🎧Deep Dive: Keratitis— Don’t Miss the Red, Painful Eye

Let’sget laser-focused 🔬. If you’re revising for the MSRA or just want to truly understand whatkeratitis is (and why it's urgent), this is your express pass to mastering theessentials.

👁️What is Keratitis?

It’sinflammation of the cornea — the clear, front part of your eye. And when it’sinfectious, it’s a genuine sight-threatening emergency ⚠️.Unlike conjunctivitis, this one can scar or even perforate the eye if not treated fast.

🧫Causes:

Splitinto infectious vsnon-infectious ⬇️

🦠Infectious

• Bacterial: Staphaureus, Pseudomonas (esp. incontact lens wearers)

• Viral: Herpes simplex

• Fungal: Fusarium,Aspergillus

• Parasitic: Acanthamoeba(linked to tap water + contact lenses)

🌬️Non-infectious

• Photokeratitis (UVexposure – skiing, welding)

• Exposure keratitis(eyelids don’t close)

• CLARE (ContactLens Acute Red Eye – sterile)

• Dry eye, trauma,autoimmune inflammation

⚠️Major Risk Factors

👁️ Wearing contact lenses — especially poor hygiene,sleeping in them, or water exposure

🧼 Dirty hands, old lenses, tap water rinsing

💥 Eye trauma

🧬 Immunosuppression

💧 Dry eyes

💼 High-risk jobs (e.g. welders, lab workers)

💡Mnemonic:

“Painful Red Eye? Think 4PAD.”

4PAD = Foreignbody sensation, Pain, Redness, Photophobia, Discharge

🔍Diagnosis

🔎Slit lamp exam — look for opacity, infiltrates, ulcer

🧪Corneal scraping +culture — for bacteria, fungi

🧬PCR — useful for viruses, Acanthamoeba

🧫Fluorescein staining — to reveal ulcers

📷OCT or confocal microscopy— advanced cases

💊Management

🎯 Depends on the cause:

🦠Infectious

• Topicalantibiotics (e.g. fluoroquinolones)

• Antivirals (e.g.acyclovir for HSV)

• Antifungals (e.g.natamycin)

• Oral or IV medsfor severe cases

🧘Non-infectious

• Lubricating drops

• Topical steroids(specialist use only)

• Treat underlyingcause (dry eye, autoimmune)

🆘Key Rule for MSRA:

If a contact lens wearer presents with a painful red eye — assume microbial keratitis until proven otherwise.

🛑 Stop lens use

💉 Start broad-spectrum antibiotic drops

📞 Urgent same-day ophthalmology referral

💡Mnemonic:

“Red, Painful, No Contacts Now” = Stop lenses,Treat immediately, Refer fast.

📉Complications

❌ Corneal scarring (→ permanent vision loss)

❌ Corneal perforation

❌ Secondary endophthalmitis

❌ May need corneal transplant if severe

💡 Prognosis: GOOD if treated early. BAD if delayed.

🧠Summary Recap

• Keratitis =corneal inflammation (infectious or not)

• Risk ↑ withcontact lenses, trauma, poor hygiene

• Red, painful,photophobic eye = RED FLAG

• Treat underlyingcause

• Urgent referral ifinfection suspected

🧠 Ready to reinforce your learning?

📚 Keratitis Revision Notes:

https://www.passthemsra.com/topic/keratitis-revision-notes/

🃏 Flashcards:

https://www.passthemsra.com/topic/keratitis-flashcards/

📂 Accordion Q&A Notes:

https://www.passthemsra.com/topic/keratitis-accordion-qa-notes/

🧪 Rapid Quiz:

https://www.passthemsra.com/topic/keratitis-rapid-quiz/

🎯 Practice Questions:

https://www.passthemsra.com/quizzes/keratitis/

🌐 For full revision support:

https://www.passthemsra.com

🎁 Free learning tools:

https://www.freemrsra.com

Thanksfor tuning into this DeepDive on Keratitis — because visionmatters, and knowledge saves sight. See you in the next one! 🎙️👁️

#MSRA #MSRARevision#PassTheMSRA #FreeMSRA #Keratitis #RedEye #MedicalEducation #GPTraining#OphthalmologyMSRA #MSRAFlashcards #MSRAQuiz #SightThreatening#ContactLensRisks #MSRAAccordions #MultiSpecialtyRecruitmentAssessment

🩺HypertensiveRetinopathy – When Blood Pressure Hits the Retina

Welcome to the DeepDive. In this episode, we’re unpacking hypertensiveretinopathy — a key ophthalmology topic and classic MSRA favourite.

We’ll take youthrough what it is, how it develops, how it looks on fundoscopy, and why it's avital clue to wider systemic disease. All explained clearly, with mnemonics andclinical pearls to make it stick.

👁️Definition:

Hypertensiveretinopathy = retinal damage from chronic highblood pressure. The sustained vascular pressure causes progressivechanges in retinal arterioles, leading to visual changes and a reflection ofsystemic risk.

🧠Grading –Keith-Wagner-Barker Classification (Stages I–IV):

🔹Stage I

• Arteriolar narrowing
• “Silver wiring” – shiny, reflective vessels
• 🧠 Mnemonic: Skinny, wiggly, silver vessels

🔹Stage II

• AV nicking/nipping (artery compresses underlying vein)
• 🧠 Mnemonic: Artery nips the vein

🔹Stage III

• Cotton wool spots (nerve fibre infarcts)
• Flame + blot hemorrhages
• Hard exudates (macular star possible)
• 🧠 Mnemonic: Fluffy white & red spots, star in the centre

🔹Stage IV

• Papilledema (optic disc swelling)
• Sign of malignant hypertension – emergency
• 🧠 Mnemonic: Papa of all signs

🧬Pathophysiology:

🔸 High BP → endothelial damage → arteriolosclerosis

🔸 Vessel narrowing → ischemia → cotton wool spots

🔸 Leakage → hemorrhages, exudates

🔸 Severe ↑BP → optic disc swelling (papilledema)

⚠️Risk Factors:

• Long-standing hypertension
• Poor BP control
• Smoking, diabetes, obesity, sedentary lifestyle
• Increasing age

🔍Clinical Features:

🧑‍⚕️Exam findings(Fundoscopy)

• Narrowed/tortuous vessels
• AV nicking
• Hemorrhages (flame/blot)
• Cotton wool spots
• Hard exudates
• ± Papilledema in severe disease

👁️Patient symptoms

• Often asymptomatic early
• Blurred vision, visual field loss in advanced stages

🩻Investigations:

• Dilated fundoscopy
• OCT (for macular oedema)
• Fundus photography
• Fluorescein angiography (if needed)
• BP monitoring – essential for diagnosis and management

💊Management:

✔️Primary aim: Control blood pressure

• Antihypertensives
• Lifestyle changes: stop smoking, exercise, healthy diet
• Regular retinal exams
  ✔️ Urgent ophthalmology referral for stage IV/malignant hypertension

📈Prognosis:

• Good if BP is controlled early
• Some changes are reversible
• If untreated → risk of permanent vision loss, macular oedema, or optic neuropathy

🚨Complications toKnow:

• Visual field loss
• Retinal haemorrhages
• Macular oedema
• Ischemic optic neuropathy
• Retinal detachment (rare)

📚Useful Resources

• Revision Notes → https://www.passthemsra.com/topic/hypertensive-retinopathy-revision-notes/

• Flashcards → https://www.passthemsra.com/topic/hypertensive-retinopathy-flashcards/

• Accordion Q&A→ https://www.passthemsra.com/topic/hypertensive-retinopathy-accordion-qa-notes/

• Rapid Quiz → https://www.passthemsra.com/topic/hypertensive-retinopathy-rapid-quiz/

• Quiz Link → https://www.passthemsra.com/quizzes/hypertensive-retinopathy/

🧠MSRA Key Takeaway:

Hypertensiveretinopathy is not just an eye issue — it's a red flag for systemic vascular damage. Know the grading,know the signs, and remember: BP control =retina protection.

🔗 Check out PassTheMSRA.com and FreeMSRA.com for more revision content, quizzes, and tools to sharpen your prep.

#MSRA#HypertensiveRetinopathy #Ophthalmology #MSRAQuiz #Fundoscopy #Papilledema#AVNicking #CottonWoolSpots #PassTheMSRA #FreeMSRA #MedicalRevision