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The Red Eye
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The Red Eye

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  • 1. The red eye Dr. May Bakkar
  • 2. Lecture outline • • • • • Blood supply to the eye Related anatomic structure Symptoms and signs-based on cause Diagnosis Summary
  • 3. Assessment of dry eye History Good examination Better diagnosis and management of the red eye
  • 4. Related anatomical structures to the red eye • Lids • Conjunctiva • Episclera • Sclera • Cornea • Anterior Chamber • Orbit
  • 5. Lids • Allergy • Blepharitis - itching, burning, FB sensation – tearing – crusting – inspissated oil glands – swollen lids – conjunctival injection – Rx - lid hygiene, topical antibiotic, oral doxycycline
  • 6. Red eye related to the Conjunctiva • Subconjunctival Haemorrhage • Conjunctivitis – Bacterial – Viral – Allergic • Conjuntivitis in infants • Other conjunctival lesions
  • 7. Subconjunctival Haemorrhage •No pain or mild discomfort • No disturbance of vision • May be history of trauma – exclude foreign body • Well demarcated area • No discharge • Check for areas of other bruising, history of anticoagulants • (?Check BP, ? Anticoagulant status, ? FBC)
  • 8. Conjunctivitis-Bacteria • Discomfort – mild gritty • Discharge – mucopurulent • Lids - papillae • Systemic symptoms – nil • Normal Vision • No Staining of cornea • Rx – antibiotics eg Chloramphenicol
  • 9. Conjunctivitis -Viral • Discomfort – Mild Gritty • Photophobia -Slight/moderate • Secretion or discharge -Watery. • Visual acuity – normal or some instance reduced • Corneal opacities – subepithelial • Lids - follicles • Systemic symptoms- sometimes associated with sore throat or flu like symptoms • Pre-auricular lymph node may be swollen • Rx - conservative
  • 10. Conjunctivitis- Chlamydial • Discomfort - gritty • Photophobia -Variable • Discharge -Watery ± pus • Visual acuity – Normal, some instances Reduced • Lids – inf follicles • Preauricular node • Systemic symptoms – None, or related to STD (Sexually transmitted diseases) • Hyperaemia –Diffuse conjunctival • Cornea –clear. Late: pannus and/or diffuse fibrosis, also of conjunctiva • Rx – tetracycline or erythromycin orally, topical oflox and GUM referral
  • 11. Conjuctivitis-Allergic • Bilateral • Discomfort – itching • Discharge – clear • Seasonal • Concurrent systemic symptoms e.g., rhinitis • Chemosis • Papillae/cobblestones • Rx – avoidance of stimulus, mast cells stabilisers, antihistamines, steroids
  • 12. Conjunctivitis-infant • Immature local immunity • May result in serious corneal disease/blindness • May result in serious systemic disease • Ophthalmia neonatorum (< 1 month old) notifiable disease • May be contracted from STD in mother at birth • Causes bacterial, Chlamydia, gonorrhea, herpes • Conjunctival scrapes and cultures , specialist care
  • 13. Other conjunctival lesions • Malignancies – Haemangioma – Squamous cell carcinoma – Lymphomas Haemangioma Squamus cell carcinoma
  • 14. Red eye related to the- Episclera – pingueculum – pterygium – Episcleritis
  • 15. Pinguecula • A yellow-white deposit on the bulbar conjunctiva adjacent to the nasal or temporal aspect of the Limbus • These may become inflamed and cause an acute red eye • Histological examination shows degeneration of the collagen fibres of the conjunctiva/episclera • Rx Lubricants/ steroid
  • 16. Pterygium • Triangular sheet of fibrovascular tissue • Invades the cornea. • Patients who have been living in hot climates and may represent a response to chronic dryness and exposure to the sun. • These may become inflamed and cause an acute red eye.
  • 17. Episcleritis • Episcleral layer • Blanch with Phenylephrine 2.5% • May have underlying aetiology- e.g. rheumatoid factor (RhF) • Lubricants, topical steroid, oral NSAID (non steroidal antiinflammatory drugs)
  • 18. Red eye related to the- Sclera • Scleritis is frequently bilateral and, characteristically, associated with severe pain. • Purplish hue with involvement of the deep episcleral vessels • Systemic diseases are present in 50% of patients. • Rx – NSAIDs or Steroids
  • 19. Red eye related to the- Cornea • Marginal Keratitis • Bacterial Keratitis • Viral Keratitis • Amoebic Keratitis • Abrasions / dry eye
  • 20. Marginal Keratitis • Mild discomfort • Vision sl reduced • Mild photophobia • Usually assoc.blepharitis / contact lens • Rx lid hygiene, topical steroids + a/b
  • 21. Corneal Ulcers - Bacterial • • • • • • • • • May be associated with CL Pain+++ Reduced Vision Photophobia Discharge – Watery or Mucopurulent Corneal opacification Staining with Fluourescein Anterior chamber inflammation +/- hypopyon • Rx – antibiotics following scape
  • 22. Corneal ulcer-viral • Herpes simplex • Primary episode associated with vesicular rash • Recurrent • Pain++ • Photophobia • Discharge Watery • Reduced corneal sensation • Dendritic ulcer – highlighted by fluourescein • Rx antiviral
  • 23. Cornea-Acanthamoeba • History of CL wear • Photobobia • Discharge watery++ • Stroma Oedema • Prominent corneal Nerves • Ring infiltrates • Symptoms worse than signs
  • 24. Cornea-abrasion /foreign bodies
  • 25. Red eye related to the- Anterior chamber • Uveitis • Acute Angle Closure Glaucoma
  • 26. Uveitis • Previous history • Pain- moderate • Photophobia - Moderate / Severe • Secretion or discharge –Watery • Visual acuity – Poor • Onset -Gradual (1-2 days) • Systemic symptoms – Sometimes • Unilateral or bilateral
  • 27. Uveitis • Hyperaemia -Circumcorneal • purple + diffuse conjunctival • Cornea –Keratic precipitates • Anterior chamber -flare, cells +/• Hypopyon • Iris - Often hyperaemic • Pupil -Contracted +/- Synechiae • May have activity in posterior chamber and signs in fundus Sometime
  • 28. Acute angle closure Glaucoma
  • 29. Acute angle closure Glaucoma • Hypermetropia • Previous history • Episodes of blurring pain or haloes for an hour or two in some early evenings for a few weeks • Pain severe, radiating to forehead, with vomiting • Slight photophobia • Watery secretion or discharge • Visual acuity –reduced usually onset 2• 3 hours • Systemic symptoms- Often prostration • and vomiting because of pain • Unilateral usually • Age Usually 50 +
  • 30. Acute Angle Closure Glaucoma • Hyperaemia - Circumcorneal purple + diffuse, conjunctival • Corneal epithelial oedema • Anterior chamber shallow (N.B. see fellow eye) • Iris - Oedematous and hyperaemic • Pupil - Dilated, oval • Pupil light reflex - Absent or reduced • IOP- Very high • Tenderness - Marked
  • 31. Orbit • Thyroid eye disease – proptosis – pain/photophobia – reduced VA – lid retraction – lid lag – restriction of ocular movement – injection over muscle insertions – exposure keratopathy
  • 32. Summary-assessment • Onset • Duration • Pattern of redness • Presence of discomfort/pain/photophobia • Presence of discharge - watery/mucus/pus • Systematic examination of the eye
  • 33. Acknoweledgment • These lectures are kindly provided by the University of Manchester. Thanks for Dr Tarik Aslam.

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