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Flashcards in SS2 Deck (22)
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1

What can cause a red eye?

Conjunctivitis
Subtarsal or conjunctival foreign body
Corneal abrasion
Episcleritis.
Dry eye -
Blepharitis
Ectropion (outward rotation of the eyelid margin).
Entropion (inward rotation of the eyelid margin).
Trichiasis (misdirection of the eyelashes towards the cornea).

Acute glaucoma.
corneal ulcer (bacterial, viral or fungal),
contact lens-related red eye
corneal foreign body.
Anterior uveitis.
Scleritis.
Trauma.
Chemical injuries.
Neonatal conjunctivitis.

2

What is conjunctivitis?

inflammation of the conjunctiva - infective or allergic

3

What are the key symptoms of conjunctivitis

Red eye - generalised, often bilateral.
Irritation, grittiness and discomfort are typical.
Discharge, which may be watery, mucoid, sticky or purulent depending on the cause.

4

What are the key signs of conjunctivitis

Conjunctival injection with dilated conjunctival vessels.
Conjunctival oedema

Follicles or papillae:
Conjunctival follicles = round collections of lymphocytes, most prominent in the inferior fornix, which appear as small, dome-shaped nodules - caused by viruses, atypical bacteria and toxins

Papillae = cobblestone appearance of flattened nodules with central vascular cores, appearing red on the surface and pale at the base on the tarsal surface of upper eyelid - caused by allergic immune response, response to a foreign body such as a contact lens.

5

What can be used in the management of allergic conjunctivitis

Topical mast cell stabilisers - Sodium cromoglycate
Topical antihistamines

6

What can be used in the management of infective conjunctivitis

bacterial - most cases of bacterial conjunctivitis are self-limiting and management is usually supportive. Conjunctivitis caused by gonococcal or chlamydial infection should be treated with antibiotics - chloramphenicol

7

What is the difference between scleritis and episcleritis

Episcleritis = inflammation of the superficial, episcleral layer of the eye. It is relatively common, benign and self-limiting.

Scleritis = inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications, which nearly always requires systemic treatment.

8

In which patients is scleritis more common

rheumatoid arthritis
Wegener's granulomatosis,
SLE
reactive arthritis,
polyarteritis nodosa
ankylosing spondylitis.
gout,
Churg-Strauss syndrome
syphilis.

9

What are the symptoms of episcleritis

Acute onset of redness with discomfort
Discomfort, grittiness, aching in or around the eye
Watering and occasional mild photophobia.

No other associated ocular symptoms.
No discharge other than watering.
Visual acuity normal

10

What are the symptoms of scleritis

Subacute or gradual onset
Presents early, as symptoms are severe.
Boring eye pain, often radiating to the forehead, brow and jaw and usually severe.
Pain worse with movement of the eye and at night (may wake the patient).
Associated watering, photophobia.
Gradual decrease in vision.
Diplopia.
Occasional associated systemic symptoms (fever, vomiting, headache).

11

What are the signs of episcleritis

Sectoral/diffuse redness.
Engorged episcleral vessels extending radially.
Translucent white nodule may be present within the inflamed area.
Visual acuity is normal.

12

What are the signs of scleritis

Visual acuity may be reduced or normal.

Anterior:
Sectoral or diffuse redness.
Scleral, episcleral and conjunctival vessels all involved.
Sclera may take on a bluish tinge ± may be thin and oedematous.
The globe is tender.

Posterior:
Lid oedema.
Proptosis.
Optic disc swelling.
Retinal detachment can occur.

13

Which diseases are associated with episcleritis

UC
Crohn's

RA
SLE
Wegener's
hyperuricaemia

14

What is the treatment for episcleritis

Artificial tears
topical NSAIDs

Where the episode is more severe, a short course of topical steroids may be required (under the supervision of an ophthalmologist).

15

What is used in the treatment of scleritis

oral NSAIDs or steroids
immunosuppressive therapy such as methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or ciclosporin

16

What is uveitis

inflammation of the uveal tract (iris, ciliary body, and choroid).

17

What is anterior uveitis

inflammation in the anterior segment of the eye

iritis = inflammation that is confined to the anterior chamber)

iridocyclitis = inflammation that is confined to the anterior chamber and anterior vitreous

18

Which systemic conditions can cause anterior uveitis

Seronegative spondyloarthropathies (ankylosing spondylitis, juvenile rheumatoid arthritis, Reiter's syndrome, and inflammatory bowel disease).
Behçet's disease.
Sarcoidosis.
Psoriasis (with or without associated arthritis).
Multiple sclerosis.

HLA-B27

19

What are some infective causes of uveitis

HSV,
VZV,
CMV,
toxoplasmosis.

histoplasmosis,
Lyme disease,
syphilis,
toxocariasis,
tuberculosis.

20

What are the symptoms of uveitis

Pain in one or both eyes (may be worse on reading - contracting the ciliary muscle)
Red eye
Diminished or blurred vision
Watering of the eye.
Photophobia.
Flashes and floaters.
An unreactive or irregular-shaped pupil resulting from previous attacks.

21

What is seen on examination in anterior uveitis

KPs - inflammatory cells clumped together on the posterior (endothelial) part of the cornea as little white spots

hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level

visual acuity initially normal → impaired

on slit lamp: hazy anterior chamber

reduced IOP

22

How is uveitis managed?

Non-infectious:
Corticosteroids - topically, orally, intravenously, intramuscularly, or by periocular or intraocular injection or implant.
Taper slowly
A cycloplegic-mydriatic drug (for example cyclopentolate 1% or atropine 1%) to paralyse the cliary body - relieves pain and prevents adhesions between the iris and lens.

Infectious uveitis
appropriate antimicrobial drug
corticosteroids
cycloplegics.