TUTORIAL 1: history and taking and differential diagnosis of Red eye Flashcards
What pathology of the eyelid can cause a red eye?
Trichiasis- eyelashes are angled backwards
Entropion- eyelid turning inwards
Ectropion-eyelid turning outwards, exposure of eye
Blepharitis
What pathology of the conjunctiva can cause red eye?
Conjunctivitis (infective and allergic)
Sub-conjunctival haemorrhage
Sub-tarsal foreign body (under eyelid)
What pathology of the episclera/sclera can cause red eye?
What pathology of the cornea can cause red eye?
What pathology of the anterior chamber/uvea can cause red eye?
episcleritis
scleritis
keratitis
corneal FB/abrasion
acute angle closure
acute anterior uveitis
What are the common non sight-threatening causes of red eye?
Infective conjunctivitis
Allergic conjunctivitis
Dry eye/blepharitis
Sub-conjunctival haemorrhage
Corneal abrasion
Episcleritis
What are the sight-threatening causes of red eye?
Anterior Uveitis
Microbial keratitis
Scleritis
Acute angle closure
Chemical trauma
What is the structure of ophthalmic history?
Presenting complaint- RFV
History of presenting complaint
POH
PMH
Medication history- prescribed and over the counter
Systems review- link between systemic disease and ocular presentation
Family history
Social history- do they live alone (may need somone to put in drops)
How can you investigate a presenting complaint?
Unilateral or Bilateral
History of presenting complaint
Time course: sudden or gradual onset (hours, days, weeks), constant or intermittent?
Associated features: reduced vision, visual field loss, diplopia, pain, discharge,foreign body sensation, itch, headache, photophobia, jaw claudication/scalp tenderness (if presenting with headache, can be temporal arthritis)
Severity: mild, moderate, severe (scale of 1 to 10), define it (10 is unimaginable pain)
Treatment: medical or self treatment
Exacerbating factors: what makes it worse?
Relieving factors: what makes it better?
What should you ask about past ophthalmic history?
Eye problems in the past?
Previous surgery? (especially if clinical presentation has occurred a in a short period of time after surgery)
Amblyopia? (vision isn’t improving, is this recent or always been like that)
Contact lens wear? (bacterial keratitis)
What examination tests should you do?
Visual acuity (unaided, aided, pinhole-any underlying uncorrected error)
Pupil reactions
Direct, near and consensual, RAPD
External eye examination
Lids, lashes, conjunctiva, cornea, anterior chamber, iris, lens, anterior vitreous
Angle estimation
Diagnostic stain: fluorescein
Intra-ocular pressure
Posterior eye examination
What are the red flags in a px presenting with red eye?
moderate-to-severe eye pain or photophobia
marked redness of the eye − the greater the redness, the more likely it is that the cause is serious
reduced visual acuity
red-eye associate headache and vomiting − raised intraocular pressure (IOP) must be excluded
What is the timing of acute anterior uveitis?
What are the symptoms?
What are the risk factors?
What is the severity?
What is the treatment?
What are the exacerbates?
Hours (1st episode may be longer for reoccurance)
Unilateral
May be reoccurant
Pain (deep ache)
Photophobia
Epiphoria
Reduced VA
Risk factors: autoimmune diseases e.g. rheumatoid arthiritis, injury, infection
moderate
analgesics for pain
reading/close work
What is the timing of acute angle closure?
What are the symptoms?
What are the risk factors?
What is the severity?
What are the exacerbates?
hours
Haloes around light
Pain (8-9 on scale)
Unilateral
Reduced vision
HIGH HYPERMETROPES-have a shallower anterior chamber.
AGE-
Lens increasing in size as we get older
happening less due to cataract
ETHNICITY
East asian
severe
low light levels as pupil is more dilated
What is the timing of scleritis?
What are the symptoms?
What is the severity?
days or weeks
Deep ache Pain-wakes them at night
Reduced Va
Bilateral in 50%
May be reoccurant
Tenderness of globe
Photphobia
epiphoria
severe
