7270530
Description
Flashcards by Liam Musselbrook, updated more than 1 year ago
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Created by Liam Musselbrook
about 8 years ago
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| Question | Answer |
| Non-painful causes of red eye with normal visual acuity (VA) | Conjunctivitis Subconjunctival haemorrhage Episcleritis |
| Painful cause of red eye with variable VA? | Scleritis |
| Painful causes of red eye with decreased VA | Keratitis Uveitis Acute Angle Closure Glaucoma |
| Causes of conjunctvitis | Viral - usually adenovirus Bacterial: S. aureus, S. epidermis, S.pneumoniae, H. influenzae Allergic |
| Symptoms of conjunctivitis | Gritty/itchy discomfort (but severe pain not normal) Eye watering Discharge: Bacterial - sticky/purulent Viral - watery Allergic - stringy Photophobia if corneal involvement (rare) |
| Signs of conjunctivitis | Red and inflamed conjunctiva Viral infection: follicular lid appearance and lymphadenopathy Allergic: papillae |
| Chlamydia conjunctivitis | Suspect in young patients Green stringy discharge in the morning Inferior conjunctival follicles Preauricular lymph nodes |
| Management of conjunctivitis | Viral/allergic usually self-limiting Bacterial needs treatment: - Chloramphenicol drops - Fusidic acid drops - Ciprofloxacin drops Antihistamine drops for allergic |
| Subconjunctival haemorrhage | Painless, sudden onset Trauma or spontaneous If post. edge not visable - suspect retrobulbar haemorrhage VA normal Well defined area of redness |
| Symptoms of episcleritis | Often recurrent Most common in young women Acute onset Often asymptomatic Dull ache or gritty/pin-prick sensation Eye watering and photophobia |
| Signs of episcleritis | Localised redness in sector of eye (often wedge-shaped) Vessels may be moved over sclera and blanch with pressure/vasoconstrictor (cf. scleritis) Translucent white inflammatory nodule VA unaffected |
| Causes of episcleritis | Idiopathic (70%) Systemic disease-associated: - IBD - PAN - RA - SLE |
| Management of episcleritis | Usually self-limiting Artificial tears NSAID/corticosteroid drops if severe |
| Scleritis: what is it, what can be the end-result and what is it associated with? | Whole thickness inflammation of sclera Necrosis and perforation in severe cases Associated with systemic disease in 50%: RA, SLE, PAN, Wegner's granulomatosis infections (rare) |
| Symptoms of scleritis | Severe boring eye pain Worse on movement May radiate to brow and jaw Gradual onset |
| Signs of scleritis | Diffuse engorgement of scleral vessels Globe tender No discharge VA initially unaffected but may decrease |
| Management of scleritis | Oral/topical NSAIDS/corticosteroids |
| What is keratitis? What can commonly cause it? | Inflammation of the cornea Corneal abrasion or prolonged contact lens wear |
| Corneal abrasion | Epithelial breach due to trauma (foreign bodies etc.) Risk of infection - chloramphenicol prophylaxis |
| Common organisms of bacterial keratitis | S. aureus Psuedomonas (contact lenses) Viral: herpes simplex keratitis Acanthomoeba |
| Presentation of bacterial keratitis | Circumcorneal/diffuse redness Pain/foreign body sensation Photophobia Reduced VA Discharge Epithelial defect appears green with flourescein White cell infiltrate |
| Management of bacterial keratitis | Topical antibiotics Cycloplegia and analgesia |
| HSV keratitis | Pain, photophobia, redness, reduced VA Superior dendritic ulcers Decreased corneal sensation Management: antivirals (acyclovir), cycloplegia and analgesia No steroids - accelerates progression |
| VZV keratitis (Herpes Zoster Opthalmicus) | Reactivation in CN V1 (shingles) Pain, photophobia, redness, reduced VA Neuralgia Macular papular rash Ulceration and keratitis in ~65% |
| Complications of VZV keratitis/HZO | Posterior uveitis Optic neuropathy Cranial nerve palsies Uveitic glaucoma |
| Management of VZV keratitis/HZO | Systemic antivirals Lubricating eye drops, +/- topical corticosteroids |
| Fungal keratitis | Commonly Candida, Aspergillus, Fusarium RFs: trauma, immunosuppression Signs: grey elevated infiltrate with feathery edges +/- satellite lesions +/- epithelial defect |
| What is anterior uveitis? | Uvea = iris, ciliary body, choroid Anterior uveitis affects iris and ciliary body (75-90% of cases) Most common in working age individuals May be recurrent Usually unilateral although affected eye May alternate |
| Presentation of anterior uveitis | Pain Photophobia Circumcorneal redness Reduced VA Lacrimation Constricted pupil (iris spasm) |
| What can be seen with a slip lamp test in a patient with anterior uveitis? | Keratitic precipitates Cells and flares in aqueous Hypopyon Synechiae (adhesions between iris and lens) |
| Causes of anterior uveitis | Idiopathic (50%) Associated with: ankylosing spondylitis, IBD, psoriasis, sarcoidosis, Behcet's disease, reactive arthritis Infection: HSV/VZV, TB, syphilis, CMV, toxoplasmosis |
| Management of anterior uveitis | Topical steroids Cycloplegia to prevent synechiae |
| Intermediate uveitis | Primarily affects vitreous Floaters, decreased VA Pars planitis: Formation of snowballs (inflammatory cells in vitreous), Snowbanking - formation of exudate at ora serrata Associated with MS, sarcoidosis, lymphoma |
| Posterior and panuveitis | Affects choroid, retina and optic nerve head (posterior uveitis) or all of uveal tract (panuveitis) Associated with lymphoma, sarcoid, Behcet’s, HSV/VZV, TB |
| Key distinguishing features of acute angle closure glaucoma | Severe pain (may be ocular or headache) Decreased visual acuity, patient sees haloes Semi-dilated pupil Hazy cornea |
| KDF of anterior uveitis | Acute onset Pain Blurred vision and photophobia Small, fixed oval pupil, ciliary flush |
| Management of acute angle closure glaucoma | Reduce aqueous secretion - acetazolamide Induce pupil constriction - topical pilocarpine |
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