Red Eye

Question 1

How do you obtain accurate ocular history?

Answer 1

1. Onset? Sudden or Progressive?
2. Timeline? Hours, days, or intermittent?
3. Family Hx of red eye?
4. Medications?
5. Hx of trauma or extraordinary events?
6. Contact lens wear & schedule of contact lens wear?
7. Recent infections?
8. Loss of vision?
9. Pain and description of pain.
10. Discharge?
11. Itching?
12. Sensitivity to light?
13. Change in symptoms w/ environment?

Question 2

Answer 2

Acute angle closure glaucoma

(Can be differentiated from open angle glaucoma, because it creates a red eye)

Question 3

Answer 3

Ciliary flush episcleritis

Question 4

Answer 4

Viral conjunctivitis

(note the cobblestone appearance)

Question 5

Why can’t you use steroids for this condition?

Answer 5

It will eat through the cornea

(herpes simplex keritisis)

Question 6

Answer 6

Nodular scleritis

(Cornea will be normal with a slight left exam)

Question 7

Answer 7

• Dacryocystitis
• This is not an infection and does not require antibiotics. Most clear on their own.

Question 8

symptoms

Answer 8

tearing

Question 9

treatment

Answer 9

• You must wait 6 months to prove this usually due to an obstruction in the nose or the valve under the inferior turbinate
• parents can press on it to drain it

Question 10

Answer 10

1. Abnormal, triangular tissue growth that grows over the cornea from the nasal side.
2. Associated with ultraviolet exposure (more commonly seen in tropical climates)

Question 11

Treatment

Answer 11

• Treated by surgical excision, but only if it encroaches on the visual axis.
• must be 3.5 mm

(20% recurrence rate, experimental new procedure with amniotic membrane graft w/no recurrence)

Question 12

Answer 12

Purulent conjunctivitis (bacterial)

Notice creamy-white discharge and conjunctival hyperemia (common in many infections of conjunctiva)

Question 13

Most common complaint with patients presenting with pure electric providers?

Answer 13

Waking up with a crusted shut eyelid

(vision & cornea fine, red eye present)

Question 14

Answer 14

Large keratic percipitate: clumps of white cells are sticking to the endothelium of the cornea

Question 15

Answer 15

Corneal edema (corneal disruptions) that are obvious by the loss of a sharp corneal reflex to a more dulled & diffuse one.

Question 16

Answer 16

Corneal leukoma (scar)

Question 17

Answer 17

Irregular corneal reflex- Epithelium disruption

(Irregular corneal reflex caused by a booklice irregularity from the normal a shark light reflect)

Question 18

Answer 18

Corneal ulcer - bacterial with hypopyon

The eye shows a white corneal opacity w/ and irregular corneal reflex, along w/ that there is a prominent layer of purulent materal at the inferior aspect of the anterior chamber (hypopyon)

Question 19

Answer 19

Chronic proptosis due to orbital tumor

Question 20

Answer 20

Treatment: radiation, eye drops to keep it moist (otherwise it will dry out and perforate)

(they may develop nerve defect after)

Question 21

What is this? trmt?

Answer 21

Syringomas - milia

excise - will leave a scar

Question 22

Answer 22

• Subconjunctival hemorrhage caused by a broken blood vessel
• No damage, no visual defects

(If there are more than four of these instances in one year you must refer to hematologist)

Question 23

Treatment

Answer 23

• Clears up on its own
• Artificial tears may help

Question 24

Answer 24

Entropion: preseptal orbicularis rolls over the pretarsal orbicularis and rolls the eyelid inwards.

Eyelashes rub on the eye and scratched the cornea

(ENtropion goes INward)

Question 25

Treatment

Answer 25

Surgery: shorten the eyelid or create acantholysis and suture the eyelid back (they can tape it themselves while they await surgery)

Question 26

Answer 26

Question 27

Ectropion subjects new patient to\_\_\_\_\_\_.

Answer 27

recurrent conjunctivitis

Question 28

Treatment

Answer 28

Surgery: (Taking a skin graft from the upper lid, lower lid, behind the ear or supraclavicularly)

Question 29

Disease? Cause?

Answer 29

* Bell's Palsy paralytic ectropion * CN VII (can't close their eye, eyebrow droops due to orbicularis m.)

Question 30

Treatment

Answer 30

Surgery (sometimes they can't close their eye afterwards, you can put gold weights in their upper eyelid to weigh it down)

Question 31

Answer 31

Hyperthyroidism does not necessarily cause lid retraction. The lid retraction makes this Graves disease.

Question 32

Treatment:

Answer 32

Stable for 6 months → surgical spacer placed between the levator and the top of the tarsus.

Question 33

What are the nine diagnostic steps for red eye?

Answer 33

1. Determine the pattern of redness 2. Conjunctival discharge 3. detect opacity of the cornea or irregularities of the cornea surface 4. Fluorescein strip : corneal abrasion 5. Estimate anterior chamber depth 6. The regularity of the pupils asymmetry of pupil size 7. IOP 8. Ptosis or lid malfunction 9.

Question 34

Important symptoms of red eye?

Answer 34

1. Severe pain 2. Blurred vision 3. Halos - acute onset 4. Reduced visual acuity 5. Ciliary flush 6. Corneal edema or at the little disruption 7. Pupillary abnormality 8. Shallow anterior chamber 9. elevated IOP 10. Proptosis