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CMED 312 Ophtha module > Trans 005 The Red Eye > Flashcards

Trans 005 The Red Eye Flashcards

1
Q

What causes the red eye?

A

❛ The reason why it’s red is because the conjunctiva or subconjunctival vessels are congested or dilated. ❜
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2
Q

❛ These are fluid-filled skin lesions around the eye/eyelids. These could be signs of herpes zoster infection, similar to your rubella or chickenpox. ❜
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A

Vesicles

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3
Q

❛ Usually found underneath your eyelids, in your palpebral conjunctiva. And they are fluid-filled cystic lesions that can be found in the upper or lower palpebral conjunctiva ❜
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A

Follicles

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4
Q

❛ Usually found in the cornea. They are the dilated capillaries or dilated small vessels. Para siyang sun rays around the cornea. ❜
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A

Ciliary flush

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5
Q

❛ the irregularity results from the adherence of iris to the lens that’s why the pupil is not a perfect circle. So, this is a clue that you might have an inflammation inside the eye if you have irregular pupil. ❜
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A

Synechia

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6
Q

❛ are cuboidal elevated lesions that looked like cobble stones in the palpebral conjunctiva. We’ll discuss this more on allergic or infectious conjunctivitis. ❜
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A

Papillae

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7
Q

Most common

Foreign body?

A

❛ Metallic foreign body is the most common, that’s embedded in your cornea or conjunctiva and causing irritation. ❜
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8
Q

❛ Corneal ulcer that is contact lens related is very serious and very aggressive condition; usually caused b ❜
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A

❛ pseudomonas, ❜

— Page 2

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9
Q

❛ accumulation of pus in your anterior chamber – it is a chamber between the cornea and iris. ❜
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A

Hypophon

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10
Q

❛ whitish lesion in the fluid level because of gravity, and that’s a serious sign of ❜
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A

intra ocular infection -

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11
Q

❛ When you say dendritic ulcer it is branched lesions. Instead of circular lesions, sometimes you can see branched/dendritic (parang mga arms). If you see those lesions, usually it’s pathognomonic for ❜
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A

Herpes simplex infection

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12
Q

❛ If you have hyperemia around your eyelid margins especially on the eyelash area, it’s ❜
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A

Blepharitis ❛ an infection of the eyelid margin. Usually patient would complain of foreign body sensation, itchiness, and discharge also. ❜
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13
Q

Bacterial versus viral conjunctivitis

A

❛ Conjunctivitis is common, whether it’s bacterial or viral. Some conjunctivitis will have follicles – circular fluid-filled spaces. So those are follicles and called Follicular Conjunctivitis

Figure 3. Conjunctivitis w/ follicular

In Viral Conjunctivitis you’ll have papillae – ito yung may cobble-stone appearance. Or a patient can have both in one condition ❜
— Page 2

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14
Q

Conjunctivitis versus dry eyes

A

❛ Conjunctivitis – inflammation of the conjunctiva secondary to infection, allergic condition, or inflammatory condition  Dry eye – usually caused by irritation of the conjunctiva ❜
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15
Q

❛ you wear contact lens and you don’t rest your eyes, then you’ll have red eye ❜
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A

Contact lens over wear syndrome

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16
Q

❛ inflammation or infection of the cornea. ❜

— Page 2

A

Keratitis

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17
Q

❛ one of the few emergency condition in ophthalmology, where one of the first presentation would be redness aside from the severe eye pain, headache, and sudden blurring of vision. ❜
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A

❛ Acute Angle Closure Glaucoma ❜

— Page 2

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18
Q

❛ abnormal growth of eyelashes. If you have an inward growth of eyelashes, it can rub on the cornea and cause irritation and redness. ❜
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A

Trichiasis

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19
Q

❛ inward rolling of the eyelid so the lashes rub on the cornea or ocular surface ❜
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A

Entoprion

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20
Q

❛ abnormal outward deviation of the eyelid causing redness and dry eye. ❜
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A

❛ Ectropion ❜

— Page 3

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21
Q

❛ infection of the lacrimal sac located in the medial canthus causing redness in the medial part of your eyelid. It’s like a sty in the middle part of your eye ❜
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A

❛ Acute Dacryocystitis ❜

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22
Q

❛ Triangular fold of conjunctiva that usually grows from the medial portion of the palpebral fissure towards & invades the cornea ❜
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A

Pterygium

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23
Q

Pterygium. versus

Pinguecula

A

❛ If you have a similar lesion, a thickening of the conjunctiva with fibrovascular growth that is not yet encroaching the cornea we call it Pinguecula. They are similar but different in severity. ❜
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24
Q

❛ Predisposing factors ❜
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In pterygium

A

❛ o Hot climate o Chronic dryness o Exposure to sun (prevalent in Southern countries) ❜
— Page 3.

Management is surgical removal

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25
Q

❛ • ‘Extensive bleeding under the conjunctiva’

• Features: red eye, comfortable, no visual disturbance ❜
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A

❛ SUB-CONJUNCTIVAL HEMORRHAGE ❜

— Page 3

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26
Q

❛ FUNCTION:

  • Transmission of light
  • Refraction of light

• Barrier against infection, foreign bodies ❜
— Page 3

A

Cornea

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27
Q

5 layers of the cornea

A

❛ 5 LAYERS

  1. Epithelium
  2. Bowman’s membrane
  3. Stromal
  4. Descemet’s membrane
  5. Endothelium ▪ Extensive sensory fiber network (V1 distribution) ❜
    — Page 3
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28
Q

❛ What are the diseases in the Cornea that can cause Red Eyes? ❜
— Page 3

A

❛ Corneal Ulcer

• Corneal Abrasion ❜
— Page 3

And corneal foreign body

29
Q

❛ Epithelium defect due to trauma or contact lens use  Common in basketball players or in accidental rubbing of the eye, like in the skin when there is abrasion – but this is very painful because the cornea has many sensory nerves. Any small abrasion would cause discomfort to the patient. ❜
— Page 3

A

Corneal abrasion

30
Q

Explain the use of fluorescein due in confirmations corneal abrasion

A

❛ o Use fluorescein and blue light, defect shine in green  In the clinic, we confirm abrasion through fluorescein dye test. After applying topical anesthesia, we apply a drop of fluorescein from the strip in the eyes. And then we expose it to blue light. The abraded site will stain. ❜
— Page 3

31
Q

Management for corneal foreign body?

A

❛ • Management:

o Topical antibiotic (drop/ointment)  For both Corneal Abrasion and Foreign Body are topical antibiotic. But do not use your higher order antibiotics like your Fluoroquinolones or 4th generation Quinolones to prevent resistance.

 Usually we use Tobramycin, Gentamicin, Chloramphenicol  We give antibiotics to prevent infection, because Abrasion and Foreign Body can lead to Corneal Ulcer Tropical NSAIDS, cyclopegic Tight Patch  For corneal abrasion, tight path is for faster epithelial healing. ❜
— Page 4

32
Q

Infective versus non-infective keratitis

A

❛ Types:

o Infective – Bacterial, Viral, Protozoal
o Noninfective – Autoimmune (RA, SLE), or Nonautoimmune (Marginal Keratitis) ❜
— Page 4

❛ Inflammation of the Cornea  If you don’t see any discharge, no problem in the conjunctiva, no blepharitis, no foreign bodies sensation, and no corneal ulcer – you can think of Keratitis.

 Not really common, but when you see the cornea it should be DULL, it is not clear. ❜
— Page 4

33
Q

Causes of bacterial keratitis

A

❛ o Staphylococcus Epidermidis o Staphylococcus Aureus o Streptococcus Pneumoniae o Coliforms o Pseudomonas o Haemophilis ❜
— Page 4

34
Q

Term for Dee dry eye

A

❛ Keratoconjunctivitis Sicca (Dry Eye) ❜

— Page 4

35
Q

Predisposing factors in bacterial keratitis

A

❛ Keratoconjunctivitis Sicca (Dry Eye)  Too much dryness in the eye, your eyes are prone to abrasion and infection.

o A breach in corneal epithelium (ex: following trauma)  Like your abrasion or foreign body, it can lead to bacterial keratitis o Prolonged Contact Lens wear  Usually, Pseudomonas o Prolonged used of topical steroids  As Primary Health care physician, most safe to prescribe a simple antibiotic drops or ointments that will prevent infection. Avoid prescribing steroids because it can worsen. ❜
— Page 4

36
Q

Signs and symptoms of bacterial keratitis

A

❛ Symptoms & Signs:

o Severe pain o Purulent discharge o Ciliary Injection o Visual Loss ❜
— Page 4

❛ Hypopyon o White corneal Opacity (can be seen with the naked eye) ❜
— Page 4

37
Q

Causes of viral keratitis

A

❛ Causes: Type 1 or Type 2 Herpes Simplex Virus ❜

— Page 4

38
Q

Signs of viral keratitis

A

❛ Fever o Vesicular Lid Lesion o Follicular Conjunctivitis o Pre-auricular lymphadenopathy ❜
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39
Q

Pathognomonic viral keratitis

A

❛ Dendritic Ulcer on Cornea ❜
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❛ Dendritic ulcers may heal without scar, but may progress to stromal keratitis, a/w inflammatory infiltration, oedema and ultimately loss of corneal transparency and permanent scarring → if severe – corneal graft ❜
— Page 4

40
Q

Tx for viral keratitis

A

❛ Rx: Topical Antivirus (Trifluridine) – heals within 2 weeks  Difficult to diagnose with the bare eye. ❜
— Page 4

41
Q

❛ There is a clear demarcation in the midline of the face. The cheeks are also clean, meaning upper quadrant is only affected. This is the distribution of your Trigeminal Nerve.

If you see this, an upper quadratic lesion with respect to the midline, think of ❜
— Page 5

A

Herpes zoster ❛ HERPES ZOSTER OPTHALMIICUS (OPHTHALMIC SHINGLES) ❜
— Page 5

42
Q

Causative agent of ❛ HERPES ZOSTER OPTHALMIICUS (OPHTHALMIC SHINGLES) ❜
— Page 5

A

❛ Varicella Zoster Virus ❜

— Page 5

43
Q

Accompanying signs and s/plans herpes zoster ophthalmicus

A

❛ Accompanied by:

o Prodromal period with systematically flu-like symptoms o Vesicles o Lid swelling o Iritis, secondary to Glaucoma ❜
— Page 5

44
Q

Management of ❛ HERPES ZOSTER OPTHALMIICUS (OPHTHALMIC SHINGLES) ❜
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A

❛ Oral Antiviral (acyclovir, famciclovir) ❜

— Page 5

45
Q

❛ Commonly due to use of contact lenses and exposure to contaminated water or soil ❜
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A

❛ PROTOZOAL KERATITIS ❜

— Page 5

46
Q

Causative agent of protozoal keratitis

A

❛ Acanthamoeba Keratitis ❜

— Page 5

47
Q

❛ Presentation:

o Painful Keratitis o Redness of Eye o Photophobia ❜
— Page 5

What condition?

A

❛ PROTOZOAL KERATITIS ❜

— Page 5

48
Q

Management protozoal keratitis

A

❛ Rx:

o Topical Chlorhexidine o Polyhexamethylenebiguanide (PHMB) o Propamidine ❜
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❛ Presentation is similar to Bacterial Keratitis, that is why it is important to do corneal scraping and culture sensitivity and gram-stain. ❜
— Page 5

49
Q

❛ Etiology: Mostly idiopathic, rest collagen vascular diseases, infections (herpes zoster, herpes simplex, syphilis), IBD  Mostly there is no reason at all it is idiopathic, or you

can have it if you have autoimmune diseases like

collage vascular diseases, infections – it is not specific Rx: Self-limited, Tropical steroid if painful ❜
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What condition of sclera

A

Episcleritis

50
Q

❛ inflammation or congestion of your deeper scleral vessels. ❜
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A

Scleritis

51
Q

True or false ❛ In episcleritis and scleritis, it is NOT your conjunctival vessels that are congested, it is the deeper vessels in your bulbar conjunctiva. ❜
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A

True

52
Q

How to differentiate episcleritis and salerïïis

A

❛ We can differentiate Episcleritis from Scleritis using Phenylephrine Drops.

 If you put Phenylephrine Drops and the redness goes away – it is usually EPISCELRITIS  If it does not go away, then it is usually SCLERITIS.  Your ordinary Eye-Mo has some Phenylephrine. ❜
— Page 5

53
Q

❛ Is blood in the front (anterior) chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea ❜
— Page 5

A

❛ HYPHAEMA ❜

— Page 5

54
Q

❛ Irritation of cornea due to aberrant eyelashes grow inward with a normal eyelid position

• May result from chronic inflammatory lid diseases (blepharitis), Steven-Johnson Syndrome, Trauma, Burn, etc. ❜
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A

❛ TRICHIASIS ❜

— Page 6

55
Q

Management of trichiasis

A

❛ Rx:

o Topical Lubricant o Epilation with forceps o Electrolysis for isolated lashes o Cryotherapy o Laser Ablation o Surgery in cases resistant to other treatment ❜
— Page 6

❛ If it is a single or few lashes growing inward, we just epilate the eyelashes. We pluck it out. We can also use lubricants  For recurrent cases, we use Electrolysis, we electrocute the follicles where they grow. For permanent result. ❜
— Page 6

56
Q

❛ Irritation of eye and cornea due to inturning, usually of the lower lid.

 There is abnormal eyelid position, like there is inward deviation. The lower lid is inward, causing the eyelashes to grab on the cornea  Usually caused by Orbicularis Oculi Muscle Spasm ❜
— Page 6

A

Entropion

57
Q

Types of Entropion

A

❛ Orbicularis Oculi Muscle Spasm
o Involutionary (Senile) Entropion ❜
— Page 6

❛ Cicatrical Entropion ❜
— Page 6

❛ Congenital Entropion ❜
— Page 6

58
Q

❛ Due to old age ▪ Affects mainly lower lid ▪ Constant rubbing of lashes in longstanding cases results in ulceration and pannus formation ❜
— Page 6

What type of entropion

A

❛ Involutionary (Senile) Entropion ❜

— Page 6

59
Q

❛  Can be caused by trauma leading to scarring ▪ Both eyelids can be affected ▪ Caused by severe scarring or palpebral conjunctiva, which pulls the margin towards the globe ❜
— Page 6

A

cicatrical entropion

60
Q

❛ Caused by improper development of retractor aponeurosis insertion into inferior border of tarsal plate ❜
— Page 6 ❛ Sign: Inturning of entire lower eyelid and lashes with absence of lower lid crease ❜
— Page 6

What type of entropion

A

❛ Congenital Entropion ❜

— Page 6

61
Q

❛ Eversion of the lid leads to disruption of tears flow  Here, this is outward rolling of your eyelids. This causes disruption of tear flow. ❜
— Page 6

A

ectropion

62
Q

Types of ECTROPION

A

❛ o Congenital
o Involutionary (Senile) Entropion
▪ Affects lid of elderly (weak orbicularis oculi)
▪ Results in Epiphora

o Cicatrical Entropion
▪ Caused by scarring or contracture of skin and underlying tissue, pulling eyelid away from the globe
▪ Defect may be local (trauma) or general (burns or dermatitis)

o Paralytic Ectropion
▪ Caused by facial nerve palsy (mga ana-stroke)

o Mechanical Ectropion

▪ Caused by lid edema, herniated fat or tumor on or near the lid margin which mechanically evert the lid ❜
— Page 6

63
Q

❛ Inflammation of orbital contents posterior to orbital septum

• Can cause blindness &. May spread to cause brain abscess  Important to diagnose in children because it can lead to blindness due to increase in intraocular pressure and compression of the optic nerve, and the infection may spread to the brain and cause brain abscess.

• Often arises from adjacent ethmoid sinus (facial, tooth infection/ trauma)  Usually caused by any infection from the ethmoid sinus ❜
— Page 6

A

Orbit cellulitis

64
Q

Cause of orbit cellulitis

A

❛ Haemophilus Influenzae ❜

— Page 7

65
Q

Signs and simp tons Arbil aulitis

A

❛ Symptoms & Signs:

o Painful eye o Periorbital inflammation and swelling o Reduced eye movement o Conjunctiva Injection o Possible Visual Loss o Systemic illness and fever  By pulling up the eyelid and asking them to follow your finger, the affected eye remain frozen. This is already a severe sign, meaning the retroorbital space is already compressed causing optic nerve compression. ❜
— Page 7

66
Q

Mx of orbital cellulitis

A

❛ Broad Spectrum Antibiotics ❜

— Page 7

67
Q

❛ Purulent inflammation of all layers of the eye  Aside from the tissues around your eye, the wall of your eye is also infected ❜
— Page 7

A

Panophtalmitis

68
Q

❛  If there is swelling of medial cantus, think of acute dacryoadenitis o Inflammation of the lacrimal gland ❜
— Page 7

A

Acute dacryoadenitis

CMED 312 Ophtha module (19 decks)

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