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OPTO3003 > W5 Red eye > Flashcards

W5 Red eye Flashcards

1
Q

DDX for red eye:

A

CL related
Corneal epithelial defect
Ant. Chamber disease
Eye wall inflammation

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2
Q

Presentation of corneal abrasion (trauma):

A

Hx trauma
Sharp pain
Watery, photophobic, blur
*W/o infiltrates, rare AC inflammation

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3
Q

Presentation of corneal erosion

A

Hx trauma/recurrance (<>3mo)
Associated poor healing/DED/dystrophy
Severe sharp pain
Watery, photophobic, blur
*W/o infiltrates, rare AC inflammation

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3
Q

Presentation of foreign body:

A

Hx trauma
Cornea/conj. Body present
Pain
Watery, photophobic, blur
Rare stromal haze/oedema on FB, or AC inflammation

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4
Q

Presentation of AACG:

A

Hx DM/HT
Ache pain w/ Headache, nausea, vomiting
IOP(40-60), closed AC angle, corneal oedema
Mid dilated pupils
Blur based on symptom severity

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4
Q

Presentation of uveitis:

A

Hx uveitis episodes/autoimmune cond.
Ache pain
Circumlimbal hyperaemia, photophobia, corneal oedema/precipitates (endoth.)
AC inflammation, decreased IOP
Rare pos. synechiae, hypopyon(white BC inf. AC), mitotic pupil (spasm)
Blur based on symptom severity

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5
Q

Presentation of episcleritis:

A

Hx RA / autoimmune cond
Irritated to ache pain
Diffuse or sectoral hyperemia
W/o blur/watering/corneal involvement
Phenylephrine 2.5% blanches episcleral/conj. Vessels

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5
Q

Presentation of scleritis:

A

Hx RA / autoimmune / GCA
Deep boring/ache pain
Scleral hyperemia (blue colouring)
W/o blur/watering/corneal involvement
Phenylephrine 2.5% will not blanch scleral vessels

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6
Q

Presentation of sub conj. Haemorrhage:

A

Hx trauma/cough/vomit/blood thinners
Light or no pain
No symptoms (rare conj. Oedema)

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6
Q

Presentation of orbital cellulitis:

A

Hx sinus inf./trauma/insect bite
Tender hot orbit tissue
Associated with fever
Swelling can progress >proptosis/vision loss/conj. Hyperaemia

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7
Q

Functions of the conjunctiva:

A

Connect lids to eye (enclosed sac)
Mucin/aqueous production
Immune function (Macrophages, langerhans cells)
Mediates passive/active immunity

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8
Q

Structure of conjunctiva:

A

Epithelium: columnar W/ goblet apocrine glands and langerhan immune cells
Substantia propria: lymphoid layer (neutrophil/mast/Tcells) and fibrous layer (BV/nerves)

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9
Q

Types of infectious conjuntivitis:

A

Bacterial (hyper-/acute/chronic)
Adenoviral (follicular/PCF/EKC)
HSV
Chlamydial (adult inclusion/trachoma)
Fungal / parasitic / protozoan
Neonatorum

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10
Q

Types of non-infectious conjunctivitis:

A

Toxic follicular
Molluscum contagiosum
Stevens-johnson syndrome
Graft vs. host disease
Ocular cicatrical pemphigoid
Sup. Limbic kerato-

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11
Q

Types of allergic conjunctivitis:

A

SAC/PAC
Atopic
Vernal
GPC

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12
Q

Acute bacterial conjuntivitis causes/symptoms:

A

Gram+: Staph/strep aureus/pneumoniae
Gram-: haemophilus
Unilateral > bilateral (2d)
Burning pain w/mucopurulent discharge (matting) and diffuse hyperaemia
Rare papillae on tarsal conj.

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12
Q

Types of discharge in conjunctivitis:

A

Watery (viral/acute allergic): serous exudate / tears
Mucoid (chronic allergic / DED): mucoid from inflamed goblet cell
Mucopurulent (chlamydial / bacterial): mucoid and pus (leukocytes)
Purulent (gonococcal): pus

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13
Q

Signs of conj. Inflammation:

A

Hyperaemia: from prostglandin release
Oedema: serous leakage from BV tight jun. via prost. release
Membranes: pseudo/true
Cicatrisation: scarring
Follicles/papillae

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14
Q

Hyperacute bacterial conjuntivitis management:

A

GP referral for systemic tetracycline/erythromycin
Untreated > cornea ulceration > endophthalmitis

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15
Q

Follicles and papillae:

A

F: lymphocyte hyperplasia at fornix/tarsal > grey (macrophage) masses
P: epith. Hyperplasia w/ infiltrate mast cells/eosinophils/fibroblasts > tarsal vascular cobblestones

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15
Q

Hyperacute bacterial conjuntivitis causes/symptoms:

A

Neisseria gonorrhoeae via genital spread
Pain + tender preauricular lymphadenopathy
Rapid onset uni/bilateral, hyperaemia/chemosis w/great purulent discharge

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16
Q

Acute bacterial conjuntivitis management:

A

Self limiting (3w)
Chloramphenicol .5% qid 1w to slightly reduce symptoms

17
Q

Chronic bacterial conjuntivitis causes/symptoms:

A

Any bacterial conjuntivitis lasting > 3w
Related to blepharitis
Burning pain
Light hyperaemia on bulbar and tarsal conj.
Mucoid discharge w/papillae, lid crusting

18
Q

Chronic baterial conjunctivitis management:

A

Lid hygiene regime
Chloramphenicol .5% qid 1w

19
Q

Follicular adenoviral conjuntivitis:

A

Serotyes 1-11/19
Unilateral > bilateral (1w)
Ocular discomfort, watery, hyperaemia, tarsal follicles, preauricular lymphadenopathy
Self limiting 1-3w

19
Q

Pharyngeal conjuntival fever:

A

Adenovirus serotype 3/4/7
Pharyngitis, fever, conjuntivitis
Mild hyperemia, chemosis, watery, follicles
Common SPEE, swolen preauricular lymphnodes (ears)
Self limiting 2-3w, cold compress w/lubricants (comfort)

20
Q

Epidemic keratoconjuntivitis causes/symptoms:

A

Adenovirus serotype 8/19/37
Follicles, hyperemia, chemosis, watery, swolen preauricular lymph
Common subconj. Haemorrhage / membranes (true/pseudo)
SPEE > subepithelial infiltrates
Symblepharon / scarring on healing

20
Q

EKC management:

A

Self limiting 1-3w.
Cold compress / lubricants (comfort)
Topical cortico. (flarex 0.1% qid) for corneal subepithelial infiltrates

21
Q

Herpes simplex conjuntivitis

A

Common HSV-1 (ocular) initial infection (<5yo).
Irritation, Watery, follicles, preauricular lymphadenopathy, HSV vessicles (lids),
Dendritic ulcer
Self-limiting 1-2w
Corneal involvement > acyclovir 3% 5/d 1w
No steroids

21
Q

Acute inclusion conjuntivitis:

A

Chlamydia trachomatis bacteria serotye D-K (1-2w incubation)
Unilateral hyperemia, watery, purulent
Large follicles w/papillary hypertrophy (tarsal conj.) > pannus
Swolen preauricular lymph
Rare SPEE/stromal infiltrate/limbal swelling
GP systemic azithromysin 1g.

22
Q

Trachoma cause/symptoms:

A

C.trachomatis bacteria serotype A/B/C
Initial infection (1w incubation) > mild mucopurulent conjuntivitis
Recurrent infection > active chronic inflammation
Late stage > inactive inflammation

22
Q

Trachoma active inflammation:

A

Irritation, DED, blur
Follicles w/papillary hypertrophy > pannus
Thickening of tarsal conj.
SPEE, limbal follicles

22
Q

Trachoma inactive inflammation:

A

Cicatrical fibrosis of conj. > entropion > corneal scarring
Fibrosis/fusion of conj. > symblepharon
Tarsal scarring > white lines (arlt’s line)
DED from meibomian/goblet loss

23
Q

Ophthalmia neonatorum:

A

Conjuntivitis < 4 weeks old via maternal infection (chlamydia/Strep/Staph/HSV)

23
Q

Trachoma treatment:

A

Initial infection > self limiting
Recurrent > single dose of azithromycin 20mg/kg up to 1g

24
Q

Toxic follicular conjuntivitis:

A

Long term toxin exposure.
Mascara/timolol/gentamicin/preservatives > type IV delayed hypersensitivity
Uni/Bilateral hyperemia
Mixed follicles/papillae on tarsal conj.
Cold compress and removal of offending agent

24
Q

Molluscum contagiosum conjuntivitis:

A

Poxvirus nodules containing intracytoplasmic inclusions toxic to conj.
Common 2-4yo
Lid umbilated nodules
Conj. Hyperemia, follicles, mucoid
Self limiting 3-12m, lid nodule excision if needed

25
Q

Mucus fishing conjunctivitis:

A

Mechanical irritation > ropey mucoid > Px fishing mucoid > further irritation
Lubricants for comfort, education to stop fishing

26
Q

Superior limbic keratoconjuntivitis SLK:

A

Common from blink dysfunction from hyperthyroidism
Ocular discomfort, mucoid, DED
Sup. Hyperemia, papillary hypertrophy, SPEE
Requires treatment of underlying cause

27
Q

Ocular cicatrical pemphigoid (OCP):

A

Autoimmune against basement membrane of conj.
Progressive scarring > pain / tearing
Goblet loss > DED
Symblepharon
Requires biopsy > immunosuppressants

28
Q

Stevens jhonson syndrome:

A

Hypersensitivity of mucous membranes to pathogens
Acute phase (1-3w):
Malaise, headache, upper res. Infection
Mucopurulent, membranes (true/pseudo), chemosis, vessicles
Following acute phase: conj. Scarring, symblepharon, goblet/meibum loss
Systemic cortico. (fatal from sepsis otherwise)

29
Q

Graft vs. host disease:

A

Bone marrow transplant > autoimmune reaction against host
Systemic rash
Ocular ADDE, pseudomembrane, corneal sloughing
Systemic cortico. w/lubricants

30
Q

SAC/PAC patho:

A

Year long (Periennial) or seasonal allergens > type 1 immediate hypersensitivity
Allergen binds IgE on mast cells > degranulation > release of histamine (itch), prostaglandins (dilation/pain)

31
Q

SAC/PAC symptoms:

A

Recurrent mild bilateral hyperemia, tearing, mucoid
Lid oedema, conj. Chemosis, tarsal papules
Itching, associated respiratory symptoms

32
Q

SAC/PAC management:

A

Topical lubricants w/systemic anti-histamines
Topical anti-histamine/mast cell stabilliser (zaditen) if severe

33
Q

Vernal keratoconjuntivitis patho:

A

Allergen exposure usually worse in spring(vernal) > type 1 hypersensitivity
Allergen binds IgE on mast cells > degranulation > release of histamine (itch), prostaglandins (dilation/pain)
Activation of T cells > severe inflammation

34
Q

VKC symptoms:

A

Bilateral recurrent, common men <20y w/eczema/asthma
Burning, ropy mucoid, irritation
severe itching
Papillary hypertrophy w/mucous deposits between giant papillae > keratopathy
Limbal gelatinous papillae w/apical white spots (tarantas dots)
Corneal pannus, punctate, vernal shield ulcer
Keratoconus from rubbing

35
Q

VKC management:

A

Topical lubricants w/systemic anti-histamines
Topical anti-histamine/mast cell stabilliser (zaditen)
Cortico. If severe
Usually resolves after 50 years of age

36
Q

Atopic keratoconjuntivitis patho:

A

Allergen exposure (Px usually have many allergens) > type 1 immediate hypersensitivity with type IV delayed hypersensitivity.
IgE > degreanulation > histamine/prostaglandin.
Activation/infiltration of T cells > conj. Ciatration (severe inflammation)

37
Q

AKC symptoms:

A

Rare bilateral, associated atopic deratitis, common late teenage years
Similar to VKC but more severe
Severe itching, mucoid, hyperemia, chemosis
Red macerated lids, blepharitis, narrow fissure
Papules > giant papules
Conj. cicatration > symblepharon
SPEE/erosions/keratokonus

38
Q

AKC management:

A

Topical lubricants w/systemic anti-histamines
Topical anti-histamine/mast cell stabilliser (zaditen)
Cortico. If severe

39
Q

Giant papillary conjuntivitis patho:

A

Allergic or mechanical w/atopy (primary) or CLs (secondary)
Type 1 immediate HS reaction from allergens (primary) or antigen deposits on CLs (secondary)
Repeat exposure w/conj. Trauma > type IV basophil HS reaction

40
Q

GPC symptoms and management:

A

Itching, hyperemia, sup. And inf. Tarsal papillae, mucoid
Secondary cases can have increased mucoid/debris on CL w/loss of CL tolerance (symptoms worse following removal)
* Avoid allergen, topical anti histamines/mast cell stabilisers/steroids/NSAIDs
Secondary > remove stimulus, change cleaning regime, topical treatment (no steroids)

OPTO3003 (18 decks)

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