6. Laterality
• Infection may be unilateral initially but later
bilateral
• Allergy – usually bilateral, young
• Iritis / acute glaucoma – usually unilateral
6
7. Vision
• Transient blurring due to watery eyes /
discharge
• Persistent significant visual loss indicates more
serious disease
• Haloes – urgent!
7
8. General medical
• Headache, vomiting, eye pain – high IOP
• Hx of allergy, atopy, bronchial asthma, eczema
• Systemic assoc : iritis with sarcoidosis,
Ankylosing spondylitis, scleritis, CTD
• Acne rosacea assoc with blepharoconjunctivitis
• Hx of trauma to the eye – iritis, subconj
hemorrhage, glaucoma
8
9. General medical
• URTI accompanies infective conjunctivitis
• Preauricular lymphnode enlargement
9
32. Episcleritis
• Non – infective inflammation involving a
tissue layer superficial to the sclera and deep
to the conjunctiva.
• Extremely common
• Pain +/-
• Hyperemia : diffuse or segmental ( simple /
nodular )
39
36. Scleritis
• Uncommon
• More serious than episcleritis
• Oedema & cellular infiltration of the entire
thickness of sclera.
• Spectrum of disease – from self limiting to
blindness. ( necrotising & non-necrotising )
• Systemic associations – RA (most common
), Wegener’s granulomatosis, Relapsing
polychondritis, PAN ( polyarteritis nodosa ),
SLE.
43
37. Scleritis
Symptom
• Severe eye pain
• Red eyes
• Reduce vision
Signs
• Vascular congestion and
dilatation associated
with oedema. ( violet
hues )
• Eye is tender to touch
44
50. Management
• Self limiting, most no need Ix
• Broad spectrum eyedrops – CMC, gentamycin,
fucidic acid
• If x resolved – conj swab
• Atypical cases need referal – x respond to rx,
chronic
57
56. Chlamydial conjunctivitis
• Auto inoculation from genital secretions
although eye to eye spread may occur in
about 10% of cases.
• Urogenital symptoms
• Symptom – subacute, watery discharge.
Untreated may persis for several months.
63
68. Allergic conjunctivitis
Seasonal allergic
• ( hay fever )
• Spring , summer
• Tree & grass pollen
Perennial allergic
• Sym throughout the year
• Exacerbation in autum,
expose to house dust mite,
animal dander, fungal
allergens.
75
84. • Examine the hemorhage, try to see it’s border.
• If minimal – non-urgent
• Hx of penetrating, sharpnel injury must not be
taken lightly.
• If spontaneous, quite safe to refer the next
day.
• Bleeding tendency?
91
85. • If has hx of
definite trauma,
examine properly.
• Look for signs of
laceration.
• Refer eye
accordingly.
92
90. Blepharitis
Staphylococcal
• Infxn of the lid margins by
staphylococcal bacteria.
• Lid margin inflammed and
coated with scales.
• Lashes stuck together,
matted with crusts.
Seborrhoeic
• Assoc with seborrhoeic
dermatitis.
• Foamy tear film
• Can give rise to secondary
conjunctivitis
91. Rx
• Lid hygiene – reduce to bacterial load
• Antibiotics – topical ointments cmc.
• Systemic antibiotics – severe persistent cases
• Tetracycline, doxycycline
• Artificial tears
97. Pterygium
• Triangular fibrovascular
subepithelial ingrowth of
degenerative bulbar
conjunctival tissue over the
limbus to the cornea.
• Living in hot climates
• Response to chronic
dryness and UV exposure.
• Encroaches visual axis -
astigmatisme
