NW2006 High-risked red eye for medical students

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NW2006 High-risked red eye for medical students

  1. 1. High Risked Red Eye Nawat Watanachai Ramathibodi Hospital Mahidol University
  2. 2. Low Risk Red Eye    Lid • Blepharitis Lacrimal system • Dacryocystitis Conjunctiva • Conjunctivitis • Pterygium & Pinguecula
  3. 3. High Risked Red Eye 1. 2. 3. 4. Corneal defects • Abrasion • Ulceration Acute glaucoma Acute uveitis Scleritis
  4. 4. 1. Corneal Defects  1.1 Abrasion 1.2 ulceration 
  5. 5. 1. Corneal defects 1.1 corneal abrasion - Only corneal epithelium lost - cleaner 1.2 cornel ulcer - Epithelium defect with stromal defect - Much more severe/ infected
  6. 6. 1.1 Corneal abrasion    History • Trauma Symptoms • Sudden Pain • Lacrimation • Photophobia • Blurred vision Signs • • • Ciliary injection Irregular light reflex Fluorescein staining
  7. 7. 1.1 Corneal Abrasion Rx         Remove FB+/Pressure patching Debridement Contact lens Lubrication Stromal puncture Generally cure in 24-48 hrs Watch closely for superimposed infection
  8. 8. 1.2 corneal ulceration    History • Trauma+/ Vegetative materials  Occupational accident • Immune defect Symptoms : pain, lacrimation, photophobia, blurred vision Sign : ciliary injection, white corneal stromal lesion, F stain
  9. 9. 1.2 Corneal ulceration   Infection • Bacteria : Staph, Strept, Pseudomonas, Bacillus • Fungus : Aspergillus, Penicillium • Virus : HSV, HZV • Parasite Non infection • Neurotrophic • Immune mediated
  10. 10. 1.2 Corneal Ulceration Rx     Antimicrobial agents • Broad spectrum • Rapidly heavily treat Cycloplegics Steroid +/Penetrating keratoplasty
  11. 11. 2. Acute glaucoma      Sudden onset of increasing intraocular pressure Pressure may as high as 50-60 mmHg Rapid optic nerve damage due to insufficient vascular supply Other structural damage Normal IOP is around 8-21 mmHg
  12. 12. 2. Acute glaucoma   angle-closure glaucoma • Primary • Secondary  Lens dislocation  Neovascular glaucoma Open-angle glaucoma • Acute uveitis • Phacolytic glaucoma
  13. 13. 2.Acute Angle-Closure Glaucoma  Mechanism • Relative pupillary block • Iris bombe • Iridotrabecular contact
  14. 14. 2. Acute Angle-Closure Glaucoma • Relatively common in Orientals • > 40 years • Women > men  POAG Risk factors • Increased lens thickness • Small corneal diameter • Short axial length
  15. 15. 2.Acute Angle-Closure Glaucoma Symptoms - Very severe Pain - Nausea & vomiting - Halos - Blurred vision - Marked red eye
  16. 16. 2.Acute Angle-Closure Glaucoma  Signs • Ciliary flush • Elevated IOP • Corneal edema • Fixed,oval, dilated pupil • Glaukomflecken
  17. 17. 2. Acute Angle-Closure Glaucoma  AIM • Decrease IOP • Restore vision • Prevent re-increase IOP
  18. 18. 2.Acute Angle-Closure Glaucoma Medical Rx      Hyperosmotic agents Carbonic anhydrase inhibitors Beta-blockers Alpha 2 agonists Miotics
  19. 19. 2.AACG Surgical Rx  Iridectomy : the definitive treatment
  20. 20. 2.AACG Surgical Rx   Goniosynechialysis For case of anterior synechia
  21. 21. 2.AACG Surgical Rx  Filtering surgery : trabeculectomy
  22. 22. ตั้งใจเรียนหน่อยครับ
  23. 23. 3. Uveitis Inflammation of the uveal tract Opaque media  blurred vision Inflammation  red, pain, swell Tissue damage  glaucoma, cataract, retinitis etc.
  24. 24. 3. Uveitis : Classification    Anatomical Clinical Etiological
  25. 25. 3. Uveitis : Anatomical Classification     Anterior uveitis Intermediate uveitis Posterior uveitis Panuveitis A I P
  26. 26. 3. Uveitis anatomical classification post ant
  27. 27. 3. Uveitis : Clinical classification   Acute • Sudden onset • < 6 week persistence • Recurrent chronic • Prolonged persistence • Less symptomatic
  28. 28. 3. Uveitis : Etiological Classification   Exogenous • Infectious eg. Toxoplasmosis, Toxocariasis, TB Endogenous • systemic diseases eg. SLE, RA • Idiopathic
  29. 29. 3.1 Anterior Uveitis  Symptoms • Photophobia • Pain • Decreased vision • Lacrimation
  30. 30. 3.1 Anterior Uveitis • Signs  Ciliary injection  Keratic precipitates  hypopyon  Aqueous cells/flare  Iris atrophy  Synechiae
  31. 31. 3.2 Intermediate Uveitis   Symptoms  Floaters  Decreased vision  Mild eye pain Signs  Anterior vitreous cells  Mild ciliary injection
  32. 32. 3.3 Posterior uveitis  Symptoms • Floaters • Impaired vision  Signs Vitreous cells/flare  Choroiditis  Retinits  Vasculitis 
  33. 33. 3. Uveitis & Arthritis     Ankylosing spondylitis Reiter’s syndrome Psoriatis arhritis Juvenile RA
  34. 34. 3. Uveitis & Systemic diseases Non-infectious Sarcoidosis Behcet’s disease Vogt-Koyanaki-Harada syndrome Infectious AIDS Acquired syphilis Tuberculosis Leprosy
  35. 35. 3. Uveitis & Infections    Parasite • Toxoplasmosis • Toxocariasis Fungus • Histoplasosis • Candidiasis Virus • Herpes zoster • Herpes simplex • Congenital rubella
  36. 36. 3.Uveitis Goal of Treatment Prevent visual complications  Relieve discomfort  Treat the underlying disease, if possible 
  37. 37. 3.Uveitis Treatment  Cycloplegics / mydriatics • Relieve ciliary spasm • Prevent posterior synechia formation • Synechialysis
  38. 38. 3.Uveitis Treatment Options   Steroids • Topical • Periocular • Systemic Side effects • Ocular Glaucoma  Cataract  Corneal complications  • Systemic
  39. 39. 3.Uveitis Treatment options  Immunosuppressive agents • Cytotoxic drugs • Cyclosporins 0001
  40. 40. 4. Scleritis   Diffuse Nodular -Inappropriate pain -Scleral thickening -Systemic disease -Not response to drugs
  41. 41. High and Low Risked Red Eye Red eye High risk Symptoms Pain Discomfort/ irritation Conjunctival constrict/ NR Normal/ reactive Injection Pupil Ciliary Dilate/ VA Red reflex IOP Decrease Decrease/ absent Increase/ decrease/ normal Cloudy/ irregular Cornea Low risk normal Normal normal Clear/ normal
  42. 42. May the ‘light’ be with you!

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