Week 1.03 Red Eye Flashcards
Causes of red eye
- Conjunctivitis
- Keratitis
- Anterior uveitis
- Scleritis
- episcleritis
- Acute closed angle glaucoma
Suffix itis mean
Inflammatory disease
Symptoms of red eye
- redness
- Pain or irritation
- itching
- Bilateral?
- discharge
Conjunctival hyperaemia
- vessels show dilation and increase permeability
- Vessels leak proteins and inflammatory
Chemosis
- Severe Odema swelling of conjunctiva
- Vessels leak protein rich serum
- Associated with allergens
Discharge types
Mucous - vernal conjunctivitis, KCS, stringy
Purulent - severe acute bacterial, pus, white yellow
Watery - viral and allergic (acute), clear fluid discharge, resembles epiphora
Muco-purulent - mild bacteria, main cause chlamydia, combination of excess mucuos and pus discharge
What are the different types of conjunctivitis?
- Bacterial
- Viral
- Allergic
Bacterial conjunctivitis
Symptoms
- All ages
- Mono or bino
- Mild irritation 2 to 3 days
- Normal VA
- eyelids stuck together in morning
Signs
- Red towards fornices
- Vessels move on blink
- Clear
- Papillae - lumps underside eyelids
- Muco-purulent or purulent discharge
Viral conjunctivitis
Symptoms
- all ages
- Mono or bino
- Mild burning sensation 3 to 7 days
- VA mildly affected
- History of systemic illness
Signs
- Short TBUT
- Watery discharge
- Follicles - lumps
- Enlarged preauricular nodes - lymphatic response between eye and ear
Allergic conjunctivitis
Symptoms
- Quick onset hours/minutes
- Mono or often bino
- History of allergy
- itchy
- Fluctuating VA
- Seasonal
Signs
- Chemosis
- Swollen lids
- Watery discharge
- Increase in mucous
- papillae
Papillae vs follicles
Papillae
- can be BIG
- mainly upper lid
- central blood vessels
- infiltrate of inflammatory cells
- associated with chronic inflammation
Follicles
- smaller, paler
- both lids affected
- encircling blood vessel
- Hyperplasticity lymph tissue
- Associated with acute inflammation
Episcleritis
In between conjunctiva & sclera
- mild pain or painless
- may be sectoral
- photophobia
- tearing
- no effect on vision
- idiopathic 26-36% systemic disorder
- self limiting 2-3/7
Scleritis
- deep pain
- hyperaemia of scleral, episcleral and conjunctival vessels
- tearing and photophobia severe
- Gradual onset
- Gradual reduction in VA
- watery eyes
Keratitis
- can use a conjunctival hyperaemia to tell you whereabouts
- Limbal engorgement
- Pain
- Photophobia
- Corneal oedema
- Ulceration
- Reduced vision
- infiltrates
Infiltrates
- corneal lesion/opacity
- Accumulation of leukocyte and cell debris
- Indicate site of active inflammation in the stroma
Acute angle closure glaucoma
- Raised IOP
- Shallow A/C
- circumlimbal injection
- Severe pain
- Fixed mid-dilated pupil
- Corneal haze - endothelium pump doesn’t work properly
- nausea
Anterior uveitis
- Flare/cells
- keratic precipitates
- Circulimbal injection
- photophobia
- miotic pupil
- mild VA reduction
- Can be chronic
- pain
Trauma
Conjunctival haemorrhage can be caused due to trauma
Corneal trauma can cause sectoral conjunctival redness
Examination of redeye
- Case history
- VA
- Slitlamp examination - fluorine, lid eversion
- Pupils
- IOP
Process of examining on slitlamp
- lids and lashes
- meibomian glands
- Conjunctiva
- Cornea, including stain
- Tear film
- Van Herrick
- Sclerotic scatter
How can pupil size help with diagnosing redeye?
- miotic pupil - anterior uveitis
- Normal pupil - conjunctivitis?
- Mid dilated - angle closure glaucoma
Management of the different types of conjunctivitis
- viral conjunctivitis - self limiting, see GP if continues
- bacterial conjunctivitis - antimicrobial from pharmacy, chlorophenicol eye drops
- Allergic conjunctivitis - avoid allergen, or antihistamine drops
What to refer
Angle closure glaucoma is painful - emergency refer to hospital
Episcleritis - GP notification, self-limiting so no referral
Uveitis , scleritis - acute emergency hospital referral, if recurrent sometimes managed by GP
Keratitis - microbial emergency refer, sterile contact lens associated manage and monitor
