Karteikarten
Ophthamology: Conditions Causing Acute Red Eye (Conjunctivitis, keratitis, Uveitis, Acute Glaucoma)
Karten in diesem Stapel (12)
- 1—Conjunctivitis
- 2—Bacterial conjunctivitis in a child with associated discharge
- 32405 S & Sx of conjunctivitis.* Soreness
* Redness
* Discharge
* Acuity is generally good
K & C p1057. - 4Causes & Rx of conjunctivitis.* Bacterial - usually bilateral + purulent discharge. Rx - empirical ABx Rx with chloramphenicol drops QDS for 5-7/7. If ineffective take swab.
* Chlamydial - chlamydia trachomatis is sexually transmitted (seen in developed countries), trachoma isn't sexually transmitted (seen in tropics & middle east). Onset is slow with little discharge. Rx - topical erythromycin.
* Viral:
> Adenoviral - highly contagious. May have been cold/flu like Sx. Associated with chemosis, lid oedema, palpable preauricular lymph node. May cause loss of acuity. Rx - usually self-limiting. Lubricants & cold compresses for Sx. Good hygiene.
> Herpes simplex - usually unilateral. Causes palpable preauricular lymph node & cutaneous vesicles on eyelids & periorbitally. May cause corneal ulcer. Rx - usually self-limiting though topical aciclovir is often used.
K & C p1059. - 5—Severe keratitis due to a fungal infxn
- 6What is keratitis? S & Sx & causes?Inflammation of the cornea. Initially produces a localised oedema of the cornea, rapidly followed by infiltration of inflammatory cells, hence the invariable sign of localised corneal opacity.
S & Sx:
* Usually unilateral
* Red - especially near infxn
* Sticky (bacterial)
* Watery (viral)
* +++ P
* Photophobic
* Acuity may be affected
* Hypopyon (bacterial)
* Corneal opacity
Causative organisms include:
* Staphylococci & Streptococci
* Herpes Simplex
* Trachoma
* Adenovirus
* Herpes Zoster
From P-Year opthamology notes on moodle. - 7Rx for keratitis.* Bacterial - fluoroquinolone g. (eg ciprofloxacin)/hourly for 48/24 then QDS for 5/7.
* Viral - aciclovir oc. or ganciclovir 5x/daily for 1-2/52
From P-Year lecture notes. - 8What is uveitis (aka iritis)? S & Sx & causes?Inflammation of the uveal tract, which includes the iris, ciliary body & choroid. May be classed as anterior, intermediate (affecting the ciliary body), or posterior (choroid).
S & Sx typically:
* Blurred vision
* P
* Redness
* Photophobia
* Floaters (posterior)
* Dots on rear of cornea (keratic precipitates)
* Adhesions from iris to lens (posterior synechiae)
Causes:
* Ankylosing spondylitis & positive HLA-B27
* Arthritis
* Inflammatory bowel DS
* Sarcoid
* TB
* Syphilis
* Toxoplasmosis
* Behçet’s syndrome
* Lymphoma
* Viruses - herpes, CMV, HIV
K & C p1062 & P-Year lecture notes. - 9Rx for uveitis.* Topical steroid eg dexamethasone g.)
* Dilating g. eg cyclopentolate g.
* Ix for systemic conditions
From P-Year lecture notes. - 10—Acute angle-closure glaucoma. Hazy cornea & fixed mid-dilated pupil.
- 11Besides an ocular emergency what is acute angle-closure glaucoma? S & Sx?There is a sudden rise in intraocular pressure to levels greater than 50 mmHg. This occurs due to reduced aqueous drainage as a result of the ageing lens (middle-older age pt's) pushing the iris forward against the trabecular meshwork.
S & Sx:
* Sudden onset of painful (may be severe) red eye
* Blurred vision
* N & V
* Headache
K & C p1062. - 12Rx of acute angle-closure glaucoma.* Systemic acetazolamide (PO or IV) - turns off fluid production in ciliary body
* Pilocarpine g. - pulls iris away from trabecular meshwork
* Topical ocular antihypertensives & topical steroids
* Definitive Rx = bilateral laser iridotomy (makes a hole in iris to allow fluid passage)
From P-Year lecture notes.
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