RED EYE
Seminar presentation by:- Health
officer students(III year)
MODERATORS:
DR. JAFAR KEDIR
DR. SISAY BEKELE
07/08/13 RED EYE 2
Objectives
At the end of this presentation you should know:
The approach to a patient with a red eye.
How to distinguis...
Outline
Approach to a patient with a RED EYE.
Brief discussion of DDx of RED EYE and their
managements.
Summary
07/08/1...
Introduction
 A "red eye" is a common presenting complaint.
 Some patients need urgent ophthalmic referral and
treatment...
Causes of Red eye
Referred to
ophthalmologists
Manageable by primary care
clinician
 ACG
 Hyphema
 Hypopyon
 Iritis
 ...
History
Duration
Unilateral/bilateral
Pain and its severity
Vision
Foreign body sensation
Photophobia
Trauma
07/08/...
Cont’d…
Contact lens use
Discharge, other than tears, that continues
throughout the day
 Previous treatments
Allergies...
General observation and P/E
Objective foreign body sensation.
Objective photophobia.
Signs of rhinorrhea, lymphadenitis...
Ophthalmologic examination
 Visual acuity (in crude categories)
 Penlight examination
 Eyelids and lacrimal sac
 Purul...
Cont’d…
 Severe pain is not relieved
with topical anesthetics;
topical steroids are
needed; or the patient has
vision los...
Summary of how to Dx Red eye
07/08/13 RED EYE 13
Con’t…
07/08/13 RED EYE 14
Angle closure glaucoma
Iritis
Hyphema
Hypopyon
Keratitis (Infectious)
Bacterial
Viral
07/08/13 RED EYE 15
Causes of...
Normal Aqueous flow
07/08/13 RED EYE 16
1.Acute angle-closure glaucoma
07/08/13 RED EYE 17
The iris root occludes the trabecular meshwork, completely obstructing ...
cont’d…
- Results in a sudden severe rise in IOP
- May be acute and painful or chronic asymptomatic
- Due to occlusion of ...
Sign and symptom
Symptoms:
 Rapid unilateral loss of vision
 Periocular pain and head ache
 Red eye
 photophobia
 Nau...
Sign and symptom con’t…
Signs
Marked conjunctival and ciliary injection
Shallow AC and corneal edema
Decreased VA
Aqu...
Treatment
 Medical
 Dimox po
 Pilocarpine eye drops
 Stretch the peripheral iris and open the angle
 Oral acetazolami...
2. Iritis(Anterior Uveitis)
 Inflammation of the Iris (anterior uveal tract)
 Is usually autoimmune and of unknown ethio...
Iritis con’t…
Both conditions manifest with:-
 Ciliary injection
 The cornea and AC marginally hazy from inflammatory c...
C/F
Reddened eye, especially adjacent to the iris
Decreased vision
Pain in the eye or brow region
Worsened eye pain wh...
Iritis Exams and Tests
Dx is confirmed by examining the eye with a slit
lamp
Cells (WBC) and flare (particles of protein...
Treatment
Rule out inflamation of the posterior segment of
eye
Topical steroids
Dilating drops(Cycloplegics)
Relief pa...
AACG Vs Iritis
07/08/13RED EYE 27
3. Hyphema
It is blood in the front
(anterior chamber)
It may appear as a reddish
tinge/small pool of blood
at the botto...
Hyphema con’t…
Causes:-
Blunt /lacerating trauma
Intraocular surgery
Spontaneously
 Iris melanoma, keratouveitis (e.g...
Traumatic hyphema
Complications of traumatic hyphema
Increased intraocular pressure
Peripheral anterior synechiae
Opti...
Treatment
It is important to identify and treat associated ocular injuries, which
often accompany traumatic hyphema.
We ...
4. Hypopyon
It is pus in the eye.
It is a leukocytic exudate, seen in the anterior
chamber, usually accompanied by
Redn...
Hypopyon
Ethiologies
Fungal:-
Aspergillus and Fusarium sp
.,Behcet'sdisease,
Endophthalmitis, and
panuveitis/panophthal...
5. Keratitis
Inflammation of the cornea
Infectious causes:
Bacterial
 S.aureus,
P.aeruginosa,Staphylococcus,
S.pneumon...
Risk factors
Overnight wear of contact lenses
It can occur in patients who do not wear contact lenses
or who wear them o...
Signs and Symptoms
Symptoms
Pain
FB sensation
Blurred vision
Photophobia
Signs
Perilimbal redness
Reduction of visio...
Herpetic keratitis
07/08/13 RED EYE 37
Treatment
Herpes simplex dendritic ulcer
Topical acyclovir eye ointment
Bacterial corneal ulcer
Broad spectrum antibio...
07/08/13 RED EYE 39
keratitis Iritis PACG
symptom Pain/photopho
bia
Pain/photophobia Severe pain
discharge watery watery w...
Red eye manageable by primary
care clinician
Conjunctivitis
Blepharitis
Subconjunctival haemorrhage
Corneal abrasion
...
1. Conjunctivitis
 Commonest cause of red eye and most common
infectious eye disease
 Cause:-infectious e.g viral,bacter...
Bacterial Conjunctivitis
 Acute bacterial conjunctivitis
-caused by direct eye contact with infected secretions
Symptoms...
Clinical features:
 Conjunctiva injection
 Mucopurulent discharge
 Crusted eyelid margin
 eyelid edema
07/08/13 RED E...
Cont’d …
 Diagnosis:
 Clinical
 Gram stain &Culture
 Neonates or immunocompromised hosts
 Severe purulent discharge
...
Cont’d …
Chronic bacterial conjunctivitis
-Sign & symptom-persistes for at least 4 wks with
frequent relapses.
Hyperacut...
Ophthalmia Neonatorum
Inflammation of the conjunctiva within one month of
life
Purulent/mucoid discharge one or both eye...
Ophthalmia Neonatorum
Chlamydial trachomatis (developed countries)
Neisseria gonorrhea (developing countries)?
Rx
 Cho...
Viral conjunctivitis
Avoid unnecessary treatment with antibiotics and
wrong use of steroids.
Adenovirus (3,8,19) common ...
Cont’d …
Adenoviral keratoconjunctivitis
 the most common external ocular viral infection that
may be sporadic or occur ...
Cont’d …
Presentation is usually with unilateral watering ,
redness , discomfort and photophobia
Eyelid oedema and tende...
Allergic conjunctivitis
 Often associated with atopic disease such as allergic
rhinitis, eczema, asthma.
 two types:
1. ...
Cont’d…
Treatment
Remove the allergen if identified
h1 receptorantagonist
-(Azalastine,emedastine)
Mast cell stabilize...
Allergic conjunctivitis
07/08/13 RED EYE 53
Condition Signs Symptoms Causes
Viral conjunctivitis
Normal pupil size
&rxn to light
Diffuse conjunctiva
injection,
Preaur...
2. Eyelid disorders
 Blepharitis:Is a chronic inflammatory condition of eye lid margins
classification
 Anterior bleferi...
Cont’d …
Posterior blepharitis
 It is caused by meibomian gland dysfunction
 Bacterial lipase results in formation of f...
Cont’d…
07/08/13 RED EYE 57
3. Subconjunctival hemorrhage
 It is spontaneous subconjucitival
haemorrhage
• usually no symptoms; pointed out by
observ...
4. Corneal abrasion
 It is a defect in epithelial surface of cornea that is
caused by mechanical trauma to the surface of...
Figure : Linear corneal abrasions stained with fluorescein.07/08/13 RED EYE 60
5. Corneal foreign bodies
Are extremely common and cause irritation.
Leukocytic infiltration.
Secondary infection and c...
Figure : Corneal foreign body07/08/13 RED EYE 62
Cont’d…
Rx:
1. The foreign body is removed under slit-lamp
visualization.
2. Magnetic removal may be useful for a deeply
e...
Tips in corneal foreign bodies
 Any discharge, infiltrate or significant uveitis,
should raise suspicion of secondary bac...
6. Dry eye(keratoconjunctivitis
sica)
Its Cause;-decreased tear production
Associated with:-
increased age
Female sex
...
07/08/13 RED EYE 66
7. Episcleritis
Episcleritis: an acute inflammation of subconjuctival
episcleral tissue.
Sign and symptom:
Tearing,
ph...
Episcleritis
07/08/13 RED EYE 68
8. Scleritis
It is a severe inflammation of sclera may result in
melting and perforation.
Associated with systemic disea...
condition sign symptoms cause
Dry
eye(keratoconjuc
tivitis sicca)
hyperemia, no
corneal involvement
mild pain,
intermitten...
summary
Cause of red eye can be diagnosed through detailed
patients history & careful eye examination
Treatment is based...
References
Uptodate 19.3
Kanski clinical ophthalmology, a systematic
approach, 6th
edition.
American Family Physician, ...
07/08/13 RED EYE 73
Chala kenenisa,ophtha seminarppt.
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Chala kenenisa,ophtha seminarppt.

  1. 1. RED EYE
  2. 2. Seminar presentation by:- Health officer students(III year) MODERATORS: DR. JAFAR KEDIR DR. SISAY BEKELE 07/08/13 RED EYE 2
  3. 3. Objectives At the end of this presentation you should know: The approach to a patient with a red eye. How to distinguish patients who must be referred to an ophthalmologist from patients who can be managed by the primary care clinician. The management of the self limiting red eyes. 07/08/13 RED EYE 3
  4. 4. Outline Approach to a patient with a RED EYE. Brief discussion of DDx of RED EYE and their managements. Summary 07/08/13 RED EYE 4
  5. 5. Introduction  A "red eye" is a common presenting complaint.  Some patients need urgent ophthalmic referral and treatment.  Vast majority can be treated by the primary care clinician.  Conjunctivitis (allergic or viral) is probably the most common cause of red eye in the community setting. 07/08/13 RED EYE 5
  6. 6. Causes of Red eye Referred to ophthalmologists Manageable by primary care clinician  ACG  Hyphema  Hypopyon  Iritis  Infectious keratitis  Bacterial  Viral  Conjunctivitis  Eye lid disorders  Subconjunctival hemorrhage  Corneal abrasion  Corneal FB  Episcleritis  Dry eye syndrome 07/08/13 RED EYE 6
  7. 7. History Duration Unilateral/bilateral Pain and its severity Vision Foreign body sensation Photophobia Trauma 07/08/13 RED EYE 8
  8. 8. Cont’d… Contact lens use Discharge, other than tears, that continues throughout the day  Previous treatments Allergies or Systemic diseases. 07/08/13 RED EYE 9
  9. 9. General observation and P/E Objective foreign body sensation. Objective photophobia. Signs of rhinorrhea, lymphadenitis or other URTIs. 07/08/13 RED EYE 10
  10. 10. Ophthalmologic examination  Visual acuity (in crude categories)  Penlight examination  Eyelids and lacrimal sac  Purulent discharge  The pattern of redness and its appearance  White spot, opacity or foreign body on the cornea  Hypopyon or hyphema  Pupil reaction to light  Pupil very small (1 to 2 mm) in size  Slit lamp biomicroscope 07/08/13 RED EYE 11
  11. 11. Cont’d…  Severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss,  Copious purulent discharge,  Corneal involvement,  Traumatic eye injury,  Recent ocular surgery,  Distorted pupil,  Herpes infection, or  Recurrent infections. 07/08/13 RED EYE 12 Generally referral is necessary when:-
  12. 12. Summary of how to Dx Red eye 07/08/13 RED EYE 13
  13. 13. Con’t… 07/08/13 RED EYE 14
  14. 14. Angle closure glaucoma Iritis Hyphema Hypopyon Keratitis (Infectious) Bacterial Viral 07/08/13 RED EYE 15 Causes of red eye needing referral:-
  15. 15. Normal Aqueous flow 07/08/13 RED EYE 16
  16. 16. 1.Acute angle-closure glaucoma 07/08/13 RED EYE 17 The iris root occludes the trabecular meshwork, completely obstructing drainage of aqueous fluid from the anterior chamber. The resulting rapid elevation of intraocular pressure requires urgent intervention to prevent permanent visual loss.
  17. 17. cont’d… - Results in a sudden severe rise in IOP - May be acute and painful or chronic asymptomatic - Due to occlusion of anterior chamber angle - May cause permanent visual loss from optic nerve damage 07/08/13 RED EYE 18
  18. 18. Sign and symptom Symptoms:  Rapid unilateral loss of vision  Periocular pain and head ache  Red eye  photophobia  Nausea and vomiting 07/08/13 RED EYE 19
  19. 19. Sign and symptom con’t… Signs Marked conjunctival and ciliary injection Shallow AC and corneal edema Decreased VA Aqueous flare and cell Vertically oval, fixed and semidilated pupil Dilated iris blood vessels Severely elevated IOP (50-100) mmHg Gonioscopy of the other eye shows occludable angle 07/08/13 RED EYE 20
  20. 20. Treatment  Medical  Dimox po  Pilocarpine eye drops  Stretch the peripheral iris and open the angle  Oral acetazolamide  Reduce IOP by inhibiting aqueous fluid production  Control inflammation - steroids / NSAIDs  Surgery  Laser peripheral iridotomy  Surgical peripheral iridectomy  Trabeculectomy :- uncontrolled IOP, chronic 07/08/13 RED EYE 21
  21. 21. 2. Iritis(Anterior Uveitis)  Inflammation of the Iris (anterior uveal tract)  Is usually autoimmune and of unknown ethiology  Can be a consequence of blunt trauma (traumatic iritis) or nontraumatic iritis is associated with certain diseases like 07/08/13 RED EYE 22  Tuberculosis  Syphilis  Toxoplasma  Reactive arthritis  Is often very similar to AACG in appearance
  22. 22. Iritis con’t… Both conditions manifest with:-  Ciliary injection  The cornea and AC marginally hazy from inflammatory cells  The eye is moderately painful in the early stages of the condition.  There are two key differences based on IOP and Pupil size  In AACG the IOP becomes very high (50-80 mm Hg) rapidly  In iritis the IOP is usually somewhat low; however, IOP can be elevated if there are a lot of inflammatory cells (flare) in the anterior chamber  The iritic pupil is typically constricted and poorly reactive to light with posterior adhesions on the lens (synechiae), which may give the pupil an irregular shape 07/08/13 RED EYE 23
  23. 23. C/F Reddened eye, especially adjacent to the iris Decreased vision Pain in the eye or brow region Worsened eye pain when exposed to bright light Small pupil or irregular and reacts poorly to light Blurred vision Headache 07/08/13 RED EYE 24
  24. 24. Iritis Exams and Tests Dx is confirmed by examining the eye with a slit lamp Cells (WBC) and flare (particles of protein) in AC Keratic precipitates(KPs)  Clumps of inflamatory cells over cornea) Ophtalmoscopy:- Normal vitreous and retina unless posterior uveitisis involved Topical anesthetics do not relieve the pain associated with iritis 07/08/13 RED EYE 25
  25. 25. Treatment Rule out inflamation of the posterior segment of eye Topical steroids Dilating drops(Cycloplegics) Relief pain Prevent synechiae formation 07/08/13 RED EYE 26
  26. 26. AACG Vs Iritis 07/08/13RED EYE 27
  27. 27. 3. Hyphema It is blood in the front (anterior chamber) It may appear as a reddish tinge/small pool of blood at the bottom of the iris or in the cornea. A sign of significant blunt or penetrating trauma to the globe 07/08/13 RED EYE 28
  28. 28. Hyphema con’t… Causes:- Blunt /lacerating trauma Intraocular surgery Spontaneously  Iris melanoma, keratouveitis (e.g., herpes zoster)  Leukemia  Hemophilia,  Use of substances that alter platelet or thrombin function (e.g., ethanol, aspirin, warfarin) 07/08/13 RED EYE 29
  29. 29. Traumatic hyphema Complications of traumatic hyphema Increased intraocular pressure Peripheral anterior synechiae Optic atrophy Corneal bloodstaining Secondary hemorrhage, and accommodative impairment 07/08/13 RED EYE 30
  30. 30. Treatment It is important to identify and treat associated ocular injuries, which often accompany traumatic hyphema. We recommend activity restriction (quiet ambulation) Medications  Cycloplegics,  Systemic or topical steroids  Antifibrinolytic agents,  Analgesics and antiglaucoma medications  Rigid shield. Indications for surgical intervention include  Presence of corneal blood staining  Dangerously increased intraocular pressure despite maximum tolerated medical therapy, among others. 07/08/13 RED EYE 31
  31. 31. 4. Hypopyon It is pus in the eye. It is a leukocytic exudate, seen in the anterior chamber, usually accompanied by Redness of the conjunctiva and the underlying episclera. Formation of the exudate w/c settles at the bottom due to gravity. It is sight-threatening infectious keratitis or endophthalmitis until proven otherwise. 07/08/13 RED EYE 32
  32. 32. Hypopyon Ethiologies Fungal:- Aspergillus and Fusarium sp .,Behcet'sdisease, Endophthalmitis, and panuveitis/panophthalmitis 07/08/13 RED EYE 33
  33. 33. 5. Keratitis Inflammation of the cornea Infectious causes: Bacterial  S.aureus, P.aeruginosa,Staphylococcus, S.pneumoniae Viral  HSV 07/08/13 RED EYE 34 - With red eye, photophobia, and foreign body sensation shows infectious keratitis.
  34. 34. Risk factors Overnight wear of contact lenses It can occur in patients who do not wear contact lenses or who wear them on a daytime only basis. Breakdown in local or systemic host defense mechanisms, including Dry ocular surfaces Topical corticosteroid use predispose to bacterial Immunosuppression keratitis 07/08/13 RED EYE 35
  35. 35. Signs and Symptoms Symptoms Pain FB sensation Blurred vision Photophobia Signs Perilimbal redness Reduction of vision Dendritic ulcer (Viral) Corneal inflitrate(Bact, fungal) Fluorescein and Rosebengal dye  Pooling over the ulcer  Dendrites/pseudodendrites  Staining of devitalized cells Hypopyon- in severe cases 07/08/13 EYE 36
  36. 36. Herpetic keratitis 07/08/13 RED EYE 37
  37. 37. Treatment Herpes simplex dendritic ulcer Topical acyclovir eye ointment Bacterial corneal ulcer Broad spectrum antibiotics Take sample for culture and sensitivity test Fungal Keratitis Antifungal ointments NB: Steriods agravate viral and fungal corneal ulcer and keratitis so DON’T GIVE 07/08/13 RED EYE 38
  38. 38. 07/08/13 RED EYE 39 keratitis Iritis PACG symptom Pain/photopho bia Pain/photophobia Severe pain discharge watery watery watery vision blurry blurry blurry Hyperemia cilliary cilliary cilliary Cornea altered altered steamy Pupil +/-miosis miosis Mid dilated IOP normal +/- normal elevated Table 1. DDx of Red Eye
  39. 39. Red eye manageable by primary care clinician Conjunctivitis Blepharitis Subconjunctival haemorrhage Corneal abrasion Corneal FB Episcleritis Dry eye syndrome 07/08/13 RED EYE 40
  40. 40. 1. Conjunctivitis  Commonest cause of red eye and most common infectious eye disease  Cause:-infectious e.g viral,bacterial,clamidial -noninfectious e.g allergic  Symptoms:  FB or gritting sensation,  Signs: swollen eye lids,  matted lashes,  ocular hyperemia (diffuse)  Etiology:  Staphylococcus,  pneumococcus, or hemophillus  Transmission: Finger, fomites and flies 07/08/13 RED EYE 41
  41. 41. Bacterial Conjunctivitis  Acute bacterial conjunctivitis -caused by direct eye contact with infected secretions Symptoms and Signs <3-4 wks Acute onset of redness ,grittness,burning and mucopurulent discharge Usually bilateral On waking the eyelids are frequently stuck together and difficult to open. Cause;-S.aureus in adults S.pneumonai & H.influenza in children 07/08/13 RED EYE 42
  42. 42. Clinical features:  Conjunctiva injection  Mucopurulent discharge  Crusted eyelid margin  eyelid edema 07/08/13 RED EYE 43 Cont’d …
  43. 43. Cont’d …  Diagnosis:  Clinical  Gram stain &Culture  Neonates or immunocompromised hosts  Severe purulent discharge  Cases unresponsive to initial RX  Treatment  Most are self limited but antibiotics speed recovery and prevent recurrence 1. Drops: CAF, ciprofloxacin or other fluoroquinolones, gentamicin, tobramycin, 2. Ointments: CAF, genta, TTC, erythromycin… 07/08/13 RED EYE 44
  44. 44. Cont’d … Chronic bacterial conjunctivitis -Sign & symptom-persistes for at least 4 wks with frequent relapses. Hyperacute bacterial conjunctivitis -Infection has sudden onset & progress rapidly leading to corneal perforation  Ophthalmia Neonatorum 07/08/13 RED EYE 45
  45. 45. Ophthalmia Neonatorum Inflammation of the conjunctiva within one month of life Purulent/mucoid discharge one or both eyes Cause  Chemical(silver nitrate)  Chlamydia trachomatics  Neisseria gonorrhea  Staph aureus, Staph. Epidermidis, Strept. Pneumoniae/viridans, gram negatives  Herpes simplex 07/08/13 RED EYE 46
  46. 46. Ophthalmia Neonatorum Chlamydial trachomatis (developed countries) Neisseria gonorrhea (developing countries)? Rx  Choice of antibiotic same as adults except systemic Tetracyclines are contraindicated in neonates Prophylaxis  1% Tetracycline  0.5% Erythromycin 07/08/13 RED EYE 47
  47. 47. Viral conjunctivitis Avoid unnecessary treatment with antibiotics and wrong use of steroids. Adenovirus (3,8,19) common cause of acute follicular conjunctivitis (PCF) Herpes simplex conjunctivitis. Signs and Symptoms: pain, photophobia, tearing, edema of the lids, chemosis, hyperemia, sub epithelial infiltrates, +/- fever, sore throat and LAP Treatment: Cold compresses 07/08/13 RED EYE 48
  48. 48. Cont’d … Adenoviral keratoconjunctivitis  the most common external ocular viral infection that may be sporadic or occur in epidemics in hospitals , schools and factories o Transmission-by respiratory or ocular secretion and dissemination is by contaminated equipment such as towels , tonometer head 07/08/13 RED EYE 49
  49. 49. Cont’d … Presentation is usually with unilateral watering , redness , discomfort and photophobia Eyelid oedema and tender pre-auricular LAP Severe infection may result in conjunctival hemorrhage 07/08/13 RED EYE 50
  50. 50. Allergic conjunctivitis  Often associated with atopic disease such as allergic rhinitis, eczema, asthma.  two types: 1. Seasonal allergic conjunctivitis – Onset during summer and spring – Allergens are tree and grass pollens 1. Perennial allergic conjunctivitis – Symptomatic throughout the year – Allergens are house dust mites, animal dander… 07/08/13 RED EYE 51
  51. 51. Cont’d… Treatment Remove the allergen if identified h1 receptorantagonist -(Azalastine,emedastine) Mast cell stabilizers (sodium cromoglycate, nedocromil, lodoxamide) Antihistamines (levocabastine, epinastine…) Steroids – only in severe cases 07/08/13 RED EYE 52
  52. 52. Allergic conjunctivitis 07/08/13 RED EYE 53
  53. 53. Condition Signs Symptoms Causes Viral conjunctivitis Normal pupil size &rxn to light Diffuse conjunctiva injection, Preauricular LAP Mild to no pain, diffuse hyperemia, mild itching, watery to serous discharge, Adenovirus Enterovirus, HSV, influenza Bacterial (acute & chronic) conjunctivitis Eyelid edema, conjunctival injunction, no corneal involvement Mild to moderate pain, purulent discharge, mucopurulent secretion with bilateral glued eyes In children;- S.pneumoniae H. Influenza In adults S.aureus Allergic conjunctiva injunction, no corneal involvement, large cobblestone papillae under upper eyelid, chemosis Bilateral eye involvement, painless tearing, intense itching, diffuse redness, watery discharge Airborne pollens dust mites, animal dander, ethers 07/08/13 RED EYE 54 Table 2. Summary of conjuctivitis
  54. 54. 2. Eyelid disorders  Blepharitis:Is a chronic inflammatory condition of eye lid margins classification  Anterior bleferitis  Posterior bleferitis  Chronic Anterior blepharitis  It is inflammation around the base of eyelashes  It is staphylococcal or seborrhoeic  Symptoms  Burning, grittiness, mild photophobia  Symptoms worsen in the morning  Treatment  Lid hygiene  Antibiotics  Weak topical steroid 07/08/13 RED EYE 55
  55. 55. Cont’d … Posterior blepharitis  It is caused by meibomian gland dysfunction  Bacterial lipase results in formation of free fatty acid  Symptoms  Similar to anterior blepharitis  signs  Erythema and telangiectasia of posterior lid margin  Oily and foamy tear  Frothy discharge on lids  Treatment  Lid hygiene  Systemic tetracycline  Topical steroids 07/08/13 RED EYE 56
  56. 56. Cont’d… 07/08/13 RED EYE 57
  57. 57. 3. Subconjunctival hemorrhage  It is spontaneous subconjucitival haemorrhage • usually no symptoms; pointed out by observer • blood red patch on eye • spontaneous or associated with coughing, sneezing, and staring  Management • Eliminated trauma • Ask about medication such as asprin, or warfarin • Reassure the pt that it will take about two weeks to resolve 07/08/13RED EYE 58
  58. 58. 4. Corneal abrasion  It is a defect in epithelial surface of cornea that is caused by mechanical trauma to the surface of the eye  Classification:-  traumatic corneal abrasion  foreign body related abrasion  contact lens related abrasion  Treatment  Supportive care  Cycloplegics(atropin,cyclopentolase)  Pain control(NSAIDS)  Topical antibiotics07/08/13 RED EYE 59
  59. 59. Figure : Linear corneal abrasions stained with fluorescein.07/08/13 RED EYE 60
  60. 60. 5. Corneal foreign bodies Are extremely common and cause irritation. Leukocytic infiltration. Secondary infection and corneal ulceration. Mild secondary uveitis is common with irritative miosis and photophobia. Ferrous foreign bodies→rust staining of the bed of the abrasion. 07/08/13 RED EYE 61
  61. 61. Figure : Corneal foreign body07/08/13 RED EYE 62
  62. 62. Cont’d… Rx: 1. The foreign body is removed under slit-lamp visualization. 2. Magnetic removal may be useful for a deeply embedded metallic foreign body. 3. A residual 'rust ring' is easiest to remove with a sterile 'burr'. if available. 4. Antibiotic ointment is instilled together with a cycloplegic and/or ketorolac to promote comfort. 07/08/13 RED EYE 63
  63. 63. Tips in corneal foreign bodies  Any discharge, infiltrate or significant uveitis, should raise suspicion of secondary bacterial infection and be managed as for a corneal ulcer.  Metallic foreign bodies are often sterile due to acute rise in temperature during transit through the air but organic and stone foreign bodies, however, carry a higher risk of infection. 07/08/13 RED EYE 64
  64. 64. 6. Dry eye(keratoconjunctivitis sica) Its Cause;-decreased tear production Associated with:- increased age Female sex medication(e.g anticholinergic) Treatment Application of artificial tear Use of well fitting eye glasses with side shields Cyclosporine ophthalmic drops 07/08/13 RED EYE 65
  65. 65. 07/08/13 RED EYE 66
  66. 66. 7. Episcleritis Episcleritis: an acute inflammation of subconjuctival episcleral tissue. Sign and symptom: Tearing, photophobia, and tenderness. Localized episcleral(s/c) hyperemia. Treatment: Self-limiting but NSAID and Corticosteroids. 07/08/13 RED EYE 67
  67. 67. Episcleritis 07/08/13 RED EYE 68
  68. 68. 8. Scleritis It is a severe inflammation of sclera may result in melting and perforation. Associated with systemic diseases such as RA and other connective diseases. Sign and Symptoms: Severe pain aggravated with ocular motility. Hyperemia, tenderness and +/- fever, arthralgia. Treatment: medical evaluation,  corticosteroids,  NSAID and immunosupressants. 07/08/13 RED EYE 69
  69. 69. condition sign symptoms cause Dry eye(keratoconjuc tivitis sicca) hyperemia, no corneal involvement mild pain, intermittent excessive watering Imbalance in any tear component, medication Blepharitis Danbroff-like scaling on eyelashes, swollen eyelids, Red, irritated eye that worse up on walking, crusted eyelids Staphylococcal infection Corneal abrasion Reactive miosis, corneal edema or haze, normal anterior chamber, visual acuity depends on position of abrasion Unilateral or bilateral sever eye pain, red watery eyes, photophobia, foreign body sensation Direct injury from an object(e.g finger, paper,stick) contact lenses Subconjuctival hemorrhage bright red patch on white sclera, no corneal involvement Mild to no pain, no vision disturbance no discharge Spontaneous cause HTN, sever coughing, straining, bleeding disorders, blunt eye trauma 07/08/13 RED EYE 70 Table 3. Summary of DDx of red eye
  70. 70. summary Cause of red eye can be diagnosed through detailed patients history & careful eye examination Treatment is based on underlying etiology Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye 07/08/13 RED EYE 71
  71. 71. References Uptodate 19.3 Kanski clinical ophthalmology, a systematic approach, 6th edition. American Family Physician, Volume 81, Number 2, January 2010. (www.aafp.org/afp) 07/08/13 RED EYE 72
  72. 72. 07/08/13 RED EYE 73

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