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Hospital Based Practice Eyes.

Acute Red Eye.Acute conjunctivitis.

General symptoms. Altered sensation Red eye Discharge Normal vision

General signs. Red eye.

Greater in fornices. No abnormalities of

Vision Cornea Pupils.

Bacterial conjuctivities. Symptoms.

Lids stuck down in mornings.Sensation of foreign bodyCrusting.Pseudomembranous discharge.

Management.At least 7 days of either.

Chloramphenicol ointment qds Chloramphenicol drops hourly

Drops taste terrible. Ointment to one eye will cause lazy eyes in children.

Use drops. Put ointment on both eyes.

Acute allergic conjunctivitis. Massively itchy. Watery or stringy discharge.

Immensely itchy when removed. Chemosis (grey jelly) Papillae and cobblestones.

Chemosis Papillae Cobblestones.

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Management. Antihistamine drops.

Eg. Levocabastine QDSOnly use for short periods.

Cause eye irritation if used prolonged. Mast cell stabalisers

Increase allergic threshold.Eg. Lodoxamide QDSVery effective.

Steroid drops.Only under ophthalmologist.

Never outside of hospital eye department.Only as short sharp treatment.Return to original treatment after course.

Risks of local steroids. 1 drop OD for a year guaranteed to cause cataract. 30% will get acute glaucoma within 6 weeks. Allows herpes simplex to run riot.

8/14/2019 Causes of red eye for Medical Finals (based on Newcastle university learning outcomes)

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Acute adenovirus conjunctivitis. Clinical picture.

Eyes that are.SoreSticky

Itchy Swollen lids Mucopurulent discharge. Blurred vision. Chemosis Red inner cathus Pseudomembranous discharge. Enlarged posterior auricular nodes.

Red inner cathus Pseudomembrane on lower lid.

Management. No effective management. May cause corneal scaring if severe. Highly contagious due to aerosol transmission caused by blinking.

IsolationGlasses/ ski goggles

Catch droplets.

Scarred cornea.

8/14/2019 Causes of red eye for Medical Finals (based on Newcastle university learning outcomes)

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Acute Iritis Symptoms.

Red eye

Blurred vision Photophobia.

Signs. Small pupil.

May not react directly. Irregular pupil.

If recurrent attacks. Red eye.

Worse around cornea.Compare with conjunctivitis.

Associated with HLAb27.

Iritis Recurrent Iritis, with scarring and irregular pupil.

Management. Atropine Steroids.

Corneal Ulcer Degree of severity of signs and symptoms depend on where in the cornea the ulcer is.

Ulcers in the peripheries cause less symptoms than central ulcers. Symptoms

Visual loss Pain Opacity

Signs Stains with fluorosceine. Small pupil Red eye.

Worse nearer ulcer.

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Investigating the corneal ulcer of unknown aeitiology. Remove and culture contact lenses. Triple scrape, culture and gram stain.

ViralBacterialFungal.

Causative agents. Contact lenses.

Rigid lens 0.0003%Day wear soft lens 0.03%Extended wear soft lens 3%Daily disposables ?

Bacteria.Positive cocci.

Staphylococci Streptococci

Negative cocci. Neisseria Moraxella

Positive rods. Rarely found

Negative rods. Pseudomonas Enterobacteria

Management of unknown ulcer. Sterilise with intensive antibiotics.

CiprofloxacinChloramphenicol

Hourly for 48 hours.Five times a day for 12 days.

Rehabilitate eye.Contact lensCorneal transplant.

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Dendritic ulcer. Due to herpes simplex. Symptoms.

Nil moderate loss of vision Foreign body sensation Mild, dendritic corneal opacity.

Signs.

Satins with fluorescein dye. Small pupil Red eye.

Worse nearest to ulcer.

Unstained ulcer Stained ulcer under blue light.

Management. Minimal wiped debridement. Aciclovir ointment.

Five times a day for two weeks. Rehabilitate eye.

Contact lens

Corneal transplant.

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Acute Glaucoma. Due to high pressure in the eye. Aqueous humour unable to drain. Symptoms.

Very severe pain. Nausea & vomiting Profound loss of vision.

Signs. Stony, hard eye. Minimal pupil reaction Pupil mid dilated.

Often difficult to spot. Shallow anterior chamber.

On slit light examDifficult to spot.

Normal slit lamp Shallow anterior chamber on slit lamp.

Management. Break the attack.

Diamox IVPilocarpine 2%Later

Oral glycerol Mannitol

Prevent further attacks.IridotomyDrop treatmentDrainage surgery.

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Episcleritis. Clinical picture.

Segmental redness. Pain Vascular markings not obscured.

Trivial and self limiting condition. No treatment needed.

Scleritis. Clinical picture.

Segmental redness Vascular markings not obscured. Severe pain Associated with connective tissue disease in 50% of cases.

Management. Urgent treatment with.

Steroids NSAIDs.

Sub conjunctival haemorrhage. Associated with.

Hypertension Diabetes.

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Can be spontaneous. Investigate if recurrent.

Can be traumatic. Investigate to rule out any deeper injury.

Chronic irritable eye. Is most commonly due to blepharitis

Due to eye drying out and lack of blinking.

Management. Protect from the well meaning ignorant giving steroids.

Lubrication.Lacrilube nocteViscotears qds.

Hourly if Watching TV Reading Driving Using computers

Fucithalmic acid.Good for staphylococcal causes.

Tetracycline for rosacea.

Doxycycline 100 mg.Treat for 6 months,