Acute Red Eye

Info

🌱 來自: Huppert’s Notes

Acute Red Eye🚧 施工中

Acute Red Eye

•   Physical exam: Fundoscopic exam, pupillary examination, visual acuity, EOM, peripheral vision

•   Differential diagnosis:

-   Closed-angle glaucoma: See previous section

-   Conjunctivitis

•   Description: Inflammation of the transparent membrane lining the eyelid and the anterior sclera (i.e., the white part of the eyeball)

•    Etiologies:

-   Viral: Adenovirus

•   Symptoms: Often recent URI, may having itching

•   Physical exam: Watery discharge, may have lymphadenopathy

•   Treatment: Hot compresses, self-limited

-   Bacterial: S. pneumoniae, Pseudomonas

•   Physical exam: Mucopurulent discharge

•   Treatment: Erythromycin eye drops; if contacts use fluroquinolone for Pseudomonas coverage

-   Chlamydial conjunctivitis

•   Symptoms: Often associated with nasal discharge. Assess sexual history and genitourinary symptoms.

•   Etiologies:

-   Trachoma (serotypes A,B,C): Most common cause of blindness worldwide

-   Inclusion (serotypes D-K): Genital hand-eye contact of STD

•   Physical exam: Neovascularization (pannus) of cornea

•   Diagnosis: Giemsa stain

•   Treatment: Oral tetracycline, doxycycline, or erythromycin. Treat sexual partner.

-   Allergic

•   Symptoms: Itching, tearing, nasal congestion, usually bilateral

•   Physical exam: May have eyelid edema

•   Treatment: Remove allergen, topical/systemic antihistamine

-   Irritants

•   Etiologies: Contact lens, chemicals, foreign bodies, dryness

•   Treatment: Irrigation, avoid irritants

-   Subconjunctival hemorrhage

•   Description: Bleeding underneath the conjunctiva. May be associated with Valsalva, severe cough, direct trauma. Other risk factors include coagulopathy, anticoagulant use, hypertension.

•   Symptoms: Usually unilateral bleeding underneath the conjunctiva without vision changes

•   Physical exam: Redness in conjunctiva, may be well demarcated

•   Diagnosis: Clinical diagnosis. Check INR if on warfarin.

•   Treatment: Self-limited, may use artificial tears

-   Hyphema

•   Description: Pooling or collection of blood inside the anterior chamber of the eye, usually associated with direct trauma or recent eye surgery

•   Symptoms: May have blurred vision/vision loss

•   Physical exam: Layering of blood in anterior chamber of eye

•   Diagnosis: Check intraocular pressure (may be elevated)

•   Treatment: Same day ophthalmology evaluation. Can be medically managed with corticosteroids, beta blockers, or alpha agonists. If failure to improve with medical management, may require surgery.

-   Keratoconjunctivitis (dry eye)

•   Description: Inflammation of the cornea and conjunctiva

•   Symptoms: Sensation of “sand in the eyes,” bilateral, may have frequent blinking

•   Etiologies: Medications (anticholinergics, antihistamines), autoimmune conditions (Sjögren’s syndrome), CN V/VII lesions, allergies

•   Diagnosis: Consider testing for anti-Ro and anti-La autoantibodies if risk factors for Sjögren’s syndrome

•   Treatment: Treat etiology, symptomatic relief with artificial tears vs gel, avoidance of anticholinergic and antihistamine medications

-   Blepharitis

•   Description: Inflammation of the eyelids

•   Symptoms: Crusting, burning or itching sensation. Patient may have history of seborrhea or eczema.

•   Physical exam: Inflammation of the eyelids, crusting at the base of the eyelashes

•   Treatment: Lid scrubs (consider non-fragranced baby shampoo), warm compresses, antibiotics if severe (can be associated with S. aureus super-infection)

-   Episcleritis

•   Description: Inflammation of the tissue between the sclera and the conjunctiva

•   Symptoms: Pain, photophobia, may be episodic. Patient may have history of autoimmune conditions (e.g., RA, SLE, psoriatic arthritis).

•   Physical exam: Inflammation of the vessels lining the episclera beneath conjunctiva

•   Treatment: Self-limited

-   Acute anterior uveitis (iritis, iridocyclitis)

•   Description: Inflammation of the middle layer of the eye (i.e., uvea), which includes the iris and ciliary body. Can be associated with systemic inflammatory conditions (e.g., sarcoidosis, ankylosing spondylitis, IBD, reactive arthritis).

•   Symptoms: Blurred vision, usually unilateral, severe photophobia

•   Physical exam: Inflammation of iris and ciliary body, constricted pupil of affected eye

•   Diagnosis: Consider workup for associated inflammatory conditions depending on risk factors

•   Treatment: Urgent referral to ophthalmology, topical steroids and dilating drops

-   Herpes simplex virus (HSV)

•   Symptoms: Painful, vision changes (rapidly progressing bilateral necrotizing retinitis can cause blindness)

•   Physical exam: Dendritic ulcer on cornea, peripheral pale lesion

•   Treatment: Trifluoridine eye drops or ganciclovir gel

-   Varicella zoster virus (VZV)

•   Symptoms: Unilateral painful vesicular rash, eye pain, decreased vision

•   Physical exam: Corneal ulcers, vesicular rash in trigeminal distribution, Hutchinson’s sign (lesions on nose)

•   Treatment: Oral acyclovir or valacyclovir (most effective within 72 hours of vesicle outbreak), topical steroids

-   Cytomegalovirus (CMV)

•   Symptoms: Painless, floaters or flashing lights. Patient may have history of HIV/AIDS or immunosuppresion.

•   Physical exam: Hemorrhages, fluffy granular lesions

•   Treatment: Oral valganciclovir, ensure ART compliance if HIV positive