Presentation is loading. Please wait.

Presentation is loading. Please wait.

WAOPS Spring Conference

Similar presentations

Presentation on theme: "WAOPS Spring Conference"— Presentation transcript:

1 WAOPS Spring Conference
May 31, 2014 The Waters at Minocqua 8116 US 51 South Minocqua, WI Shiloh A. Simons, DO Ministry Medical Group Ophthalmology Stevens Point , WI The Red Eye

2 Red Eye Workup History Symptoms: itching, discharge, irritation, pain, photophobia, blurred vision Unilateral or bilateral presentation Character of discharge Recent exposure to an infected individual Trauma: mechanical, chemical, ultraviolet Contact lens wear: lens type, hygiene, and use regimen Systemic diseases (e.g., genitourinary discharge, dysuria, dysphagia, upper respiratory infection, skin and mucosal lesions) Allergy, asthma, eczema Use of topical and systemic medications

3 Red Eye Workup Physical Exam Measure Visual Acuity
External Examination Pupil Exam, Motility Exam Slit-lamp examination Intraocular pressures Dilated Exam

4 Red Eye Workup External Exam
Regional lymphadenopathy, particularly preauricular Skin: signs of rosacea, eczema, seborrhea Abnormalities of the eyelids: swelling, discoloration, malposition, laxity Conjunctiva: pattern of injection, subconjunctival hemorrhage, chemosis, cicatricial change

5 Red Eye Workup Slit-lamp Exam Eyelid margins: inflammation, vesicles
Eyelashes: loss of lashes, trichiasis Lacrimal puncta and tear film Conjunctiva: injection, papillae, follicles Cornea: Epithelial defects, punctate keratopathy, dendrites, filaments, ulceration, subepithelial infiltrates Anterior chamber/iris: cells, flare, synechiae, transillumination defects

6 Red Eye Workup Diagnostic Testing Cultures: Bacterial, Viral,
Chlamydial : Suspected cases of adult and in all cases of suspected neonatal conjunctivitis. Smears/Cytology: Smears for cytology and special stains (Gram, Giemsa) Blood Tests Biopsy: Conjunctival biopsy may be helpful in cases of conjunctivitis unresponsive to therapy.

7 Red Eye Diagnosis Ocular Infections Corneal Ulcers
Bacterial Fungal Acanthamoeba Ophthalmia Neonatorum

8 Red Eye Diagnosis Ocular Infections Viral Preseptal Cellulitis
Herpes Simplex Herpes Zoster Epidemic Keratoconjunctivitis Hemorrhagic Conjunctivitis Preseptal Cellulitis Orbital Cellulitis

9 Red Eye Diagnosis Conjunctivitis Allergic Mechanical Immune Mediated

10 Red Eye Diagnosis Trauma Iritis Chalazion
Corneal Abrasion Foreign Bodies Subconjunctival Hemorrhage Iritis Chalazion Nasolacrimal Duct Obstruction Angle Closure Glaucoma

11 Ocular Infections Corneal Ulcers Bacterial Fungal Acanthamoeba Viral

12 Ocular Infections Bacterial Staphylococci Streptococci Haemophilus
50% of the infections Streptococci Haemophilus Pseudomonas Serratia Central or near central location Hypopyon Pseudomonas rapid perforation

13 Ocular Infections Fungal Candida Fusarium
Gray white with feathery border Fusarium Outbreaks due to contact lens solution contaminant Giemsa stain Natamycin 5% (50mg/mL) q 1-2 hours No patching 164 confirmed cases of Fusarium associated with Renu with Moisture Loc

14 Ocular Infections Acanthamoeba Contact lenses Poor hygiene
Homemade solution Swimming Hot tubs Extremely painful Pain out of proportion to findings, Lasts several weeks Polymyxin/neomycin/gramicidin qtts, itraconazole 400 mg po, then 200 mg po qd Perineural infiltrates Need culture with E. Coli overlay and nonnutrient agar

15 Ocular Infections Ophthalmia Neonatorum Chemical Neisseria Gonorrhoeae
Chlamydia Trachomatis Staph, Strep, Gram Neg Herpes Simplex Virus Chemical with silver nitrate, less than 36 hours Untreated chlamydial can cause otitis or pneumonia, treat erythromycin elixir 50 mg/kg/d Ceftriaxone 150 mg/ IM or cefotaxime 50/kg/bid/tid for N. gonorrhea and treat for chlamydia as well

16 Ocular Infections Viral Herpes Simplex Keratitis
Typical dendrite staining pattern 90% exposure to virus by age 10 Neurotrophic Nasal, oral, or genital lesions? Immune system or recent steroids

17 Ocular Infections Herpes Zoster Ophthalmicus Hutchinson’s Sign
Dermatome CN V Treat under 72 hours from onset to prevent chronic herpetic neuralgia Acyclovir 800mg 5 times a day, famciclovir 500 mg tid, valacyclovir 1000 mg tid for 7 – 10 days

18 Ocular Infections Viral Epidemic Keratoconjunctivitis
Adenovirus Hemorrhagic Conjunctivitis Coxsackie A Coxsackie, NY enterovirus Highly contagious

19 Ocular Infections Preseptal Cellulitis
Tenderness, redness, swelling of lids Minimal or no pain with eye movement Dacryocystitis, sinusitis, trauma Staph Aureus and H. Influenzae are common causes Erysipelas (strep cellulitis) has sharp demarcation line Amoxicillin/clavulanate or cefaclor or TMP/SMZ or Erythromycin

20 Ocular Infections Orbital Cellulitis Pain on attempted eye movement
Proptosis, chemosis, fever Admit to hospital Trauma, sinusitis, surgery Staph sp, Strep sp, H. Influenzae Mucormycosis in immunosupressed or diabetes Ceftriaxone and Vancomycin or ampicillin/sulbactam or clindamycin and gentamicin

21 Conjunctivitis Allergic Seasonal allergic conjunctivitis
Vernal conjunctivitis Atopic conjunctivitis Giant papillary conjunctivitis (GPC), which also has a mechanical component

22 Conjunctivitis Allergic papillae giant papillae

23 Conjunctivitis Mechanical Superior limbic keratoconjunctivitis (SLK)
Contact-lens-related keratoconjunctivitis Floppy eyelid syndrome Pediculosis palpebrarum (Phthirus pubis) Medication-induced keratoconjunctivitis Conjunctival chalasis

24 Conjunctivitis Mechanical Floppy eyelid syndrome

25 Conjunctivitis Immune-mediated
Ocular mucous membrane pemphigoid (OMMP) Graft-versus-host disease (GVHD) Stevens-Johnson syndrome

26 Conjunctivitis Neoplastic Sebaceous (meibomian) carcinoma
Ocular surface squamous neoplasia Melanoma

27 Corneal Abrasion No entry into anterior chamber Decreased Vision
Pain, usually improves with topical anesthesia

28 Foreign Bodies Corneal Conjunctival Intraocular Orbital
Avoid MRI with possible magnetic objects High level of suspicion with high velocity impact (grinding, hammering)

29 Subconjunctival Hemorrhage
Typically not painful, not infection. Often noticed by another or when looking in mirror.

30 Iritis Dull, aching, throbbing pain Photophobia
Recurrent or initial, traumatic Can use cycloplegia in order to examine

31 Chalazion Inflamed meibomian gland of eyelid
Usually sterile, granuloma Can try warm compresses up to four times a day. Antibiotics not necessary, but steroids can work locally. Can drain in office when not inflamed. Often recurrent, but must differentiate from cancer.

32 Nasal Lacrimal Duct Obstruction
Usually congenital and often clears by 1 year. Can try warm compresses and massage. Antibiotics not necessary but lubrication may help. Typically can probe at or after 1 year with high success rate. Parental reassurance is key.

33 Acute Angle Closure Glaucoma
Eye/Orbit Pain, Headache Blurred/Decreased Vision Colored Halos Nausea and Vomiting Narrow anterior chamber, hyperopic Precipitated by anticholinergics (antihistamines or antipsychotics), accommodation, dim illumination

34 Acute Angle Closure Glaucoma
Signs Elevated intraocular pressure Shallow anterior chamber Corneal edema Mid dilated pupil Ciliary flush Narrow anterior chamber, hyperopes Precipitated by anticholinergics (antihistamines or antipsychotics), accommodation, dim illumination

35 Questions? (715) 342-7825 office
(715) cell

36 References American Academy of Ophthalmology . Preferred Practice Patterns. San Francisco: American Academy of Ophthalmology, 2013. The Wills Eye Manual. 6th ed. Office and Emergency Room Diagnosis and Treatment of Eye Disease. Philadelphia: Lippincott Williams and Wilkins, 2012.

Download ppt "WAOPS Spring Conference"

Similar presentations

Ads by Google