Eye Anatomy and Causes of Red Eye

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Questions and Answers

Which of the following is NOT a characteristic of viral conjunctivitis?

Often associated with flu-like symptoms

Watery or mucoid discharge

Possible follicles on the palpebral conjunctiva

Mucopurulent or purulent discharge (correct)

What part of the eye is affected in uveitis?

Uveal tract (correct)

Sclera

Conjunctiva

Cornea

Which of these conditions can cause redness and irritation of the eyelids?

Blepharitis (correct)

Conjunctivitis

Keratitis

Episcleritis

Which of the following is a characteristic of adenoviral keratoconjunctivitis?

Possible subepithelial infiltrates and scarring (C) Signup and view all the answers

What is the main reason for recommending hygiene measures when dealing with viral conjunctivitis?

To prevent infection from spreading to other individuals (B) Signup and view all the answers

Which of the following is NOT a common cause of red eye?

Cataracts (A) Signup and view all the answers

What is the main reason for using topical steroids in the management of adenoviral keratoconjunctivitis?

To reduce corneal scarring and infiltrates (A) Signup and view all the answers

Which of these options is a characteristic of bacterial conjunctivitis?

Sticky eyelids on waking (D) Signup and view all the answers

Which of the following is a characteristic of scleritis?

Often associated with connective tissue disease (C) Signup and view all the answers

What is the most appropriate management for a patient with a corneal abrasion?

Topical antibiotic prophylaxis and a bandage contact lens (B) Signup and view all the answers

Which of these is NOT a symptom of allergic conjunctivitis?

Severe pain that disturbs sleep (B) Signup and view all the answers

What is the typical treatment for gonococcal conjunctivitis?

Systemic therapy with IM ceftriaxone and oral azithromycin, plus topical antibiotics (B) Signup and view all the answers

Which type of conjunctivitis is often associated with 'cobblestone papillae' on the tarsal conjunctiva?

Vernal keratoconjunctivitis (B) Signup and view all the answers

Management of episcleritis may include:

NSAIDs and mild topical steroids (A) Signup and view all the answers

Which of the following is a potential cause of a subconjunctival hemorrhage?

Trauma or Valsalva maneuver (A) Signup and view all the answers

What is the most likely management for a patient with a subconjunctival hemorrhage, after ruling out systemic issues?

Reassurance and observation (A) Signup and view all the answers

Which of the following scenarios would require urgent referral to ophthalmology?

A patient with a corneal infiltrate and hypopyon. (A), A patient presenting with sudden, severe eye pain, nausea, and vomiting, with an elevated intraocular pressure. (D), A patient with a post-surgical infection within the vitreous and aqueous humor. (E) Signup and view all the answers

Which of the following is a common management strategy for uveitis?

Topical or systemic steroids. (D) Signup and view all the answers

Which of the following is a sign of acute angle-closure glaucoma?

Sudden, severe eye pain, nausea, and vomiting, with a mid-dilated pupil. (E) Signup and view all the answers

Which of the following conditions is typically characterized by a dendritic ulcer on fluorescein staining?

Herpes simplex keratitis. (B) Signup and view all the answers

What is a common management strategy for a patient with a superficial corneal abrasion and foreign body removal?

Topical antibiotics. (C) Signup and view all the answers

What is the primary management goal in acute angle-closure glaucoma?

Reducing intraocular pressure. (D) Signup and view all the answers

Which of the following is a potential complication of uveitis?

Posterior synechiae. (D) Signup and view all the answers

Which of the following management strategies is appropriate for herpes zoster ophthalmicus?

Oral antivirals. (A) Signup and view all the answers

What is the main management strategy for a hyphema?

Rest, cycloplegics, and monitoring IOP (A) Signup and view all the answers

Which of the following diagnoses is MOST likely to present with both severe pain and vision changes?

Scleritis (B) Signup and view all the answers

Which corneal infection is particularly concerning in contact lens wearers?

Acanthamoeba (C) Signup and view all the answers

Which of the following is a true statement regarding alkali burns to the eye?

Copious irrigation should be performed before any other treatment. (A) Signup and view all the answers

Which of the following is a potential complication of a severe eye trauma?

Sympathetic Ophthalmia (B) Signup and view all the answers

What is the recommended treatment for Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?

ICU admission and multidisciplinary approach (A) Signup and view all the answers

What is the most important consideration when suspecting microbial keratitis?

Corneal scraping for culture (C) Signup and view all the answers

A patient presents with a red, painful eye and significant photophobia. What is the most likely cause?

Acute glaucoma (B), Corneal ulcer (D) Signup and view all the answers

What is the primary recommended action for chemical eye injuries?

Immediate and copious irrigation (B) Signup and view all the answers

Which of the following conditions is NOT typically associated with a watery discharge?

Bacterial conjunctivitis (C) Signup and view all the answers

A patient presents with recurrent subconjunctival hemorrhage. What is the most appropriate next step?

Check blood pressure, coagulation profile, and medication history. (D) Signup and view all the answers

What is the main reason for early ophthalmology involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN)?

To prevent scarring and symblepharon. (B) Signup and view all the answers

Study Notes

Overview of Eye Anatomy Relevant to Red Eye

Conjunctiva: Covers the sclera ("white" of the eye) up to the edge of the cornea.
Palpebral Conjunctiva: Lines the inside of the eyelids, normally transparent. Inflammation (conjunctivitis) causes redness and edema, obscuring the sclera.
Sclera: The tough, white outer layer, forming about 5/6 of the eye's exterior.
Cornea: A transparent, dome-shaped structure forming about 1/6 of the eye's surface. Highly sensitive due to its rich innervation
Uveal Tract (Uvea): Made of the iris, ciliary body, and choroid; inflammation (uveitis) causes redness, pain, and photophobia.
Eyelids and Lacrimal Apparatus: Issues with eyelids (blepharitis, styes, trauma) cause redness and irritation; lacrimal system problems cause tearing.

General Causes of Red Eye

Red eye can result from various conditions, including conjunctival (conjunctivitis, subconjunctival hemorrhage), episcleral/scleral (episcleritis, scleritis), corneal (keratitis, abrasion, ulcer), uveal (uveitis, iritis), raised IOP (acute angle-closure glaucoma), intraocular infection, trauma, and other conditions (tumors, dry eyes).

Conjunctivitis (Most Common Cause)

Viral Conjunctivitis: Often presents with watery discharge, flu-like symptoms, and palpebral conjunctiva follicles, particularly in the lower lid. Usually self-limiting within 1-2 weeks. Management is supportive (lubricants, hygiene).
Adenoviral Keratoconjunctivitis: A more severe viral form with possible pseudomembrane formation and corneal involvement, requiring a short course of topical steroids under specialist supervision. High contagion is a factor in management.
Bacterial Conjunctivitis: Presents with mucopurulent or purulent discharge (sticky eyelids), often worse on waking. Treatment includes broad-spectrum topical antibiotics (e.g., fluoroquinolones).
Gonococcal/Chlamydial Conjunctivitis: Characterized by profuse purulent discharge and potential corneal involvement. Requires systemic antibiotic treatment (e.g., IM ceftriaxone) and management of any concomitant STIs.
Allergic Conjunctivitis: Marked by intense itching, bilateral redness, watery discharge, and potentially significant inflammation, more pronounced in certain populations and environmental conditions. Treatment includes topical antihistamines and mast cell stabilizers.

Episcleritis & Scleritis

Episcleritis: Mild inflammation, sectoral redness, commonly sectoral, and often resolves.
Scleritis: Severe, often boring pain, no phenylephrine blanching, potential association with autoimmune disorders, requires systemic work-up and treatment with steroids, if necessary (can be vision-threatening).

Corneal Pathologies (Keratitis, Ulcers, Abrasions)

Corneal Abrasion: Severe pain, photophobia, foreign-body sensation; fluorescein staining reveals epithelial defect. Management includes topical antibiotics, and potentially a bandage contact lens and cycloplegic for pain.
Infectious Keratitis (Corneal Ulcer): Inflammation resulting from bacterial, viral, fungal or parasitic infections such as (Acanthamoeba), a serious complication that demands urgent management with topical antimicrobials.

Uveitis (Iritis, Iridocyclitis, Choroiditis)

Inflammation of the uveal tract (iris, ciliary body, choroid). Signs include pain, photophobia, and a possible irregular pupil. Caused by autoimmune disorders, infections, or trauma. Management includes topical/systemic steroids and/or cycloplegics.

Acute Angle-Closure Glaucoma

Sudden severe eye pain, nausea/vomiting, blurred vision, and a mid-dilated pupil. Characterised by elevated intraocular pressure (IOP). Urgent management includes decreasing IOP with medications like IV/oral acetazolamide, topical beta-blockers, alpha-agonists, and pilocarpine.

Endophthalmitis

Infection within the eye (vitreous, aqueous). Presents with severe pain, profound vision loss, and marked redness. Management necessitates urgent referral and treatment with intravitreal antibiotics, possible vitrectomy.

Ocular Trauma

Foreign Body/Abrasion: Check the cornea with fluorescein to confirm scratch. Remove foreign bodies if superficial; apply topical antibiotics.
Penetrating Injury: Immediate treatment with protective shield, intravenous antibiotics, and urgent surgical repair are required.

Chemical Eye Injuries

Immediate copious irrigation with balanced salt solutions to check the pH. Continue this until pH is normalized.

Tips

The approach to assessing eye conditions should include visualization of the structures to the best of the observer's ability. Discharge is of importance, with considerations as to the nature and appearance of any discharge. Pain assessment provides considerable insight into the potential nature, severity and possible pathology of the conditions. If the patient reports intense pain, consider depth of pathology possibilities such as the potential of corneal involvement.

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Description

Explore the intricate anatomy of the eye and the common causes of red eye conditions. This quiz covers essential structures like the conjunctiva, sclera, and cornea, alongside general causes such as conjunctivitis and uveitis. Test your knowledge on eye health and anatomy.