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How to Handle Common Eye Problems in Your Practice Shuan Dai, FRANZCO Eye Doctors Ascot Hospital

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Presentation on theme: "How to Handle Common Eye Problems in Your Practice Shuan Dai, FRANZCO Eye Doctors Ascot Hospital"— Presentation transcript:

1 How to Handle Common Eye Problems in Your Practice Shuan Dai, FRANZCO Eye Doctors Ascot Hospital

2 The Red Eye A “Red Eye” may be due to an abnormality of the ocular structures including: Adnexa Lid Disorders Lacrimal System Orbital Disease Globe Conjunctival / Scleral Disorders Corneal Disease Uveitis Glaucoma

3 Adnexal Redness Lids Blepharitis Stye Chalazion Topical Allergic Lacrimal System Dacryocystitis Canaliculitis Dacryoadenitis Orbit Cellulitis Preseptal Orbital

4 Blepharitis Symptoms & signs Crusting Oil droplets Grittiness Treatment Lid hygiene Doxycycline 100mg daily 4-6 weeks

5 Stye & Chalazion Stye & Chalazion

6 Dacryocystitis Recurrent watering eye Mucous/purulent discharge Abscess /lump over lacrimal sac Blocked tear duct

7 Ophthalmia Neonatorum Ophthalmia Neonatorum Infantile purulent conjunctivitis Chemical from antibiotic drops/silver nitrate Chlamydia Gonorrhea An ocular emergency as GC can invade the intact cornea and perforate the globe

8 Lacrimal sac mucocele An uncommon variant Look for an elevated mass extending medially Life threatening if infected – refer for intravenous antibiotics

9 Dacryoadenitis Acute painful Swelling lateral upper lid Viral/bacteria infection Oral/iv antibiotics

10 Orbital Cellulitis Proptosis Limited eye movement Reduced vision

11 Redness Confined to the Globe Conjunctiva / Sclera Subconjunctival hemorrhage Ocular injection – conjunctivitis Pingueculum / Pterygium Episcleritis Scleritis Cornea Keratitis Corneal abrasion Corneal ulcer Anterior chamber Iritis Endophthalmitis

12 Conjunctivitis Bacterial Purulent discharge Papillary reaction Associated blepharitis Viral Mucoid discharge Follicular reaction Associated URTI, epidemic Allergic Seasonal Papillary reaction Associated rhinitis, itching

13 Bacterial Conjunctivitis Symptoms: discharge, irritation Signs: papillary conjunctivitis, perilimbal injection if associated keratitis Treatment: chloramphenicol/fucithalmic Danger: if hyperpurulent (gonococcal) or recent intraocular surgery REFER!

14 Viral Conjunctivitis Highly contagious, epidemics Symptoms: previous URTI, previous contacts, mucoid discharge, often photophobia Signs: preauricular node, pseudoptosis, follicular conjunctivitis,conjunctival injection, punctate keratitis Treatment: cool compresses, ocular lubricants. Referal Warning: extreme infectivity, second eye at one week, lasts 10 – 14 days

15 Allergy - Papillary conjunctival reaction

16 Allergic Conjunctivitis Symptoms: itching, seasonal, atopic history, rhinitis Signs: papillary reaction, mucus Treatment: cool compresses, ocular lubricants, anti-histamines - topical (Vasocon A) or systemic, Opticrom (Na chromoglycate) prophylaxis Possible history of contact lens wear with giant papillary conjunctivitis Treatment: Lomide Patanol Steroid, i.e. FML

17 Pingueculum & Pterygium Pingueculum is degenerative collagen within the interpalbebral fissure Pterygium extends onto the cornea

18 Episcleritis & Scleritis Episcleritis Less painful Younger age No systemic association Diffuse Scleritis Extremely painful Elderly, RA, systemic vasculitis

19 Herpes Simplex Keratitis Viral replication in cornea Symptoms: irritation, photophobia Signs: red eye involving limbus, dendrite with terminal bulbs seen best with staining ulcer formation Treatment: refer, antivirals, BEWARE STEROIDS!

20 Herpes Zoster Herpes Zoster Ophthalmicus Suspect ocular involvement if the tip of the nose is involved (Hutchinson’s sign) Oral acyclovir & topical acyclovir

21 Iritis Etiology 50% idiopathic, unknown Ocular disease Large abrasion HSV, HZV Primary disease in young patients Systemic disease JRA – pauciarticular disease Ankylosing spondylitis Symptoms Extreme photophobia Reduced vision Signs Miosis Red eye to limbus Flare with cell Treatment Cycloplegia Topical steroids REFER

22 Acute iritis Light sensitivity Deep dull ache Smaller/ irregular pupil Often idiopathic

23 Angle Closure Glaucoma

24 Subconjunctival Hemorrhage Can occur secondary to blunt trauma or can be spontaneous Lubrication if foreign body sensation Warm compression

25 Corneal Abrasion Management Non-contact lens wearer Antibiotic ointment and patch Follow-up one day Contact lens wearer DO NOT PATCH Antibiotic ointment or drops Follow up daily until healed Treat abrasions created with organic material in this manner

26 Corneal Ulcer Risk of corneal ulcer when epithelium compromised, especially in contact lens wearers Contact lens wearers have a higher rate of colonization with Pseudomonas

27 Abrasion versus Ulcer AbrasionUlcer FluoresceinStain TransparencyTransparentOpaque Corneal contourUnchangedUneven LevelEpithelial onlyInvolves stroma

28 Superficial Corneal Foreign Body Removed under topical anesthetic With burr or 25 gauge needle Manage same as corneal erosion Encourage safety glasses Polycarbonate lenses

29 Anterior Segment Linear epithelial defects is suggestive of a foreign body under the eye lid

30 Ultraviolet Radiation(arc eye) Sources Sunlamps, welding arcs Management Cycloplegics, antibiotic ointment, patch Avoid long term topical anaethetic drop !!!

31 Chemical Injury Acid precipitates quickly Alkali continues to penetrate Therefore can progress over an extended period of time Management Continuous irrigation with saline until neutral pH Test fornices with Litmus paper Sweep fornices to remove retain debris Antibiotic ointment, cycloplegics

32 Chemical Injury Thorough irrigation before referral !!!

33 Blunt Trauma Hyphema Indicates damage to angle and/or to the iris Management Vertical position No anti-coagulants Cycloplegics

34 Blunt Trauma Damage to Iris and Lens Iridodialysis, cataract Dislocation

35 Blunt Trauma - Sequelae Angle damage which can lead to glaucoma: can develop days to years after injury

36 Blunt Trauma - Sequelae A retinal tear which can progress to a retinal detachment

37 Open Globe Injuries Blunt trauma – rupture Sharp trauma – laceration Projectile trauma Penetrating – in and out Perforating ± intra ocular foreign body – just in

38 Blunt Trauma Severe trauma that resulted in a scleral rupture with delivery of the lens

39 Sharp Trauma Corneal laceration and traumatic cataract from a thrown beer bottle

40 Penetrating Eye Injuries Intraocular foreign bodies generally have to be removed, unlike orbital (extraocular) foreign bodies

41 Perforating Trauma Patient was hammering and noticed a spark fly up to his eye.

42 Child with poor red reflex

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