The Red Eye

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The Red Eye

  1. 1. The red eye Dr. May Bakkar
  2. 2. Lecture outline • • • • • Blood supply to the eye Related anatomic structure Symptoms and signs-based on cause Diagnosis Summary
  3. 3. Assessment of dry eye History Good examination Better diagnosis and management of the red eye
  4. 4. Related anatomical structures to the red eye • Lids • Conjunctiva • Episclera • Sclera • Cornea • Anterior Chamber • Orbit
  5. 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. 6. Red eye related to the Conjunctiva • Subconjunctival Haemorrhage • Conjunctivitis – Bacterial – Viral – Allergic • Conjuntivitis in infants • Other conjunctival lesions
  7. 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. 8. Conjunctivitis-Bacteria • Discomfort – mild gritty • Discharge – mucopurulent • Lids - papillae • Systemic symptoms – nil • Normal Vision • No Staining of cornea • Rx – antibiotics eg Chloramphenicol
  9. 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. 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. 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. 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. 13. Other conjunctival lesions • Malignancies – Haemangioma – Squamous cell carcinoma – Lymphomas Haemangioma Squamus cell carcinoma
  14. 14. Red eye related to the- Episclera – pingueculum – pterygium – Episcleritis
  15. 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. 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. 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. 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. 19. Red eye related to the- Cornea • Marginal Keratitis • Bacterial Keratitis • Viral Keratitis • Amoebic Keratitis • Abrasions / dry eye
  20. 20. Marginal Keratitis • Mild discomfort • Vision sl reduced • Mild photophobia • Usually assoc.blepharitis / contact lens • Rx lid hygiene, topical steroids + a/b
  21. 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. 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. 23. Cornea-Acanthamoeba • History of CL wear • Photobobia • Discharge watery++ • Stroma Oedema • Prominent corneal Nerves • Ring infiltrates • Symptoms worse than signs
  24. 24. Cornea-abrasion /foreign bodies
  25. 25. Red eye related to the- Anterior chamber • Uveitis • Acute Angle Closure Glaucoma
  26. 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. 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. 28. Acute angle closure Glaucoma
  29. 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. 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. 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. 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. 33. Acknoweledgment • These lectures are kindly provided by the University of Manchester. Thanks for Dr Tarik Aslam.

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