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Red Eye

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Red Eye

  1. 1. The Red Eye Anmar Rahman Gordon Sanderson Cases marked are rare
  2. 2. What is the diagnosis in the case of a unilateral red eye in a 25 year old female? What is the characteristic pattern of hyperaemia called? Ciliary injection which is a characteristic of intraocular pathology as a cause of red eye Ciliary injection which is a characteristic of intraocular pathology as a cause of red eye What are these clinical signs called? Posterior synechiae Posterior synechiae Acute anterior uveitis Acute anterior uveitis
  3. 3. Uveitis • Uveitis=Iritis=Iridocyclitis • Described according to the site of involvement – Anterior = involvement of the iris – Intermediate = involvement of the ciliary body & vitreous – Posterior = involvement of the optic nerve retinal vessels or choroid
  4. 4. What are the structures on the posterior corneal surface in this case of acute anterior uveitis? Keratic precipitates Keratic precipitates
  5. 5. Keratic precipitates (KP) • Cellular deposits on the corneal endothelium • Classified by – Time of onset • Non pigmented recent onset KP • Pigmented KP longstanding KP – Size • Small KP are characteristic of herpes zoster • Medium KP non specific • Large KP are a characteristic of granulomatous uveitis
  6. 6. What is the underlying pathology of the clinical sign shown below? Flare is due to the presence of proteins in the anterior chamber & indicative of disruption of the blood aqueous barrier it does not necessarily indicate active uveitis Flare is due to the presence of proteins in the anterior chamber & indicative of disruption of the blood aqueous barrier it does not necessarily indicate active uveitis Aqueous flare Which is the visibility of the beam of light in the anterior chamber Which is the visibility of the beam of light in the anterior chamber
  7. 7. Uveitis • The diagnosis of anterior uveitis includes a triad of – Ciliary injection – Flare & Cells in the anterior chamber – Keratic precipitates
  8. 8. Abnormal Conjunctival Reactions
  9. 9. Conjunctival Papillae What is the type of conjunctival reaction?
  10. 10. Conjunctival Papillae • A non specific conjunctival reaction composed of hyperplastic conjunctival epithelium thrown into folds with an underlying inflammatory cell infiltrate & a central vessel • Causes – chronic blepharitis, allergic conjunctivitis, bacterial infection, conjunctival foreign bodies (contact lens-related, suture, prosthetic eye)
  11. 11. Follicles What is is the type of conjunctival reaction in this 15 year old patient with bilateral red eyes of 2 weeks?
  12. 12. Conjunctival Follicles • Represent hyperplasia of the lymphoid tissue of the conjunctival stroma • Causes – viral infections, chlamydial infections, hypersensitivity to topical medication
  13. 13. What is the type of conjunctival reaction? (hint: the conjunctiva displays bleeding points on attempting to remove the white material) Membranous conjunctivitis Membranous conjunctivitis Conjunctival membrane
  14. 14. Conjunctival Membranes • Pseudomembranes consist of coagulated exudate adherent to the inflamed conjunctival epithelium. – Causes: severe conjunctivitis, ligneous conjunctivitis • True membranes form when the inflammatory exudate penetrates the conjunctival epithelium. Removal of the membrane results in hemmorhage. – Causes: conjunctivitis due to β-haemolytic streptococci and diphtheria.
  15. 15. What is the diagnosis of this bilateral conjunctival reaction in this 18 year old female? Ligneous conjunctivitis Ligneous conjunctivitis
  16. 16. Ligneous Conjunctivitis • A chronic conjunctivitis characterized by the formation of pseudomembranes on the palpebral surfaces which progress to thick, tough, nodular masses replacing the normal mucosa
  17. 17. What are the clinical signs in this 38 year old patient who sustained a chemical injury? Corneal pannus Symblepharon
  18. 18. Cicatrizing conjunctivitis • A form of chronic conjunctivitis characterized by replacement of normal conjunctival tissue by fibrous tissue • Causes: Radiation exposure, chemical injury, adenoviral conjunctivitis, trachoma
  19. 19. What is the diagnosis in this asymptomatic elderly patient? Subconjunctival haemorrhage Subconjunctival haemorrhage
  20. 20. Gradual onset swelling of the eyelids in these two patients the conjunctival surface shows the hyperaemic vascular mass. What is the diagnosis? Chalazion Chalazion Granuloma on the conjunctival surface
  21. 21. Chalazion • A chronic lipogranulomatous inflammatory lesion caused by obstruction of gland orifices and stagnation of sebaceous secretions. • Risk factors – Acne rosacea – Seborrhoeic dermatitis
  22. 22. What is the diagnosis in this 65 year old patient with a red eye for 6 months? Conjunctival squamous cell carcinoma Conjunctival squamous cell carcinoma
  23. 23. Conjunctival squamous cell carcinoma • Squamous cell carcinoma is a slowly growing tumour, which may invade the sclera and cornea and even penetrate the globe. It rarely metastasizes. • Presentation is usually in late adult life. The tumour may arise from pre-existing intraepithelial hyperplasia or de-novo.
  24. 24. What is the diagnosis of this unilateral conjunctival lesions that have been present for 3 months? Conjunctival squamous cell papilloma Conjunctival squamous cell papilloma
  25. 25. Conjunctival Squamous cell papilloma • A benign and self-limiting neoplasm. • Caused by infection with human papilloma virus types 6 and 11. Commonly in children and young adults, located in the inferior fornix.
  26. 26. Corneal abnormalities
  27. 27. What is the diagnosis of this case of keratitis in a 23 year old patient with a history of prolonged sun exposure? Herpes simplex virus dendritic keratitis Herpes simplex virus dendritic keratitis What stain is used in this examination? Rose Bengal Rose Bengal
  28. 28. HSV Dendritic Keratitis • HSV is a DNA virus infection is spread by direct contact of infectious secretions with epidermis or mucous membrane. • Dendrites have a branching, linear pattern which have terminal bulbs; devitalized cells stain with Rose Bengal.
  29. 29. Corneal scar resulting from herpes simplex virus dendritic keratitis Corneal scar resulting from herpes simplex virus dendritic keratitis
  30. 30. A 32 year old patient developed a skin rash of dermatomal distribution followed by a 1 week history of a red eye What is the etiology of this condition? Herpes zoster virus Herpes zoster virus
  31. 31. Non-specific Bacterial Keratitis A 23 year old female presented with a 4 day history of a painful red eye What is the diagnosis? Ulcerative keratitis Ulcerative keratitis
  32. 32. Ulcerative keratitis • A group of diseases characterized by sloughing of the corneal epithelium combined with inflammation and/or dissolution of the corneal stroma, which, if untreated, may eventually lead to corneal perforation. • The pathogens able to produce corneal infection in the presence of an intact epithelium – Neisseria gonorrhoeae – Corynebacterium diphtheriae – Listeria sp – Haemophilus sp
  33. 33. What are the clinical signs? What topical antibiotic has been used? Abnormal vascular pattern due to conjunctival peritomy due to previous surgery Abnormal vascular pattern due to conjunctival peritomy due to previous surgery Hypopyon Hypopyon Corneal edema Corneal edema Ulcerative keratitis Ulcerative keratitis Ciprofloxacin resulting in a white crystalline deposit on the cornea Ciprofloxacin resulting in a white crystalline deposit on the cornea Diagnosis: Neurotophic keratopathy with bacterial superinfection Diagnosis: Neurotophic keratopathy with bacterial superinfection
  34. 34. Neurotrophic keratopathy • A degenerative disease characterized by decreased corneal sensitivity and poor corneal healing. This disease leaves the cornea susceptible to injury and decreases reflex tearing. Epithelial breakdown can lead to ulceration, infection, melting, and perforation secondary to poor healing.
  35. 35. What complication of ulcerative keratitis is shown in the photograph? Descemetocele Descemetocele
  36. 36. Descemetocele • An acquired corneal ectasia secondary to ulcerative keratitis
  37. 37. Keratoconus Keratoconus What is the diagnosis of ocular appearance in a 42 year old patient with progressive astigmatism? Munson’s sign
  38. 38. Keratoconus • A progressive, noninflammatory, bilateral (but often asymmetric) cornea ectasia, characterized by paraxial stromal thinning that leads to corneal surface distortion.
  39. 39. Keratoglobus Keratoglobus What is the diagnosis of this corneal abnormality?
  40. 40. Keratoglobus • A corneal ectasia similar to keratoconus involving the axial and peripheral cornea
  41. 41. A 45 year old patient with RA developed a 2 day history of a red painful eye with a nodule What is the differential diagnosis? Episcleritis Scleritis Episcleritis Scleritis
  42. 42. Episcleritis Scleritis Ocular discomfort Mild Severe Headache No Yes Associated systemic disease 30% 50% Conjunctival Nodule Mobile Non mobile Tender globe Minimal Severe Scleral thinning & necrosis Absent Present Intraocular complications (cataract, glaucoma, retinal detachment, uveitis) Absent Present
  43. 43. What is this structure in a patient with underlying recurrent scleritis? Uveal tissue secondary to scleral thinning Uveal tissue secondary to scleral thinning
  44. 44. Scleromalacia perforans Scleromalacia perforans What is the diagnosis of this cause of scleral thinning in a female with RA and no history of ocular pain?
  45. 45. Scleromalacia perforans • A type of painless necrotizing scleritis that typically occurs in women who have long- standing rheumatoid arthritis (RA). • In these cases yellow scleral nodules develop without much redness or pain. These nodules, which are histopathologically similar to rheumatoid nodules, may necrose and slough to leave defects in the sclera
  46. 46. The Orbit
  47. 47. What is the diagnosis in this patient that presented 4 days after excision of a skin lesion of the left temple in the absence of an optic neuropathy & the presence of normal ocular motility? Wound Preseptal cellulitis Preseptal cellulitis
  48. 48. Preseptal cellulitis Postseptal cellulitis Optic neuropathy Absent Present Limitation in ocular motility Absent Present Fever Absent Present Treatment Oral antibiotics Intravenous antibiotics Surgical evacuation of sinus or superiosteal collections
  49. 49. A 70 year old female presented with a 5 day history of diplopia -3 Limitation on elevation of the right eye Medial displacement of the globe Conjunctival chemosis What investigations are indicated to identify the underlying pathogenesis? What are the clinical signs shown?
  50. 50. Soft tissue swelling of the Left lateral orbit Fluid in the maxillary sinus CBC, inflammatory markers, CT orbits What is the diagnosis in the presence of normal CBC & inflammatory markers? Orbital pseudotumour Orbital pseudotumour What are the radiological signs?
  51. 51. Orbital Pseudotumour • A nonspecific, idiopathic, benign inflammatory process characterized by a polymorphous lymphoid infiltrate with varying degrees of fibrosis. • The clinical course of the disorder may be acute, subacute, or chronic. Although it can occur in childhood, the peak incidence is during the fourth and fifth decades of life.
  52. 52. Trauma
  53. 53. What is the diagnosis in this case of trauma? Hyphaema Hyphaema
  54. 54. Anterior chamber Fluid Accumulations • Hyphaema=Blood • Hypopyon=Pus • Hyperoleum=Silicone oil
  55. 55. Cataract Corneal laceration What are the clinical signs in this case of trauma? Penetrating eye injury Penetrating eye injury What is the diagnosis?
  56. 56. What surgical procedures have been performed in this case? Artificial Iris
  57. 57. Corneal graft
  58. 58. Cataract extraction (lens cortex remnants shown)
  59. 59. Corneal Laceration
  60. 60. What are the clinical signs other than red right eye? Heterochromia irides, right exotropia Heterochromia irides, right exotropia In the presence of right vitreous haemorrhage & raised intraocular pressure what is the diagnosis? Hemosiderosis bulbiHemosiderosis bulbi
  61. 61. Hemosiderosis bulbi • Deposition of haemoglobin on intraocular structures due to longstanding intraocular haemorrhage.
  62. 62. Lid Malpositions
  63. 63. EctropionEctropion What is the diagnosis?
  64. 64. Ectropion • Ectropion is abnormal eversion of the lid margin resulting in corneal exposure, epiphora, keratinization of the palpebral conjunctiva • Subtypes: – Involutional – Paralytic – Mechanical – Cicatricial
  65. 65. Right Entropion & Bilateral senile ptosis Right Entropion & Bilateral senile ptosis What is the diagnosis?
  66. 66. Entropion • Eyelid malposition resulting in inversion of the eyelid margin • Subtypes: – Involutional – Spastic – Cicatricial
  67. 67. Anterior chamber
  68. 68. What is the substance deposited in the anterior chamber in this patient that has had a retinal detachment repair?
  69. 69. Silicone oil (hyperoleum) Silicone oil (hyperoleum)
  70. 70. Silicone Oil • A tamponade agent used as a vitreous substitute in post-vitrectomy retinal detachment repair
  71. 71. A 88 year old patient presented with a painful red eye 1 day after a complicated cataract extraction What are the clinical signs? Corneal wound Corneal edema Dilated Pupil What is the diagnosis? Acute glaucoma Acute glaucoma

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