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Acute unilateral red eye Dr. Anthony Hall MD, FRANZCO.

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Presentation on theme: "Acute unilateral red eye Dr. Anthony Hall MD, FRANZCO."— Presentation transcript:

1 Acute unilateral red eye Dr. Anthony Hall MD, FRANZCO

2 differential diagnosis of the unilateral red eye Eyelid Eyelid Conjunctiva Conjunctiva  Conjunctivitis Cornea Cornea  Corneal foreign body/ulcer  Infectious keratitis Sclera Sclera Anterior chamber Anterior chamber  Iritis  Angle closure glaucoma Orbit Orbit

3 Eyelid

4 Acute lid problems Chalazion Chalazion Preseptal cellulitis Preseptal cellulitis

5 Chalazion Obstructed and infected and inflamed meibomian gland Obstructed and infected and inflamed meibomian gland Unilateral, unifocal lid swelling Unilateral, unifocal lid swelling

6 Chalazion – initial treatment Topical antibiotics Topical antibiotics  + oral if associated cellulitis Hot compresses Hot compresses If fails then surgery If fails then surgery

7 Chalazion – surgical treatment LA LA Lid everted Lid everted Chalazion incised form tarsal surface Chalazion incised form tarsal surface

8 Preseptal cellulitis Acutely unwell Acutely unwell Swollen, tender red eyelid Swollen, tender red eyelid No orbital signs No orbital signs  No proptosis, visual loss, movement problems

9 Orbital vs preseptal cellulitis The orbital septum divides the eyelid from the orbit The orbital septum divides the eyelid from the orbit

10 Conjunctiva

11 Conjunctivitis Viral  Watery discharge  URTI Allergic  Itch  Stringy discharge  Atopic patient Usually bilateral!!

12 Viral conjunctivitis URTI URTI Acute pain, redness, and watery discharge Acute pain, redness, and watery discharge Normal pupil Normal pupil Normal VA Normal VA Normal cornea Normal cornea Management Management

13 Allergic conjunctivitis Atopy Atopy Sub-acute irritation, itch, redness, and stringy discharge Sub-acute irritation, itch, redness, and stringy discharge Normal pupil Normal pupil Normal VA Normal VA Normal cornea Normal cornea

14 Subconjunctival haemorrhage

15 Cornea

16 Keratitis Suspect if  Corneal fluorescein stain (dendritic)  Focal corneal swelling  Past history HSV/VZV  Contact lens wear  Post trauma

17 Keratitis management HSV HSV  Topical aciclovir till epithelium healed

18 Keratitis management Bacterial Bacterial  Intensive topical antibiotics

19 Corneal foreign body/ulcer Suspect if  History of grinding etc  Fluorescein staining  Corneal/subtarsal foreign body  Always evert eyelid

20 Management of corneal FB Topical LA Remove fb with 23 G needle Oc Chloro and pad 24 hrs

21 Corneal ulcer Without Fluorescein: Underlying cornea is clear - iris details are seen

22 Fluorescein with or without cobalt blue filter

23 Anterior chamber

24 Trauma Hyphaema or corneal abrasion may follow trauma In this setting beware of  Keratitis  Perforation

25 Iritis (acute anterior uveitis) Inflammation confined primarily to the iris and anterior chamber Inflammation confined primarily to the iris and anterior chamber Resolving totally within three months Resolving totally within three months (not associated with other significant anterior or posterior segment pathology) (not associated with other significant anterior or posterior segment pathology)

26 Iritis - symptoms pain pain redness redness photophobia photophobia epiphora epiphora

27 Iritis - signs ciliary flush small irregular pupil AC cells and flare keratic precipitates hypopyon iris nodules spill over vitritis

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29 Iritis - aetiology

30 B 27 related diseases Ankylosing spondylitis Ankylosing spondylitis Psoriatic arthritis Psoriatic arthritis Reiters syndrome (reactive arthritis) Reiters syndrome (reactive arthritis) Inflammatory bowel disease associated arthropathy Inflammatory bowel disease associated arthropathy

31 Sarcoidosis Multisystem granulomatous disease  90% lung  90% lymph node  25-50% joint involvement  25% skin  25% eye

32 Syphilis Primary  4-6 weeks of ulcer Secondary  2-4 months  Skin rash and lymphadenopathy  Eye and CNS involvement Latent/tertiary  CVS and CNS

33 Viral Suspect if  History of simplex or zoster  Chronic course  Iris changes  High pressure  Keratitis (old or new)

34 Investigation of AAU Most important Most important  Clinical  History  Family history  Examination Less important  HLA B 27  Sarcoidosis  CXR  ACE  Syphilis serology

35 Principles of management of Iritis Determine the underlying cause Determine the underlying cause Control the inflammation Control the inflammation Detect and control ocular complications of Detect and control ocular complications of  the inflammation  the treatment

36 How to control the inflammation Adequate high potency topical steroids Adequate high potency topical steroids Sub conjunctival steroids Sub conjunctival steroids Oral steroids Oral steroids Aggressive dilation Aggressive dilation Regular and close review Regular and close review

37 Acute angle closure glaucoma Unusual Severe pain Profound visual loss Cloudy cornea Fixed mid position pupil Treatment  iridotomy

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42 Orbital disease

43 Orbital cellulitis Pre septal Pre septal  Acute lid swelling  No chemosis, visual loss or eye movement disorder  Secondary to trauma, chalazia, lacrimal sac disease Orbital  Lid swelling  Chemosis, visual loss, eye movement abnormalities  Secondary to sinus disease

44 Pre septal Orbital

45 Treatment Pre septal Antibiotics Orbital Image Drain sinus disease Antibiotics Drain orbital disease

46 Key steps in the diagnosis of the unilateral red eye History History Ocular Ocular  Previous episodes  CL wear  Trauma Systemic Systemic  Auto-immune disease  Recent URTI Examination  VA  Cornea  Pupil  Conjunctiva

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