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clinical medicine red eye month 1 week 4 T3
clinical medicine red eye month 1 week 4 T3
20
Medical
Graduate
09/24/2018

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Cards

Term
Sign of Ocular Inflammation: Etiologies
Definition
• Conjunctivitis
• CornealAbrasion
• Foreign Body
• Allergies
• Subconjunctival Hemorrhage • Keratitis
• Iritis
• Glaucoma (Acute angle)
• Chemical Exposure
• Scleritis
Term
Focused History: Red Eye - questions to ask
Definition
• Unilateral or Bilateral?
• Isthereeyepain?Lengthoftime?Typeofpain? • Istheeyeitchy?
• Istheredischargefromtheeye?
• Anyvisionchanges?
• Anyrecenteyetrauma?
• Anyrecenteyesurgery?
• Previous episodes of red eye?
• Any systemic illnesses which could contribute?
• Any allergies which could contribute?
Term
[image]
Definition
eye with inflamed or irritated conjunctiva
Term
[image]
Definition
diffuse reddness. not seeing any structures in the conjunctiva, all blood- diffuse subconjunctival hemorrhage. upper eyelid is swollen. eyelashes w/o evidence of trauma- not in misdirection, no tear or problems w eyelid margin. corneal light reflux- clear cornea. pupil black and round. iris is diffuse and homogeneous in color. there may be clear or bloody discharge, hard to tell
Term
[image]
Definition
allergic conjunctivitis
-esp seen in spring and fall w allergies. redness of the conjunctiva. almost always bilateral. the eyelids have a reddness to the lower and upper eyelid. in more severe presentations can be swollen shut. not as defusely red, mainly on nasal aspect
Term
Management: Allergic Conjunctivitis
Definition
- Topical treatment:
• Histamine H1 receptor antagonist
• Mast cell stabilizer
• Histamine H1 receptor antagonist + mast cell stabilizer
• Non-steroidal anti-inflammatory
- Often systemic co-treatment is needed and helps
- Co-management with internist, pediatrician, primary care provider
Term
[image]
Definition
viral conjunctivitis. impt to assess face. typically caused by adenovirus. highly contageous. common cold in the eye. unilateral but a few days to a week later can spread to the other eye as well. nasal and temporal redness and increased tearlake. use slit lamp to look at cornea and evaluate for mild cloudiness (SEI- subepithelial infiltrates- viral particles deposit in endothelium of cornea). lower eyelid mildly swollen- distinguish from allergeis and foreign body
Term
Management: Viral Conjunctivitis
Definition
-Adenovirus: highly contagious
• Often starts in one eye and then presents in the fellow eye
• Recommend no work/school in the initial presentation
• Recommend hand washing, no sharing of towels, avoidance of food preparation and interacting with others
• Lubricant eye drops (artificial tears) and avoiding antibiotic and steroid eye drops initially
• Resolution typically within 1-3 weeks
Term
[image]
Definition
Bacterial Conjunctivitis
-rarer, most of the cornea looks clear, can see corneal light reflex, mucus in left eye, thick yellowy mucus- impt to culture from each eye individually. culture in case doesn't respond to 1st line of antibiotic to get sensitivities
Term
Management: Bacterial Conjunctivitis
Definition
• Culture from conjunctival fornix is important
• Careful evaluation of the cornea
• In adults: Staphylococcus aureus infection is common
• In children: Streptococcus pneumoniae and Haemophilus influenzae and are more common
• Topical treatment based on sensitivities to antibiotics in severe cases, immune compromise, contact lens wearers, in neonates
• Typically: Ofloxacin 0.3%:1 drop qid for 1 week
Term
[image]
Definition
Subconjunctival Hemorrhage
-localized, well circumcised area of inferior temporal quadrant of conjunctiva on left, maybe from foregin body, valsalca maneuver, surgery. likely will resolve w/i 10-14 days or sooner
-on right- more diffuse and deeper red. from a foreign body, trauma, surgery. may take up to 2-3 weeks to resolve
Term
Management: Subconjunctival Hemorrhage
Definition
• Resolution without eye drops or ointment
• Reassurance given to patient and family re: decreasing/resolving hemorrhage in 1-2 weeks
• Typically noted after eye surgery, after valsalva manuevers
• Important to evaluate for conjunctival FB
• Important to evaluate to any prior episodes
• Important to ask patient about systemic illnesses
Term
[image]
Definition
Foreign Body (Corneal)
-red eye secondary to corneal FB. slit lamp photograph. diffuse reddness and injection of conjunctiva. metallic foreign body in superficial layer of cornea- epithelium. diffuse inflammatory reaction. likely just from FB bc pubil is round and reactive, no distortion, iris is flat and all normal crypts. no distruption of integrity and health of iris
Term
Management:
Red Eye Secondary to Corneal FB
Definition
• Remove Corneal Foreign Body at slit lamp w a burr- numb eye, examine for rust ring after removal
• Start topical antibiotic (Moxifloxacin 0.5%)
• Evaluate visual acuity, intraocular pressure
• Perform dilated retinal exam
• Redness of conjunctiva should resolve with removal of corneal FB
Term
[image]
Definition
Keratitis
-infection of the cornea causing a red eye. very white circular well circumscribed opacity on the cornea w stuck on appearance. can see most of iris, haziness of cornea around opacity (not healthy), diffusely red conjunctiva, conjunctiva appears to be swollen - chemosis,
Term
Management:
Red Eye Secondary to Keratitis
Definition
• Complete evaluation at the slit lamp
• Measurement of depth of corneal opacity
• Assessment of visual acuity, intraocular pressure
• Culture of corneal opacity may be needed for treatment
• Start topical antibiotics (Moxifloxacin0.5%)
• Resolution/improvement/decrease of conjunctival redness should occur with resolution of corneal opacity
Term
[image]
Definition
Scleritis: Nodular and Diffuse
-sclera is the white layer under the conjunctiva. can have a blue hue. can be nodular (on left)(could have autoimmune illness like rheumatoid arthritis). on right- diffuse scleritis, blood vessels stop right next to cornea at the limbus- white line of the limbus, solidly deep red (scleritis)
Term
Management: Scleritis
Definition
• Evaluation of conjunctival tissue movement with Q-tip
• Assessment of episcleritis versus scleritis
• Episcleritis: self-limiting and resolves within 2 weeks
• For scleritis:
- evaluation of presence or absence of nodules
• Assessment of visual acuity, intraocular pressure, cornea, anterior chamber, iris
• Evaluation for the presence/absence of systemic disease, ie: autoimmune disease, RA, SLE
• If needed:
- co-management with rheumatologists for immunosuppressant treatment
Term
[image]
Definition
acute glaucoma
-ocular emergency, rarer, on PE redness of eye- corkscrew type blood vessels that go all the way to the limbus + middilated pupil- wont' react well to light/frozen + cloudy cornea- haziness w corneal light reflex, not perfect view of iris
Term
Management:
Red Eye Secondary to Acute Glaucoma
Definition
• Ocular emergency
• Assessmentofintraocularpressure,visual acuity is critical
• Assessmentofcornea,anteriorchamber, iris/pupil
• Topical treatment needed as well as systemic treatment (depending on the level of intraocular pressure)
- Treat with precaution/awareness of patient’s allergies and medical history
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