Blok Special sense

1. Red Eye
Group 14
Tutor : dr. Abdul Mubdi

2. Group 14
• Aulia Amani 110 2015 0009
• Nada Nahda 110 2015 0024
• Ainun Jariyah Muliadi 110 2015 0033
• Asyaratun Qamila R. 110 2015 0119
• Nur Zamzam Azizah 110 2015 0059
• Afrilia Chaerunnisa 110 2015 0065
• A. St. Zuraidha P. A. 110 2015 0081
• Indah Chintya Maharani 110 2015 0089
• Muhammad Rizky Hidayat 110 2015 0096
• Reza Novriadi Khautsari 110 2015 0109

3. Scenario
An 18 year old woman came to the primary
health care centre with red eye complaints that
had been experienced since 3 weeks ago.
Complaints accompanied by itching, often
recurring and self-limiting without treatment.
Visus ODS 6/6, conjunctiva: hyperaemic

4. DIFFICULT WORDS
• None
•
KEY WORDS
• 18 year old woman
• Red eye since 3 weeks ago
• Itchy
• Often recurring
• Self-limiting without treatment
• Visus ODS 6/6
• Conjunctiva: hyperaemic

5. Questions
1. What are the causes of red eye?
2. Explain the classification of red eye?
3. What are the parts of the eye that contributes to the symptoms?
4. What is refraction? what parts of the eye contribute to the visus?
5. What is the interpretation of physical examination (visus ODS 6/6) based
on the scenario?
6. What caused itchy eye and conjunctiva hyperaemic?
7. Why the symptoms often recurring?
8. What additional anamnesis and physical examination we should do?
9. What are the Differential Diagnosis (DD)?
10. What treatments we should do?
11. How to prevent the recurrent symptoms?
12. What kind of facilities available in health primary centre to treat and
diagnose this patient?

6. 1. What are the causes of red eye ?

7. The most common cause of eye
redness is inflamed vessels on
the surface 0f the eye. Various
irritants can cause this to occur,
including:
• Dry eye
• Exposure to the sun
• Dust
• Allergic reactions
• Colds
• Bacteria or viruses
• coughing
Other conditions that may
cause eye redness include:
• Trauma or injury of the eye
• A rapid increase eye
pressure that results in pain
• Scratches of the cornea
cause by irritants pr overuse
of contact lens
• Bleeding problems
Krucik, George. Eye Redness: Causes, Symptomps and Diagnosis http://www.healthline.com/symptom/eye-redness acces

8. 2. Explain the classification of red
eye?

9. • Red eye can be categorized into:
• 1. Red eye with normal vision
• a. Eye eye with normal vision and not dirty or
secretions
Pterigium :
It is a degenerative and invasive conjunctival
fibrovascular growth

10. Pseudopterigium :
It is a conjunctival
attachment with a defective
cornea.
Subconjunctival hematoma :
May occur in situations where the
blood vessels are fragile
(age,hypertension,arteriosclerosis,
haemorrhagicconjunctivitis,anemia
, anticoagulant use and whooping
cough).

11. Episcleritis :
is an inflammatory reaction of the vascular
connective tissue located between the
conjunctiva and the surface of the sclera.
Has a special image of a local bump with a
firm limit and purple red color under the
conjunctiva, and when the press gives pain
Scleritis :
Usually caused by abnormal or systemic
disease. More commonly caused by
connective tissue disease, post herpes,
syphilis, and gout. Feeling pain does not
remove dirt, visible lump colored a little
more orange blue, regarding the entire circle
of the cornea, so that looks anletic scletitis.

12. b. Red eyes with normal and dirty eyesight or secretions
Conjunctivitis :
Conjunctival inflammation or
inflammation of the mucous membrane
that covers the back of the eyelids and
eyeballs, in the form of acute and chronic,
the cause of conjunctivitis include
bacteria, chlamydia, allergies, viral toxic,
associated with systemic disease
Conjunctivitis Dry Eyes (Dry Eye) :
Keratoconjunctivitis sica is a dry state
of the corneal and conjunctival
surfaces resulting from reduced tear
function

13. 2. Red eyes with visions dropped suddenly
Corneal Ulcers:
It is the partial loss of the
corneal surface due to
corneal tissue death.
Keratitis :
It is an inflammation of
the cornea.

14. Uveitis :
Uvea inflammation can affect only the front of
the uvea tissue or the rainbow film (iris) and
this is called an iritis.
Acute Glaucoma :
Red eyes with sudden
down vision are acute
closed angle glaucoma.
Reference : Sidarta, Rahayu (2014) Ilmu penyakit mata, Ed.5. Jakarta. FKUI

15. 3.what parts of the eye that
contributes to the symptomps ?

16. • conjunctiva bulbi
• conjunctiva palpebra
• Sklera
• episklera
Referensi : repository.usu.ac.id

17. 4. what is refraction? What parts of
the eye contribute to the visus ?

18. • Eye refraction is a change of course of light caused by eye
refractory media.
• Eye refraction devices consist of
• 1. Cornea
• 2. aqueous humor
• 3. Lens
• 4. vitreous humor
Referensi : repository.usu.ac.id

19. 5. What is the interpretation of
physical examination (visus ODS 6/6)
based on the scenario?

20. http://www.m.webmd.boots.com/a-to-z-guides/visual-acuity accessed on Sept 10, 2017

21. 6. What caused itchy eye and
conjunctiva hyperaemic?

22. Itchy Eye
Itchy eye can be the chief complaint for a number of
ocular surface diseases.
• Atopic keratoconjunctivitis,
• vernal keratoconjunctivitis,
• allergic conjunctivitis and atopic dermatitis are part of the
spectrum of ocular allergies.
• dry eye syndrome
• meibomian gland dysfunction
• Blepharitis
• contact lens–induced conjunctivitis,
• giant papillary conjunctivitis and
• contact dermatoblepharitis.
md, Jocelin Kurnian. The Itchy Eye: Diagnosis and Management of Ocular Pruritus. 2010. Page 1.
Optalmica Pearls, External Disease

23. Konjungtivitis Hiperemis
Konjungtivitis hiperemis is The reddish color of the
conjunctiva due to vasodilation of blood vessels and
increased blood vessels and this will occur in the entire
conjunctiva but not necessarily on both eyes it hit all.
Various irritants can cause this to occur, including:
• Dry eye
• Exposure to the sun
• Dust
• Allergic reactions
• Colds
• Bacteria or viruses
• Coughing
•Riordan-Eva P, Whitcher JP. Vaughan & Asbury’s General Ophthalmology. Ed ke-16. Philadelphia: McGraw-Hill. 2012

24. Other conditions that may cause eye
redness include:
• Trauma or injury of the eye
• A rapid increase eye pressure that results
in pain
• Scratches of the cornea cause by irritants
pr overuse of contact lens
• Bleeding problems
•Riordan-Eva P, Whitcher JP. Vaughan & Asbury’s General Ophthalmology. Ed ke-16. Philadelphia: McGraw-Hill. 2012

25. 7. Why the symptom often
recurring ?

26. Sumber: Imunologi dasar, Karnen G. B, Iris .R, edisi ke 8, Fakultas Kedokteran Universitas Indonesia.

27. 8. What amanesis and physical
exam that we should do?

28. Anamnesis
• Chief complain
• When the condition started
• Whether the condition (bilateral?unilateral
• Is there is any decreased visual activity ? How that? (progressif?
Suddenly? )
• Foreign body sensation?
• Use contac lens ?
• Any discharge ? How that (purulent/mucous)
• Is that worse in the morning ?
• History of family ?
• Hisotry previous disease ?
• History of drug ?

29. Physical examinations
• . Anterior segment: – Eyebrows, eyelids, tarsal conjunctiva, bulbar
conjunctiva, cornea, anterior chamber, iris, pupil, and lens (at least,
use a penlight; if available: loupe)
• Posterior segment: – Vitreous, retina, optic disc
• Visual activity
• Inspections any injury performed to exclude periorbital injury
• Inspection ocular surface subtarsal surface
• discharge: bacterial conjunctivitis, keratitis
• Pattern of redness: diffuse redness (usually conjunctivitis) vs. cilliary
flush
• redness is near the limbus where there is transition from the cornea
to the sclera; usually indicates more serious entities)
•Diagnosis and Management of Red Eye in Primary Care by medlineplus.gov

30. Additional examination
• Skin Prick test
• Patch test
• Lab test (complete blood count)
• culture
• Schimmer test

31. Preference: Medlinesplus.gov

32. 9. What are the Differential
Diagnosis (DD)?

33. CONJUNCTIVITIS
Clinical sign Bacterial Viral Allergic Chlamydial
Red eye + + + +
Congestion Marked Moerate Mild to moderate Moderate
Chemosis ++ ± ++ ±
Subconjunctival
haemorrahages
± ± ± -
Discharge Purulent or
mucopurulent
watery watery mucopurulent
Papillae ± - ++ ±
Follicles - + - ++
Pseudomembrane ± ± - -
Pannus - - - (except vernal) +
Pree-auricular
lymph nodes
+ ++ - ±
Referensi : Bowling, Brad. 2016. Kanski’s Clinical Ophthalmology A SYSTEMATIC APPROACH EIGHTH EDITION. Printed in China : ELSEVIER limited.
Khurana, A K. 2007. Comprehensive OPHTHALMOLOGY fouth eddition. New Delhi : NEW AGE INTERNATIONAL (P) LIMITED, PUBLISHER.
Gerhard K. Lang, M. D. 2000. Opthalmology. New York : Thieme Stuttgart

34. Clinical evaluation
• Symptoms
• Discharge
• Conjunctival reaction
• Membrane
• Enlarged of lymph

35. Konjungtival infection

36. Irritation conjunctivitis
• Irritation conjunctivitis is caused by irritant
such as wind, dust, smoke, make up
materials, etc.
• Symptom:
- conjunctival injectio
- the sensation of foreign body
- pain

37. Treatment
• Any solid material must be removed
• Intensive topical steroids
• Compree cold water

38. EPISCLERITIS
• Benign inflamation of episclera
• Young age
• Woman >> Man
• Mild discomfort
Etiology
• Idiopathic
• Found in association w/ gout, psoriasis

39. Signs & Symptoms
•Redness
•Mild discomfort (gritty, burning, or foreign
body sensation)
•Types of episcleritis:
1.simple/diffuse episcleritis
 sectoral (on or two quadrants) redness
 recurren (60%)
2.Nodular Episcleritis
Nodule surrounded by injection

40. • Diffuse Episcleritis
• Nodular Episcleritis

41. Treatment
1.Cold compress
2.Topical corticosteroid
3.Systemic NSAID : flurbiprofen 300 mg OD

42. 10. What are the treatments we
should do?

43. General treatment for the case in the scenario :
1. Compress with cold water in several times a day1
2. Local palliative measures which provide immediate relief
include:2
a. Vasoconstrictors like adrenaline, ephedrine, and naphazoline.
b. Sodium cromoglycate drops are very effective in preventing
recurrent atopic cases.
c. Steroid eye drops should be avoided. However, these may be
prescribed for short duration in severe and non-responsive
patients.
3. Systemic antihistaminic drugs are useful in acute cases
with marked itching.2
1. John T. Mata Dan Kedaruratan Mata. (John T, ed.). Penerbit buku kedokterean EGC; 2015.
2. Khurana AK. Comprehensive Ophtalmolohy. Fourth. New Age International (P) Ltd; 2007.
www.newagepublishers.com.

44. 11. How to prevent the recurrent
symptoms ?

45. The prevention :
1. Stay in a cool room1
2. Regulary use of eye drop to inhibiti
histamine.2
3. Desensitization has been tried without much
rewarding results. However, a trial may be
given in recurrent cases.3
1. Khurana AK. Comprehensive Ophtalmolohy. Fourth. New Age International (P) Ltd; 2007.
www.newagepublishers.com.
2. Riordan-eva P, Whitcher JP. Vaughan & Asbury OFTALMOLOGI UMUM. 17th ed. (dr. Diana Susanto, ed.).
Penerbit buku kedokterean EGC; 2013.