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Red eye (Cornea (Abrasion (Pathology Surface layer of epithelium is…
Red eye
Cornea
Abrasion
Pathology Surface layer of epithelium is disturbed, usually by trauma
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Management
- Upper lid eversion and examination of upper/lower fornices for foreign bodies
- Topical chloramphenicol
- Referral to ophthalmology if recurrent
Contact lens keratitis
Pathology Infection in contact lens wearers. Some pathogens can cause perforation eg. Pseudomonas aeruginosa
Presentation
- Unilateral red eye
- Pain and photophobia
- Tearing
- May see a white spot on cornea
Management
- Urgent ophthalmic opinion
- Corneal scrape
- Contact lens wear break
- Topical quinolone eg. ofloxacin, levofloxacin
Acanthamoeba keratitis
Pathology Acanthamoeba found in soil, fresh or brackish water and upper respiratory tract. Causes serious infection in contact lens wearers and agricultural workers
Presentation
- Ring infiltrates
- Perineural infiltrates
Management Continues for months as organisms can encyst and lie dormant
- Topical amoebicides eg. propramidine isethionate 0.1%
Dendritic ulcer
Pathology HSV causes a branching tree-like ulcer on the cornea. Caused by reactivation from trigeminal ganglion
Presentation
- Red, painful eye
- Photophobia
- Epiphora
- Visual acuity may be decreased
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Management
- Immediate referral to ophthalmology
- Topical aciclovir 3% 5x daily
Pterygium
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Management Where it does encroach on vision or distort shape of eye, can be treated surgically. Topical lubricants/steroids may be necessary for periodic inflammation
Anterior uveitis
Pathology Inflammation of of the iris, ciliary body, choroid. Often no cause found ie. autoimmune
Presentation Acute pain, photophobia, reduced acuity, lacrimation, circumcorneal redness, small pupil
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Management Aim to prevent damage from prolonged inflammation.
- Prednisolone 0.5-1%/2h to reduce inflammation.
- Cyclopentolate 0.5%/8h to keep pupil dilated and reduce synechiae
- Slit lamp to monitor inflammation.
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Conjunctiva
Conjunctivitis
Infective
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Presentation Red eye, watering, discharge, itching/burning, crusting of lid margins, flu-like symptoms. Diffuse redness, mucopurulent discharge
Management
- Hygiene advice - no contact lenses, don't share towels
- Chloramphenicol drops/2-3h (fusidic acid in pregnancy)
- Topical lubricants will soothe and ease itch
May take several weeks to resolve
Chlamydial
Presentation Suspect in adults with chronic non-resolving conjunctivitis +/- venereal disease history
Management
- Tetracyline or azithromycin PO
- Refer to GUM
Allergic
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Presentation Itch, watering, bilateral red eyes, eyelid oedema, conjunctival swelling
Management
- 1st line: antihistamines (oral/topical)
- 2nd line: mast cell stabilisers eg. sodium cromoglicate, nedocromil
- Topical steroids in severe cases, seek ophthalmic advice
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Sclera/episclera
Scleritis
Pathology Much less common than episcleritis. Can be classified as anterior/posterior and necrotising/non-necrotising. Associated with systemic conditions in 33-50% (RA, vasculitis, GPA, SLE). Also associated with infection (TB, syphilis), surgical trauma and lymphoma
Presentation
- Extremely painful
- Gradual decrease in vision
- Tender globe
- Scleral necrosis in necrotising disease
- Black-blue hue to choroidal tissue
Management
- NSAIDs
- Local depot steroid injections
- Oral steroids 1-2mg/kg/d
- Cytotoxics
Episcleritis
Pathology Inflammation of episcleral tissue. Common, benign and recurrent
Presentation Commonly unilateral, not always
- Sectorial redness of the eye - usually nasal or temporal quadrant
- Uncomfortable but not painful - severe pain suggests scleritis
- Watering + mild photophobia
Management If very mild - may not require treatment
- Lubricants
- Topical NSAIDs
- Oral NSAIDs
- Topical mild steroids eg. prednisolone 0.3-0.5% TDS, 10-14d
Investigations Phenylephrine drops blanch the episcleral vessels but not scleral vessels therefore phenylephrine improves episcleritis but not scleritis