The Red Eye

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The Red Eye - Dr James Beatty

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The Red Eye

  1. 1. The Red Eye Dr James Beatty
  2. 2. Overview • Usually a self limiting benign disorder • May be sight threatening • May be the sentinel of a severe underlying systemic disease • Simple history and external examination will help form a narrow differential diagnosis
  3. 3. Guidelines for early referral • Decreased vision • Painful eye (not just discomfort) • Unilateral red eye • Poor response to initial therapy
  4. 4. Take a basic history • Vision • Symptoms – Redness – Pain – Discharge
  5. 5. Anatomical approach • Eyelids • Conjunctiva • Episclera/sclera • Cornea • Iris/uvea • Glaucoma • Other
  6. 6. The Eyelids • Blepharitis – Common, chronic, bilateral – Staphylococcal or seborrhea • Symptoms (burning, grittiness, photophobia, dry eye, no loss of vision) • Signs (crusty, hyperemia, irregular lid) • Treatment (lid scrubs, O.Fucithalmic, warm compress, tear replacement)
  7. 7. Blepharitis
  8. 8. Blepharitis
  9. 9. The Eyelids • Stye or acute chalazion – Red mass on the eyelid – May respond to hot compress + oral and topical antibiotics – Move quickly to I & D if no improvement
  10. 10. Acute chalazion
  11. 11. Stye
  12. 12. Stye
  13. 13. Stye
  14. 14. The Conjunctiva • Conjunctivitis – Allergic • Seasonal, perennial, vernal, contact – Infective • Viral • Bacterial
  15. 15. Allergic • Seasonal often with hayfever • Perennial throughout the year • Vernal often with atopy • Bilateral and watery • Itchy • No decrease in VA or significant pain • Rx remove allergen, antihistamine plus mast cell stabalizer occasionally steroids
  16. 16. Allergic conjunctivitis
  17. 17. Vernal conjunctivitis
  18. 18. Viral conjunctivitis • Usually adenovirus • Contagious • Occurs in epidemics • May have flu-like symptoms • O/E: Lymph nodes,VA fine, Follicles +- Hx • Rx: Self limiting, relief of symptoms
  19. 19. Viral Conjunctivitis
  20. 20. Bacterial conjunctivitis • Usually one eye • Common in children • O/E: Purulent discharge, eyelids stuck together, VA is fine • Rx: usually self limiting, antibacterial oint.
  21. 21. Bacterial conjunctivitis
  22. 22. Gonococcus
  23. 23. Neonatal conjunctivitis
  24. 24. Pterigium • Localized area of redness • Palperable fissure • Active and inactive phases • Rx: lubricants, dark glasses, surgery • Recurrences fairly common
  25. 25. Pterigium
  26. 26. Subconjunctival haemorrhage
  27. 27. Episcleritis • Idiopathic, self limiting, focal inflammation • Usually young adults often recurrent • O/E: unilateral area of redness, no decreased VA, some discomfort • Self limiting 2 weeks • NSAID’s, lubricants
  28. 28. Episcleritis
  29. 29. Episcleritis
  30. 30. Scletitis • Very painful • Unilateral • Sectoral, nodular, diffuse • Necrotising or non necrotising with or without inflammation • VA may be decreased • Systemic association in 50 % (RA, Sarcoid, SLE, Zoster, Wegners) • Needs further investigation • Rx: Oral NSAID, Steroids, Antimetabolites
  31. 31. Scletitis
  32. 32. Scletitis
  33. 33. Cornea • Very well supplied by pain receptors • Fluorescein very helpful to identify epithelial defects • Trauma common
  34. 34. Abrassion
  35. 35. Arc eyes • Arc welding without visor or light filter (intense UV light) • Extremely painful and photophobic • Self limiting • O/E:Need local for exam • Multiple small punctate burns with Fluoroscein • Rx: antibacterial oint, cold compress, analgesia, NSAID drops +- cycloplegic
  36. 36. Foreign body • Grinding • Remove with local and sterile needle or cotton bud • Then patch and antibacterial ointment • Check under lids • If residual material refer ophthalmologist
  37. 37. Foreign body
  38. 38. Rust Ring
  39. 39. Corneal ulcers • An ophthalmic emergency, refer ophthalmologist ASAP • Painful, red, decreased vision • Staining with flouroscein
  40. 40. Viral ulcer • Hepes simplex • Recurrent, often a history of oral/nasal herpes • Typical branching/dendritic staining pattern • Steroids a big no no! • When treating a red painful eye of unknown cause, steroids should be avoided! • Rx: Acyclovir
  41. 41. Dendritic ulcer
  42. 42. Severe end stage dendritic ulcer
  43. 43. Bacterial and Fungal ulcers • Even more sight threatening • White or yellowish • Stain with flourescein • Painful with decreased vision • Often contact lens wearers/trauma • May need microscopy and cultures
  44. 44. Bacrerial ulcer
  45. 45. Iritis/anterior uveitis • Inflammation of the uvea is known as uveitis • Anterior uveitis common, but many other types of uveitis • Very often recurrent and idiopathic • May be associated with systemic disease (collagen vascular, sarcoid, syphalis, TB) • Often following blunt trauma
  46. 46. Iritis/anterior uveitis • Symptoms: photophobia, pain, decreased VA • O/E: uni or bilateral, circumcorneal injection, synechia, hypopeon • Lots of long term complications (glaucoma, cataracts) • Rx: steroids and atropine
  47. 47. Iritis/anterior uveitis
  48. 48. Iritis/anterior uveitis
  49. 49. Acute angle closure glaucoma • Glaucoma is usually chronic, painless with loss of vision in the late stages • Angle closure glaucoma is acute, painful, sight threatening. • An emergency…refer ophthalmologist ASAP
  50. 50. Acute angle closure glaucoma • Peripheral iris blocks the trabecular meshwork • Aqueous unable to drain • Very high pressure (>40mmHg) • Symptoms: severe pain, headache, nausea, vomiting, decreased vision • O/E: red eye, cloudy cornea, pupil non responsive, eye is hard on palpation, eclipse sign
  51. 51. Acute angle closure glaucoma
  52. 52. Acute angle closure glaucoma
  53. 53. Acute angle closure glaucoma • Rx: reduce the pressure with – Diamox – Oral glycerol – Topical pressure lowering drops – Miotics/pilocarpine – Oral analgesia and aniemetics – Peripheral iridectomies when clear cornea and lower pressure
  54. 54. Other
  55. 55. Acute dacryocystitis
  56. 56. Orbital cellulitis
  57. 57. Graves or Thyroid eye disease
  58. 58. Graves or Thyroid eye disease
  59. 59. Trauma
  60. 60. Trauma
  61. 61. Trauma
  62. 62. Conclusion • Short history and exam usually determines the cause • Think anatomically • Refer early if in doubt, especially if there is severe pain, corneal staining or decreased VA • Be careful of using steroids!
  63. 63. • Thank you

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