red eye and DR.txt

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kavinashah
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47985
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red eye and DR.txt
Updated:
2010-11-07 17:49:37
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red eye dm
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red eye dm
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  1. which cause of red eye always needs to be ruled out?
    acute angle closure glaucoma
  2. what needs to be asked in HPC about red eye?
    • painful
    • loss of vision
    • duration of symptoms
    • discharge
  3. what are the symptoms of bacterial conjunctivitis?
    • discomfort
    • eyelashes stuck together in mornings
  4. what would you see OE of bacterial conjunctivitis?
    • 1. diffuse conjunctival injection (red eye)
    • 2. mucopurulent DISCHARGE
    • 3. papillae - red bumps on inside of eyelid
  5. what is the Rx of bacterial conjunctivitis?
    • topical abx drops and ointment at night
    • chloramphenicol
    • counsel pt: hand washing, very contagious so don't share towels
  6. what are the symptoms of viral conjunctivitis?
    • grittiness
    • watery eye
    • photophobia if keratitis
    • associated URTI
  7. what would you see OE of viral conjunctivitis?
    • diffuse or haemorrhagic conjunctival injection - red
    • watery discharge
    • follicles
    • lymphadenopathy - preauricular node enlargement
  8. what is the Rx of viral conjunct?
    • artificial tear drops - hypromellose
    • may want to give topical abx to cover
    • counsel pt: hand washing, very contagious so don't share towels
  9. what are the symptoms of allergic conjunctivitis?
    • itching
    • hx of atopy or use of eyedrops
  10. what do you see OE allergic conjunct?
    • red watery eyes
    • chemosis
    • giant papillae
    • bilateral
  11. what is Rx of allergic conjunct?
    topical antihistamine eg sodium cromoglycate - mast cell stabilisercounsel pt: hand washing, very contagious so don't share towels
  12. what would make you suspect chlamydial conjunctivitis and treatment?
    • GU symptoms
    • tetracycline or erythromycin
  13. what are the symptoms of episcleritis?
    • mild ache
    • recurrent episodes (but self limiting)
  14. what do you see OE of episcleritis?
    • sectorial redness
    • nodule (can be moved over sclera)
    • episcleral vessels blanch with phenylephrine
  15. what is the treatment of episcleritis?
    • weak topical steroid
    • oral NSAIDs
  16. what are the symptoms of scleritis?
    • severe pain
    • wakes pt at night
    • watering of eye
    • photophobia
  17. what do you see OE of scleritis?
    • sectorial or DIFFUSE redness
    • immobile nodule
    • scleral vessels DO NOT BLANCH with phenylephrine
    • deep vessels, tortuous dilated inflamed
  18. what is the treatment of scleritis?
    • oral NSAD
    • systemic steroids
    • refer as 25% are part of vasculitis
  19. who is at higher risk of bacterial corneal ulcer?
    contact lens wearers
  20. what are the symptoms of bacterial corneal ulcer?
    • mild-sever pain
    • photophobia
    • discharge
  21. what do you see OE of bacterial corneal ulcer?
    • focal white opacity in cornea
    • overlying epithelial defect that stains with fluorescing
    • hypopyon
  22. what is the treatment of of bacterial corneal ulcer?
    • admit
    • intensive abx eye drops
  23. who is at higher risk of viral corneal ulcer?
    cold sores
  24. what are the symptoms of viral ulcer - HSV?
    • pain
    • photophobia
    • watering
  25. what do you see OE of viral ulcer?
    • eyelid vesicles
    • dendritic corneal ulcer that stains with fluorescing and rose bengal
  26. what is the treatment of viral ulcer - HSV
    aciclovir eye ointment
  27. what is the history of corneal abrasion?
    scratch to eye
  28. what are symptoms of corneal abrasion?
    • pain
    • photophobia
    • watering
    • FB sensation
  29. what do you see OE of corneal abrasion?
    epithelial defect that stains with fluorescin
  30. what is the treatment of corneal abrasion?
    ointment and double pad
  31. what is a typical hx of FB or rust ring in eye?
    grinding metal
  32. what are symptoms of FB in cornea?
    • FB sensation
    • photophobia
    • watering
  33. what do you see OE of FB?
    • FB
    • rust ring
  34. what is the treatment of FB?
    • remove FB
    • ointment pad
  35. what is the other name for iritis?
    anterior uveitis
  36. what is iritis assoc with?
    • seronegative arthropathy HLA-B27 positive eg ank spond
    • IBD
    • TB
    • sarcoidosis
  37. what are the symptoms of iritis?
    • photophobia
    • pain
    • watering
    • may have reduced visual acuity
  38. what do you see OE of iritis?
    • ciliary injection -red around cornea
    • small pupil due to iris sphincter spasm
    • irregular pupil - due to adhesion of iris to lens = posterior synechiae
    • keratin precipitates (white dots)
    • hypopyon if severe (pus in anterior chamber)
  39. what is the treatment of iritis?
    • refer to ophthalmology - don't give steroids straight away in case it is HSV!
    • topical steroids: dexamethasone
    • mydriatic: cyclopentolate -paralyses ciliary body to relieve pain, prevents posterior synechiae
  40. which conditions can precipitate acute angle closure glaucoma?
    • topical mydriatics
    • dim light - dilated pupil
  41. what causes acute angle closure glaucoma?
    • secondary to obstruction of aq hum outflow
    • closure of angle - iridocorneal angle
  42. what are symptoms of acute angle closure glaucoma?
    • pain
    • coloured halos around lights
    • frontal headache
    • reduced vision
    • blurred vision
    • N&V
  43. what do you see OE of acute angle closure glaucoma?
    • corneal oedema
    • pupil: fixed, semi dilated
    • red eye
    • increased IOP - hard on palpation
    • shallow anterior chamber - eclipse sign
    • reduced VA
  44. what is immediate treatment of acute angle closure glaucoma?
    • iv diamox acetozolamide
    • topical steroids
    • BB (timolol), PG (lanoprost), alpha2agonist (brimonidine), cholinergics (pilocarpine)
  45. what is the definitive treatment of acute angle closure glaucoma?
    • YAG laser peripheral iridotomy - make bypass
    • bilateral
  46. what are features of mild-mod NPDR?
    • Haemorrhage
    • Oedema
    • Microaneurysm
    • Exudates
  47. what are features of severe NPDR?
    • venous changes: beading, looping
    • cotton wool spots
    • IRMA - intra retinal microvascular abnormalities
  48. what does boat shaped haemorrhage indicate?
    pre-retinal haemorrhage, see in PDR
  49. what is the difference between normal retinal BV and those seen in PDR?
    PDR: bld vessels are fenestrated
  50. what are 2 complications of untreated PDR?
    • 1. fibrous component of new bv gives rise to preretinal fibrosis and tractional RD
    • 2. new vessels on iris - rubeosis iridis gives rise to rubeotic glaucoma
  51. which type of DM gets diabetic maculopathy?
    • type 2
    • get oedema and exudates at macula
  52. what are the 4 main causes of blindness in DR?
    • 1. tractional RD
    • 2. rubeotic glaucoma
    • 3. vitreous haemorrhage - sudden reduced VA
    • 4. maculopathy
  53. what is the treatment of mild NPDR?
    no Rx, review in 6/12
  54. what is the treatment of moderate NPDR?
    no Rx, review in 2-4/12
  55. what is the treatment of severe NPDR?
    no treatment, review in 2-4/12
  56. what is the treatment of macular oedema?
    laser - focal or grid
  57. what is the treatment of PDR?
    panretinal laser photocoagulation
  58. what is the treatment of vitreous haemorrhage or tractional RD?
    surgery - vitrectomy
  59. what are the symptoms of 4th nerve palsy?
    • diplopia when looking down worse
    • affected eye is higher than normal due to unopposed action of superior rectus
    • head turn and face tilt to OPPOSITE side
  60. what are the symptoms of 7th nerve palsy in eye?
    • lid ectropion - due to loss of muscle that holds it up
    • cant close eye as orbucularis oculi is paralysed - problem as cornea is expose - get dry eye and ulcer

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