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week 2: the red eye Flashcards

1
Q

what is the most common cause of a red eye?

A

Conjunctivitis* (blepharo-conjunctivitis)

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2
Q

what are some cases of red eye?

A 
Conjunctivitis (blepharo-conjunctivitis)
Keratitis
Anterior uveitis
Scleritis / Episcleritis
Acute Angle Closure Glaucoma
Subconjunctival haemorrhage
Orbital disease e.g. cellulitis
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3
Q

what ocular defences does the eye have?

A 
Lids – structure and function, blink, 
secretions - meibomian
Tears         - quantity
                        quality
                        drainage
Conjunctivae - mucous
Epithelium - conjunctival / corneal
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4
Q

the importance of tears?

A 
tear flow / blinking
mucous trapping
lysozyme
immunoglobulin : IgA, IgG
complement
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5
Q

how to take Hx of red eye PC

A 
Pain 
Foreign body sensation, grittiness, dryness
Ache
Itch
Discharge / Tearing / epiphora
Photophobia
Visual loss?
Past ocular disorders 
? Contact lenses
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6
Q

examination of red eye

A 
Facial appearance
Lids (lid margins, lashes)
Conjunctivae – (tarsal and bulbar) 
Cornea
Anterior chamber
Iris / pupil
Intra-ocular pressure (ballot the eye, hard and stony=AACG)
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7
Q

causes of Subconjunctival haemorrhage?

A

high BP,

anti-platlet drugs

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8
Q

blepheritis is what?

A

inflamed eyelids

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9
Q

types and signs of each type of blepharitis

A

Ant: Seborrhoeic (squamous) scales on the lashes
Staphylococcal – infection involving the lash follicle
Lid margin redder than deeper part of lid

Post: Meibomian gland dysfunction
( M.G.D.)
redness is in deeper part of lid
lid margin often quite normal looking

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10
Q

symptoms of blepharitis

A

similar to conjunctivitis
Gritty eyes
foreign body sensation
mild discharge

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11
Q

what is blepharitis associated with (other conditions causing red eye)

A

Conjunctivitis
Keratitis (marginal, SPK)
Episcleritis

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12
Q

signs of anterior seborrhoeic blepharitis

A 
Seborrhoeic=
Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)
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13
Q

signs of anterior staphylococcal blepharitis

A

lid margin red

Lashes distorted, loss of lashes, ingrowing lashes - trichiasis

Styes, ulcers of lid margin

corneal staining, marginal ulcers (due to exotoxin)

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14
Q

tee-pee sign?

A

anterior blepharitis

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15
Q

posterior Blepharitis aka “Meibomian gland disease” signs/symptoms

A

Lid margin skin and lashes unaffected
M.G. openings pouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian Cysts (chalazia)

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16
Q

what is posterior Blepharitis aka “Meibomian gland disease” strongly associated with?

A

Acne Rosacea (50%)

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17
Q

how to treat blepharitis

A

Lid hygiene – daily bathing / warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months

Very difficult to eradicate

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18
Q

causes of conjunctivitis

A

Infective:
Viral
Bacterial
Chlamydial

Other:
Allergic
Chemical / drugs
Skin diseases - eczema

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19
Q

symptoms of conjunctivitis

A

red eye
foreign body sensation – gritty eye
discharge – sticky eye
Itch = allergy

VISION UNAFFECTED

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20
Q

signs of conjunctivits

A

Red eye - note pattern of redness – diffuse more towards the fornices

Discharge - serous or mucopurulent

Papillae or Follicles

Sub conj. haemorrhage

Chemosis = oedema

Pre-auricular glands (if viral)

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21
Q

key characteristics of Acute bacterial conjunctivitis

A

red sticky eye

papillae

22
Q

how to treat Acute bacterial conjunctivitis

A

is self limiting - will clear up in about 14 days without treatment [topical antibiotics clear it faster]

23
Q

most common organisms involved in Acute bacterial conjunctivitis

A

Staph. aureus, Str. pneumoniae, H. infuenzae

24
Q

what causes Follicular (cobblestone) conjunctivitis?

A

viral (Adeno-, HS, HZ, molluscum contagiosum)
chlamydial
drugs e.g. propine, trusopt

note takes 2-3days for this to develop as lymphatic

25
what is chemosis
conjunctival oedema
26
what causes chemosis?
allergy or viral
27
causes of chronic conjunctivitis
``` Blepharitis Chlamydial infection Keratoconjunctivitis sicca Lacrimal disease (chr. dacryocystitis) Sensitivity to topical glaucoma medication Sub-tarsal foreign body ```
28
anatomy of the layers of the cornea. inflammation of cornea is what?
Epithelium Stroma Endothelium keratitis
29
how to examine the cornea in corneal disease?
``` Use of anaesthetics if photophobic Corneal reflex (reflection) Use of fluorescein Vascularisation Opacity Oedema ```
30
types of corneal ulcers
central(infective), peripheral (AI)
31
causes of central corneal ulcers
Viral Fungal Bacterial Acanthamoeba
32
causes of peripheral corneal ulcers
rheumatoid arthritis hypersensitivity e.g. marginal ulcers (+ rarely Wegener’s granulomatosis, polyarteritis etc)
33
symptoms of corneal ulcers
``` Pain+ – needle like severe – i.e. if corneal nerves intact _ note corneal sensation is affected by herpes viruses Photophobia Profuse lacrimation Vision may be reduced Red eye - circumcorneal ```
34
signs of corneal ulcers
``` Redness – circumcorneal Corneal reflex (reflection abnormal) Corneal opacity Staining with fluorescein hypopyon ```
35
special causes of corneal ulcers
Exposure keratitis e.g. thyroid, VII palsy Keratoconjunctivitis Sicca e.g. Sjogrens Neurotrophic keratitis e.g. H Zoster or V1 Vitamin deficiency e.g. Vit A
36
treatment for corneal ulcers
Identify cause – ‘corneal scrape’ for gram stain and culture Antimicrobial if bacterial infection: Eg ofloxacin hourly Antiviral if herpetic: Aciclovir ointment 5 x day Anti-inflammatory if autoimmune: Oral / topical steroids
37
problem with infection and contact lenses
acanthamoeba, parasites that eat keratocytes
38
causes of ant.uveitis
Autoimmune: Reiter's, Ulc colitis, Ank Spondylitis, Sarcoidosis Infective: T.B. Syphylis, Herpes simplex, Herpes zoster Malignancy: Eg. leukemia Other: idiopathic, traumatic, secondary to other eye disorders etc
39
symptoms of ant.uveitis
Pain (+ referred pain) Vision may be reduced Photophobia Red eye (circumcorneal) [NB:often missed as treated as conjunctivitis]
40
signs of ant.uveitis
``` Ciliary injection (i.e. circum-corneal ) Cells & flare in anterior chamber Keratic precipitates (around pupil on iris) Hypopyon Synechiae[Small or irregular pupil] ``` [NB:often missed as treated as conjunctivitis]
41
treatment for Anterior uveitis
topical steroids Pred Forte 1% Hourly tapering over 4-8 weeks Mydriatics eg Cyclopentolate 1% BD investigate for systemic associations if recurrent or chronic
42
what is episcleritis associated with? episcleritis describe
Association with gout Relatively common / no serious associations, recurrent, nodules may occur, self-limiting
43
what is scleritis associated with? scleritis describe PC
Association with serious systemic vasculitides e.g. Rh arthritis, Wegener’s PAINFUL + Injection of deep vascular plexus – ‘violaceous hue’ Phenylephrine test Associated uveitis common
44
how to test for scleritis?
phenylephrine test
45
how to treat episcleritis
Self limiting Lubricants / topical NSAIDs / mild steroids (beware steroid dependancy)
46
treatment for scleritis?
Oral NSAIDs Oral Steroids Steroid Sparing Agents
47
AACG PC
``` Elderly* hypermetropic – thick glasses Severe pain + nausea Circumcorneal injection Cornea cloudy (oedematous) Pupil mid dilated Eye stony hard ```
48
AACG pathogenesis
IOP rises acutely due to the drainage angle being closed (pupil dilatation precipitates it)
49
golden rule for red eye
Any red eye affecting vision or causing marked photophobia is serious and need to be referred urgently!
50
causes of a painful red eye
corneal ulcer = needle like ant.uveitis = referred pain to brow scleritis= + AACG = +++ (+nausea)
51
what is a good way to remember causes of red eye?
GO SUCK | glaucoma, orbital disease, scleritis, uveitis, conjunctivitis, keratitis
52
what is iritis?
uveitis

Ophthalmology (17 decks)

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