Red Eye

Aetiology: Adenovirus: good vision; minimal pain; bilatateral in 90%; whitish pseudomembrane and lash matting, pre-auricular lymphadenopathy, lasts 5-7/7 usually Herpes: may not be dendritic ulcer Purulent: strep; chlamydia (most likely if present for >1/12); gonococcal (copious discharge, especially in neonate, may be inflammatory membrane) Herpes; allergicManagement: if purulent, topical antibiotics, eye toilet; systemic antibiotics if gonococcal / chlamydia; if allergic, topical vasoconstrictors / NSAID, PO antihistamine

Conjunctivitis

Chlamydia trachomatis; especially in Aboriginal people; antibiotics and surgeryTrachoma

Usually monocular; vesicular rash in 5th nerve (cornea involved if tip of nose involved as nasociliary); keratitis and anterior uveitisManagement: systemic acyclovir

Herpes Zoster Ophthalmicus

Usually spontaneous; associated with HTN; if traumatic - ?hyphema, globe rupture, basal skull # (no posterior limit)Management: none

Subconjunctival

haemorrhage

Inflammation of cornea whiteness, cells and flare in anterior chamber; hypopyon if severe; unilateral blurred vision, mild headache; ulcerative keratitis may permanently impair visionAetiology: staph aureus, strep pyogenes, strep pneumoniae, pseudomonas if contact lens, herpes simplex virus (dendritic branching), fungal, mycobacterial, acanthamoeba, UV (punctate keratopathy)Investigation: corneal scrapingManagement: topical ciprofloxacin; topical steroids once infection under control

Keratitis

75% anterior; also posterior and panUveitis

Aetiology: collagen vascular diseases, sarcoidosis, inflammatory bowel disease, aortic stenosis, rheumatoid arthritis, TB, Lyme, herpes, toxoplasmosis, varicella, syphilis, leukaemia, lymphoma, malignant melanoma, Reiter syndrome, BehcetExamination: episcleral injection mostly around limbus, aching pain, photophobia (consensual), mild-mod visual acuity, small/normal/irregular pupil, usually unilateral, muddy iris, cell and flare in anterior chamber, posterior synechiae; maybe hypopyon over 2-3/7, keratic precipitatesManagement: opthalmology review; topical/PO steroids if severe and no evidence of corneal infection; dilate pupil ( pain, cell and protein release, break synechaie)

Iritis (anterior uveitis)

Painless; isolasted area; unilateral; NSAIDs; usually settlesEpiscleritis

Sectional redness with blue tinge; nodules; constant pain; associated with collagen vascular diseases; analgesia, topical steroids, cycloplegics; refer opthalmology

Scleritis

More common in Marfans; blurred vision if complete dislocation; quivering of iris when eye movedManagement: surgery

Lens Subluxation

Blood accumulates behind globe proptosis, ischaemia of optic nerve ( fixed dilated pupil), visual lossManagement: urgent lateral canthotomy

Retrobulbar Haematoma