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Ophthalmology > The red eye > Flashcards

The red eye Flashcards

1
Q

What is a subconjunctival hemorrhage?

A

Bleeding into the subconjunctival space - caused by trauma, anti-platelets, clotting problems or very high uncontrolled BP

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2
Q

How long does a subconjunctival haemorrhage take to heal?

A

1-2 week

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3
Q

What is orbital cellulitis?

A

Infection of soft tissue around the eye

Can track into the brain to cause an abscess

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4
Q

What should be included in a history of an ocular complaint?

A 
Pain: foreign body sensation, grittiness, dryness. Ache
Itch
Discharge/treating/epiphora
Photophobia
Visual loss
Past ocular disorders
Contact lenses (acanthomoeba)
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5
Q

What does a stony hard eye indicate?

A

Glaucoma

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6
Q

What is anterior blepharitis?

A

Seborrhoeic (scales on lashes)

Staphylococcal (involving lash follicle)

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7
Q

What is posterior blepharitis?

A

Meimomiain gland dysfunction

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8
Q

How can anterior and posterior blepharitis be distinguished from examination?

A

Anterior: lid margin redder than deeper part of lid
Posterior: redness is in deeper part of lid, lid margin normal looking

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9
Q

What are the symptoms of blepharitis?

A

Gritty eyes
Foreign body sensation
Mild discharge

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10
Q

What are the signs of seborrhoeic anterior blepharitis?

A

Lid margin red
Scales ++
Dandruf _
No ulceration, lashes unaffected

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11
Q

What are the signs of staphylococcal anterior blepharitis?

A 
Lid margin red 
Lashes distorted, loss of lashes, ingrowing lashes (trichiasis) 
Styes
Ulcers of lid margin
Corneal staining, marginal ulcers
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12
Q

What are the signs of posterior blepharitis?

A

Lid margin skin and lashes unaffected
MG openings pouting and swollen
Inspissated secretion at gland openings
Chalazia (meibomian cysts)

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13
Q

What dermatological sign is posterior blepharitis associated with?

A

Acne rosacea

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14
Q

What is the treatment for blepharitis?

A

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

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15
Q

What are the different types of conjunctivitis?

A 
Viral
Bacterial
Chlamydial (low grade chronic conjunctivitis)
Allergic
Chemical/drugs
Eczema
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16
Q

What are the symptoms of conjunctivitis?

A 
Red eye
Foreign body sensation - gritty
Sticky discharge
Itch = ALLERGY
VISION UNAFFECTED
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17
Q

What are the signs of conjunctivitis?

A 
Redness maximal towards the fornix 
Discharge serous or mucopurulent 
Papillae or follicles - chlamydia
Subconjunctival haemorrhage 
Chemosis 
Pre-auricular glands if viral
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18
Q

What will be present in acute bacterial conjunctivitis?

A

Red sticky eye
Papillae
Self limiting - 14 days, but topical antibiotics will clear it faster (topical chloramphenicol for 5-7 days)

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19
Q

What are the most common organisms in acute bacterial conjunctivitis?

A

S.aureus
Strep pneumoniae
H. influenzae

20
Q

What will be present in viral conjunctivitis?

A

Follicular

21
Q

What are the most common viral conjunctivitis?

A

Adenovirus
Herpes simplex
Herpes zoster

22
Q

What sign is important in herpes zoster ophthalmicus?

A

Hutchinson’s sign (affects tip of nose and therefore nasociliary nerve)

23
Q

What does chemosis commonly suggest?

A

Allergic conjunctivitis

24
Q

What causes keratoconjunctivitis sicca?

A

Sjogrens

RA

25
Q

What can cause lacrimal disease?

A

Chronic dacryocystitis

26
Q

What are the layers of the cornea?

A

Epithelium
Stroma
Endothelium

27
Q

How should corneal disease be examined?

A 
Anaesthetic if photophobic
Corneal reflex 
Fluorescein - with cobalt blue light
Vascularisation 
Opacity
Oedema
28
Q

What will cause central corneal ulcers?

A

Viral - dendritic
Fungal
Bacterial - contact lens
Acanthamoeba

29
Q

What will cause a peripheral (autoimmune) corneal ulcer?

A

RA
Hypersensitivity (marginal ulcers)
GPA

30
Q

What are the symptoms of a corneal ulcer?

A 
Severe pain 
Photophobia 
Profuse lacrimation
Reduced vision
Circumcorneal red eye
31
Q

What are the signs of corneal ulcers?

A 
Circumcorneal redness
Corneal reflection abnormality
Corneal opacity
Staining with fluorescein
Hypopyon
32
Q

What type of ulcer will herpes simplex show?

A

Dendritic

33
Q

What can lead to an exposure keratitis?

A

Thyroid eye disease

7th nerve palsy - bells palsy

34
Q

What vitamin deficiency can lead to a corneal ulcer?

A

Vitamin A

35
Q

How are corneal ulcers treated?

A

Identify cause - corneal scrape
Antimicrobial if bacterial - ofloxacin hourly
Antiviral if herpetic - aciclovir ointment
Anti-inflammatory in autoimmune

36
Q

What can cause anterior uveitis?

A 
Reiters
Ulc colitis 
Ank spond
Sarcoidosis 
Leukaemia
TB
Syphilis
H. simplex
H, zoster
Traumatic
37
Q

What are symptoms of anterior uveitis?

A

Pain
Reduced vision
Photophobia
Red eye - cirumcorneal

38
Q

What are the signs of anterior uveitis?

A 
Ciliary injection 
Cells and flare in anterior chamber
Keratic precipitates
Hypopyon
Synechiae (small or irregular pulis
39
Q

What is the classic presentation of anterior uveitis?

A 
Red eye
Dull ache
Photophobia
Referred pain to eyebrow 
Synechiae
40
Q

What is the management of anterior uveitis?

A

Topical steroids (prednisolone 1% hourly tapering over 4-8 weeks)
Mydriatics - cyclopentolate
Investigate for systemic associations

41
Q

How can episcleritis and scleritis be distinguished?

A

Episcleritis - blood vessels blanch with use of phenylephrine
Scleritis - blood vessels do not blanch

42
Q

How is episcleritis treated?

A

Lubrication +/- topical NSAID or steroid

43
Q

What is scleritis associated with?

A

Serious systemic vasculitides e.g. rheumatoid arthritis, wegener’s

44
Q

How will scleritis present?

A

Painful +++
Non Blanching
Purple
Associated uveitis common

45
Q

How is scleritis treated?

A

Oral NSAIDs
Oral steroids
Steroid sparing agents

46
Q

What is acute closed angle glaucoma?

A

IOP rises acutely due to the drainage angle being closed (pupil dilation precipitates it)
Elderly hypermetropia
Severe pain with N+V

47
Q

What are the signs of acute closed angle glaucoma?

A

Circumcorneal injection
Corneal cloudy
Pupil mid-dilated
Eye stony hard

Ophthalmology (14 decks)

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