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Ophthalmology > week 2: the red eye > Flashcards

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
Q

what is chemosis

A

conjunctival oedema

26
Q

what causes chemosis?

A

allergy or viral

27
Q

causes of chronic conjunctivitis

A 
Blepharitis
Chlamydial infection
Keratoconjunctivitis sicca
Lacrimal disease (chr. dacryocystitis)
Sensitivity to topical glaucoma medication
Sub-tarsal foreign body
28
Q

anatomy of the layers of the cornea. inflammation of cornea is what?

A

Epithelium
Stroma
Endothelium

keratitis

29
Q

how to examine the cornea in corneal disease?

A 
Use of anaesthetics if photophobic
Corneal reflex (reflection)
Use of fluorescein
Vascularisation
Opacity
Oedema
30
Q

types of corneal ulcers

A

central(infective), peripheral (AI)

31
Q

causes of central corneal ulcers

A

Viral
Fungal
Bacterial
Acanthamoeba

32
Q

causes of peripheral corneal ulcers

A

rheumatoid arthritis
hypersensitivity e.g. marginal ulcers

(+ rarely Wegener’s granulomatosis, polyarteritis etc)

33
Q

symptoms of corneal ulcers

A 
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
Q

signs of corneal ulcers

A 
Redness – circumcorneal
Corneal reflex (reflection abnormal)
Corneal opacity
Staining with fluorescein
hypopyon
35
Q

special causes of corneal ulcers

A

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
Q

treatment for corneal ulcers

A

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
Q

problem with infection and contact lenses

A

acanthamoeba, parasites that eat keratocytes

38
Q

causes of ant.uveitis

A

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
Q

symptoms of ant.uveitis

A

Pain (+ referred pain)
Vision may be reduced
Photophobia
Red eye (circumcorneal)

[NB:often missed as treated as conjunctivitis]

40
Q

signs of ant.uveitis

A 
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
Q

treatment for Anterior uveitis

A

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
Q

what is episcleritis associated with? episcleritis describe

A

Association with gout

Relatively common / no serious associations, recurrent, nodules may occur, self-limiting

43
Q

what is scleritis associated with? scleritis describe PC

A

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
Q

how to test for scleritis?

A

phenylephrine test

45
Q

how to treat episcleritis

A

Self limiting
Lubricants / topical NSAIDs / mild steroids
(beware steroid dependancy)

46
Q

treatment for scleritis?

A

Oral NSAIDs
Oral Steroids
Steroid Sparing Agents

47
Q

AACG PC

A 
Elderly* hypermetropic – thick glasses
Severe pain + nausea
Circumcorneal injection
Cornea cloudy (oedematous)
Pupil mid dilated 
Eye stony hard
48
Q

AACG pathogenesis

A

IOP rises acutely due to the drainage angle being closed (pupil dilatation precipitates it)

49
Q

golden rule for red eye

A

Any red eye affecting vision or causing marked photophobia is serious and need to be referred urgently!

50
Q

causes of a painful red eye

A

corneal ulcer = needle like
ant.uveitis = referred pain to brow
scleritis= +
AACG = +++ (+nausea)

51
Q

what is a good way to remember causes of red eye?

A

GO SUCK

glaucoma, orbital disease, scleritis, uveitis, conjunctivitis, keratitis

52
Q

what is iritis?

A

uveitis

Ophthalmology (17 decks)

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