains the lacrimal gland

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How can the third eyelid become red?

Hyperaemic
Cartilage curling outwards
Prolapse of lacrimal gland

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What name is given to enlarged lymphoid follicles?

Follicular conjunctivitis

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What are the four layers of the cornea?

Epithelium
Stroma
Descemets membrane
Endothelium

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What are the characteristics of the corneal epithelium?

Physical barrier to tears, micro-organisms, environment
Hydrophobic
Doesn’t have blood vessels in health
Has nerves

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What are the characteristics of the stroma?

Hydrophilic

Stays relatively dehydrated through the action of the endothelium (sodium/potassium pumps) and epithelium (passive)

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What is stromal overhydration called?

Corneal oedema

What is the anterior chamber?

The space between the cornea and the iris

What fills the anterior chamber?

Aqueous humour

What are the characteristics of the aqueous humour?

Fills the anterior and posterior chambers
Maintains intra-ocular pressure
Feeds the inner cornea
Produced from blood fluids by the epithelium of the ciliary body

What two diseases can affect the anterior chamber?

Uveitis increases uveoscleral outflow and decreases IOP (intra-ocular pressure) Glaucoma due to iridocorneal angle closure/clogging

What relationship exists between IOP and glaucoma/uveitis?

``` Uveitis = decrease in IOP Glaucoma = increase in IOP ```

What are the parts of the uvea?

Anterior uvea made up of the iris and ciliary body | Posterior uvea which is the choroid

What are the common denominators of the uvea?

It is a mesh of blood vessels and usually contains a lot of pigment

Other than blood vessels what else does the anterior uvea have?

Muscles - constrictor and dilator | Anterior blood ocular barrier that separates blood and aqueous humour

Other than blood vessels what else does the posterior uvea have?

Tapetum lucidum

What is miosis?

Iris spasm resulting in pain

What does endothelial cell separation into the anterior chamber result in?

Keratic precipitates Hyphema Fibrin Proteins

What is leakage of blood components seen as around the lens?

Snow banking

What are adhesions of the iris to the anterior lens called?

Posterior synechia

What are PIFMs?

Pre-iridal fibrovascular membranes

What can PIFMs result in?

Bleeding in the eye due to uveitis | Closure or blockage of the iridocorneal angle

What is rubeosis iridis?

Anterior uveitis of the uvea

What can cause redness of the anterior uvea?

PIFMs Hyphema Keratic precipitates

What can sudden decompression result in?

Inflammation Anterior synechia (iris to cornea) Bleeding from the iris and ICA due to retrograde flow of aqueous humour followed by blood

What can cause sudden decompression?

Corneal perforation | Iris and lens damage

What is the posterior uvea?

It is the choroid and is continuous with the anterior uvea

What can diseased posterior and anterior uvea present as?

Posterior and anterior uveitis Bleeding into the anterior segment of the eye (hyphema) Retinal detachment

How can the retrobulbar area become red?

Inflammation and infection | Neoplasia

How can inflammation and infection get to the retrobulbar area of the eye?

Haematogenously Nerves From the eye

Which structures of the eye can become neoplastic?

Muscle, fat, nerves, blood vessels, cartilage, glands, skin

What do retrobulbar area problems lead to?

Altered position of the eye in the orbit and relationship with eyelids Possible increased pressure around the eye Swelling or infection of the tissues around the eye Vision loss Pupillary problems Restriction of ocular movement

What are the first steps of the ophthalmic exam?

Symmetry | Tear test

What are the three main light examination techniques and what are they used for?

Distant direct - retroillumination, cataracts vs sclerosis Close direct - fundus, retina, high magnification Indirect - fundus, retina, low magnification

What are some ancillary tests used in the ophthalmic exam?

Tonometry Imaging Fluorescein Gonioscopy

What does DAMNITV stand for?

``` Degenerative/developmental Anomalous/autoimmune Metabolic/mechanical/mental Nutritional/neoplastic Inflammatory/infectious/ischaemic/inherited/iatrogenic/idiopathic Traumatic/toxic Vascular ```