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CMED 312 Ophtha module > Trans 006 Red Eye > Flashcards

Trans 006 Red Eye Flashcards

1
Q

❛ Discontinuation in normal epithelial surface of cornea associated with necrosis of surrounding corneal tissue. ❜
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A

❛ CORNEAL ULCER ❜

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2
Q

❛ Etiology o Primary event due to bacterial, rarely viral, fungal or protozoan infections (acanthamoeba).

o Secondary event that has compromised the eye ▪ e.g. corneal exposure, abrasion, foreign body, contact lens o Associated with conjuctivitis, blepharitis, keratitis, vitamin A deficency. ❜
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What disease?

A

What disease? Corneal ulcer

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3
Q

Symptoms of corneal ulcer

A

❛ Symptoms o Red eye o Pain (main feature) → worsened by movement of eyelids persists until healing occurs. (not if herpes zoster opthalmicus) o Photophobia o Watery or mucopurulent discharge ❜
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4
Q

❛ Signs o Normal or reduced VA (central ulcer) o Generalized or localized conjunctival injection o Haziness of the cornea o Hypopyon ❜
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Signs of?

A

Corneal ulcer

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5
Q

True or false

A

❛ Fluorescein MUST be used to see the ulcer ❜

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6
Q

How to manage corneal ulcer

A

❛ Investigation o Usually diagnosed through clinical appearance o Swabs and culture to identify causative organism.

• Management (urgent referral) o Drops and ointment of broad spectrum antibiotics. o Topical antiviral - for herpetic corneal infection ❜
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❛ Cycloplegic drops relieve pain resulting from spasm of ciliary muscle and prevent of the iris to the lens.

o Topical steroids - reduce local inflammatory damage ❜
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7
Q

Complications of corneal ulcer

A

❛ • Complications o Decreased vision o Corneal perforation o Endophtalmitis o Iritis ❜
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8
Q

❛ If a patient presents with red eye, rule out inflammation inside the eye by ❜
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A

❛ checking for photophobia, ❜

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9
Q

❛ If a patient presents with red eye, ❜
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❛ rule out glaucoma by ❜
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A

❛ checking for increased intra-ocular pressure ❜

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10
Q

If a patient presents with red eye ❛ rule out corneal ulcer before managing the patient as ❜
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A

Acute conjunctivitis

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11
Q

❛ there are more discharge and less tearing and less redness. It is usually self-limiting with faster healing. ❜
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What conjunctivitis?

A

Bacterial conjunctivitis

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12
Q

Etiology of bacterial conjunctivitis

A

❛ Staphylococcus, Streptococcus, Pneumococcus, Haemophilus ❜

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13
Q

Presentation of bacterial conjunctivitis

A

❛ Patient presents with:

o Red eye, purulent discharge → yellow crusts, ocular irritation (gritty, burning pain sensation).

o History of contact with infected person. Usually unilateral → bilateral. ❜
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❛ • Findings:

o Chemosis, papillae, round reactive pupil, normal vision. o Fluorescein drops no staining of the cornea ❜
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14
Q

Conjunctivitis versus chemosis

A

❛ Conjunctivitis refers to inflammation of the conjunctiva while Chemosis refers to swelling (edema) of the conjunctiva. ❜
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15
Q

How to perform

Flourescein staining

A

❛ Fluorescein staining of the cornea is performed by first placing a drop of sterile saline on a sterile fluorescein strip. The fluorescein is then placed in the inferior cul de sac of the eye by pulling down on the lower lid and gently touching the bulbar conjunctiva with the fluorescein strip. The patient blinks to distribute the dye, and the cobalt blue light is used to determine if there are any corneal epithelial defects. ❜
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16
Q

Management bacterial conjunctivitis

A

❛ o Usually self-limiting. Fails to resolve → conjunctival swabs for Culture & Sensitivity.

o General measures:

▪ Wipe off all discharge not sharing towel (prevent spread of infection) o Specific:

▪ 1) Antibiotic drops hasten resolution (used day time, broad spectrum e.g. chloramphenicol, gentamicin) ▪ 2) Antibiotic ointment (used at night, during sleep). ❜
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17
Q

❛ there is more redness and tearing, and less discharge. Symptoms last longer. ❜
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What conjunctivitis

A

❛ VIRAL CONJUNCTIVITIS ❜

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18
Q

Etiology of viral conjunctivitis? Most common?

A

❛ Etiology:

o Adenovirus (most common, highly contagious → epidemic), Coxsackie, Herpes Simplex.

o Systemic infection - influenza virus, Epstein-Barr virus, paramyxovirus (measles, mumps) rubella.

 COVID-19 infection may manifest as conjunctivitis ❜
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19
Q

Presentation of viral conjunctivitis

A

❛ Patient presents with:

o Acute onset of diffuse red eye, discharge (watery), excessive lacrimation, photophobia feel discomfort, cough cold (Adenovirus → URTl1 ) ❜
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❛ Findings:

o Lasts longer than bacterial type, diffuse conjunctival injection, preauricular lymphadenopathy, follicles chemosis, lid edema. ❜
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20
Q

Mx of viral conjunctivitis

A

❛ Self-limiting condition. Antibiotic eye drops (for example, chloramphenicol) → symptomatic relief, prevent secondary bacterial infection. ❜
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❛ Chronic, protracted course persistent corneal lesions and symptoms → steroid eye drops may be indicated o Use cold compresses lubricants e.g. artificial tears for comfort. ❜
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❛ Topical vasoconstrictors anti-histamines - for severe itchiness. ❜
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❛ Strict hygiene (highly contagious). ❜
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21
Q

2 forms of ❛ CHLAMYDIAL CONJUNCTIVITIS ❜

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A

Inclusion keratoconjunctivitis

Trachoma

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22
Q

What serotypes of chlamydia trachomatis is causing conjunctivitis

A

Serotypes d-k

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23
Q

Investigation for chlamydial conjunctivitis ❛ Culture of scrapes.

A

• Management:

Giemsa stain to screen for intracellular inclusion body of Chlamydia. ❜
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❛ Presents of Chlamydial antigens using immunofluorescence. ❜
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24
Q

Signs and symptoms of chlamydial conjunctivitis

A

❛ Signs and Symptoms: palpebral conjunctival follicles, preauricular lymphadenopathy, watery/stringy mucopurulent discharge, micropannus associated with subepithelial scarring, chemosis, lid edema ❜
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25
Q

❛ is a form of subepithelial corneal fibrovascular proliferation, which extends beyond the normal vascular arcade at the limbus. ❜
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A

❛ Micropannus ❜

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26
Q

Management for chlamydial conjunctivitis

A

❛ Management:

o Topical and systemic erythromycin, tetracycline (Contraindicated in neonates and pregnant women).

o Associated venereal disease should also be treated o Check the partner for signs of venereal disease ❜
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27
Q

❛ Features: usually both eyes. Itchiness (main feature), lid swell, conjunctival injection, chemosis

• Mostly after allergen exposure and settles after few hours

• Family history of atopy, recent contact with chemicals or eye drops usually present. ❜
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❛ Similar symptoms may have occurred in the same season in previous years. ❜
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A

❛ ALLERGIC CONJUNCTIVITIS ❜

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28
Q

❛ refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis. ❜
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A

Atopy

29
Q

❛ there is more itchiness. This presents as a milder form of viral signs and symptoms. Investigate for history of allergic exposure, family history of allergy, recent changes in bath soap or shampoo and eye medications.

o Strict hygiene (highly contagious).

• Rapid onset (lgE-mediated) ❜
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❛ Features o Itchy, lid swelling, conjunctival injection and edema (chemosis), lacrimation. ❜
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A

❛ ACUTE ALLERGIC CONJUNCTIVITIS ❜

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30
Q

2 types of acute allergic conjunctivitis

A

❛ types:

o A seasonal allergic conjunctivitis - hay fever at time of high environmental pollen, seasonal in pattern.

o Perennial allergic conjunctivitis- caused by allergens other than pollen (e.g.: house dust mite), no seasonal pattern. ❜
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31
Q

Management of allege conjunctivitis

A

❛ Management:

o A topical antihistamine (levocabastine) o Systemic antihistamine (terfenadine) o Mast cell stabilizers (e.g. sodium cromoglycate.

nodocromyl. iodoxamide) ❜
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32
Q

❛ • Often affect male children with history of atopy

• Signs and Symptoms:

o Itchiness o Lacrimation o Redness both eye o Photophobia o Limbal follicles and white spots o Giant cobblestone - papillary conjunctivitis coalesce o Ulcer and infiltration - vernal keratoconjunctivitis o Mucoid discharge - giant papillary conjunctivitis (allergy to foreign body) ❜
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❛ CHRONIC ALLERGIC CONJUNCTIVITIS ❜

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33
Q

Management chronic allergic conjunctivitis

A

❛ Management:

o Initial therapy: mast cells stabilizers or antihistamines, or agents with both properties (eg. Olopatidine) o Topical steroids (severe cases) o Giant cell papillary conjunctivitis → topical mast cell stabilizers. Stop for a period of time or permanently lens wear.

 Giant cell papillary conjunctivitis can be an allergic reaction to contact lenses. ❜
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34
Q

❛ • Neonatal conjunctivitis.

  • Any conjunctivitis occurs in the 1st 28 days of life.
  • Notifiable disease

• Important: immature eye defenses → severe conjunctivitis, with membrane formation and bleeding → serious corneal disease and blindness. ❜
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A

❛ OPTHALMIA NEONATORUM ❜

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35
Q

❛ • 2 important causative agents: ❜
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Of ophthalmia neonatorum

A

❛ ▪ Neisseria gonorrhea (corneal perforation) ▪ Chlamydia trachomatis (chronic → corneal scarring) ❜
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36
Q

Other causes of ❛ OPTHALMIA NEONATORUM ❜

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A

❛ Bacterial conjunctivitis (usually gram positive) o Herpes simplex virus (corneal scarring). ❜
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37
Q

Differential diagnosis of ❛ OPTHALMIA NEONATORUM ❜

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A

❛ o Congenital blocked nasolacrimal gland o Congenital glaucoma o Corneal examination is important → exclude ulceration. ❜
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38
Q

Management ❛ G. OPTHALMIA NEONATORUM ❜

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A

❛ • Management:

o Refer to ophthalmologist o Swab and send for culture test (mandatory) o N. gonorrhea → penicillin topically (local disease) and systemically (systemic disease) o Chlamydia topical tetracycline ointment (local disease) and systemic erythromycin (systemic disease) o Herpes simplex virus→ topical antivirals ❜
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39
Q

❛ Inflammation of the uveal tract (iris, ciliary body, choroid) ❜
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A

❛ UVEITIS ❜

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40
Q

Etiology of uveitis

A

❛ o Inflammatory - due to autoimmune disease o Infectious - caused by known ocular and systemic pathogens ❜
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❛ Infiltrative - secondary to invasive neoplastic processes Injurious - due to trauma ❜
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❛ Iatrogenic - caused by surgery, inadvertent trauma, or medication o Inherited - secondary to metabolic or dystrophic disease o Ischemic - caused by impaired circulation o Idiopathic - a category used when thorough evaluation

has failed to find an underlying cause ❜
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41
Q

Symptoms of uveitis

A

❛ o Ocular pain o Photophobia o Blurring of vision o Red eye ❜
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❛ If there is photophobia it means that there is inflammation inside the eye. ❜
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42
Q

Associated systemic diseases of ureitis

A

Associated Systemic Diseases o 1) Sarcoidosis, TB - (shortness of breath, cough) o 2) Behcet’s, psoriasis – (skin problems) o 3) Ankylosing spondylitis juvenile chronic arthritis, Reiter’s

– (back pain, arthritis)

o 4) Inflammatory bowel disease – (alteration of bowel habit) o 5) In AIDS ▪ Cytomegalovirus ▪ Human syncytial virus ▪ Cryptococcus ▪ Toxoplasma ▪ Candida ❜
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43
Q

ESR is elevated/decreased in uveitis

A

Elevated

44
Q

❛ In ophthalmology, HLA associations are strongest in diseases of the ❜
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A

uvea

45
Q

❛ If you suspect uveitis, always screen for ❜

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A

❛ tuberculosis. ❜

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46
Q

❛ are the first line treatment for the management of the inflammation.

o In more severe cases, steroid injection or even systemic therapy may be required.

o They should normally be prescribed by a specialist, as they can cause corneal ulceration when the diagnosis is herpes simplex infection, steroid glaucoma and on prolonged use, steroid cataract. ❜
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A

❛ Steroid eye drops such as prednisolone 1% ❜

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47
Q

❛ these most common complication of anterior uveitis, if numerous can cause blockage of aqueous flow leading to a rise in intra-ocular pressure and can complicate cataract operations ❜
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A

❛ Posterior synechiae ❜

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48
Q

Complication of uveitis

A

❛ Posterior synechiae ❜
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❛ o Cataract o Glaucoma o Retinal detachment o Neo-vascularization of the retina, optic nerve, or iris o Cystoid macular edema (swelling of the macula) ❜
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49
Q

❛ is a rare form of bilateral panuveitis. It is a specific type of uveitis in response to trauma to one of the eyes. ❜
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A

❛ OPHTLAMIA • Sympathetic ophthalmia (sometimes referred to as sympathetic ophthalmitis or sympathetic uveitis) ❜
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50
Q

❛ Primary narrow or closed angle glaucoma is the most common cause for glaucoma emergency cases.

  • In acute congestive cases, the onset is usually sudden.
  • Condition in which the iris is apposed to the trabecular meshwork at the angle of the anterior chamber of the eye, the outflow of aqueous from the eye is blocked, which causes a rise in intraocular pressure (IOP)

• Immediate treatment is essential to prevent damage to the optic nerve and loss of vision. ❜
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A

❛ ACUTE ANGLE CLOSURE GLAUCOMA ❜

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51
Q

❛ Angle closure may occur via 2 mechanisms ❜
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What are those

A

❛ The iris may be pushed forward into contact with the trabecular meshwork, as in pupillary block or it may be pulled anteriorly, as occurs with other inflammatory conditions. ❜
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52
Q

❛ Symptoms o 1) Onset of severe ocular pain, nausea and vomiting, headache, and blurred vision is sudden.

o 2) Patients may complain of seeing haloes around lights.

Haloes and blurry vision are the result of corneal edema.

o 3) The attack may have been precipitated by pupillary dilation, possibly during an ophthalmic examination. Patients with acute angle closure glaucoma are extremely uncomfortable and distressed.

o 4) Some patients may experience intermittent episodes of partial angle closure and relatively elevated intra-ocular pressure without ever experiencing a frank attack of angle closure glaucoma.

o 5) Patients may be totally asymptomatic. or they may report incidents of mild pain with slightly blurred vision or seeing haloes around lights. These symptoms resolve spontaneously as the angle reopens ❜
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What disease?

A

Acute angle closure glaucoma

53
Q

These are physical el amination of what? ❛ ▪ Diagnosis made by gonioscopic visualization of an occluded anterior chamber angle.

▪ Tonometry demonstrates an elevated intra-ocular pressure, which may be as high as 40-80 mm Hg.

▪ Ophthalmoscopy may reveal a swollen optic disc in an acute attack or excavation if episodes have been chronic. Unilateral involvement and worsening symptoms are common in acute attacks. ❜
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A

Acute angle closure glaucoma

54
Q

medical Management of angle closure glaucoma?

A

❛ o IV acetazolamide (↓ aqueous humor production)
o Beta blocker (↓ aqueous humor production)
o Pilocarpine (constrict pupil) ❜
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55
Q

Definitive treatment for ACG

A

❛ laser iridotomy, ❜
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It cannot be accessed by laser, surgical iridotomy

CMED 312 Ophtha module (19 decks)

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