Presentation on theme: "How to Handle Common Eye Problems in Your Practice"— Presentation transcript:
1How to Handle Common Eye Problems in Your Practice Shuan Dai, FRANZCOEye DoctorsAscot Hospital
2The Red EyeA “Red Eye” may be due to an abnormality of the ocular structures including:AdnexaLid DisordersLacrimal SystemOrbital DiseaseGlobeConjunctival / Scleral DisordersCorneal DiseaseUveitisGlaucoma
7Ophthalmia Neonatorum Infantile purulent conjunctivitisChemical from antibiotic drops/silver nitrateChlamydiaGonorrheaAn ocular emergency as GC can invade the intact cornea and perforate the globeAzithromycin can be given as a single dose of 1 gMum and sexual partner
8Lacrimal sac mucocele An uncommon variant Look for an elevated mass extending mediallyLife threatening if infected – refer for intravenous antibiotics
9Dacryoadenitis Acute painful Swelling lateral upper lid Viral/bacteria infectionOral/iv antibioticsAugmentin
19Herpes Simplex Keratitis Viral replication in corneaSymptoms: irritation, photophobiaSigns:red eye involving limbus,dendrite with terminal bulbsseen best with stainingulcer formationTreatment: refer, antivirals, BEWARE STEROIDS!
20Herpes Zoster Herpes Zoster Ophthalmicus Suspect ocular involvement if the tip of the nose is involved (Hutchinson’s sign)Oral acyclovir & topical acyclovirLong term issue: uveitis, trigeminal neuroalgiaAcyclovir oint x4 daily 1weekOral acyclovir 800mg bid for 1 week-10 days
21Iritis Signs Treatment Etiology Miosis Red eye to limbus Flare with cellTreatmentCycloplegiaTopical steroids REFEREtiology50% idiopathic, unknownOcular diseaseLarge abrasionHSV, HZVPrimary disease in young patientsSystemic diseaseJRA – pauciarticular diseaseAnkylosing spondylitisSymptomsExtreme photophobiaReduced vision
22Acute iritis Light sensitivity Deep dull ache Smaller/ irregular pupil Often idiopathic
24Subconjunctival Hemorrhage Can occur secondary to blunt trauma or can be spontaneousLubrication if foreign body sensationWarm compression
25Corneal Abrasion Management Non-contact lens wearer Antibiotic ointment and patchFollow-up one dayContact lens wearerDO NOT PATCHAntibiotic ointment or dropsFollow up daily until healedTreat abrasions created with organic material in this manner
26Corneal UlcerRisk of corneal ulcer when epithelium compromised, especially in contact lens wearersContact lens wearers have a higher rate of colonization with Pseudomonas
28Superficial Corneal Foreign Body Removed under topical anestheticWith burr or 25 gauge needleManage same as corneal erosionEncourage safety glassesPolycarbonate lenses
29Anterior SegmentLinear epithelial defects is suggestive of a foreign body under the eye lid
30Ultraviolet Radiation(arc eye) SourcesSunlamps, welding arcsManagementCycloplegics, antibiotic ointment, patchAvoid long term topical anaethetic drop !!!
31Chemical Injury Acid precipitates quickly Alkali continues to penetrateTherefore can progress over an extended period of timeManagementContinuous irrigation with saline until neutral pHTest fornices with Litmus paperSweep fornices to remove retain debrisAntibiotic ointment, cycloplegics
32Thorough irrigation before referral !!! Chemical InjuryThorough irrigation before referral !!!
33Blunt Trauma Hyphema Indicates damage to angle and/or to the iris ManagementVertical positionNo anti-coagulantsCycloplegics
34Blunt Trauma Damage to Iris and Lens Iridodialysis, cataract Dislocation
35Blunt Trauma - Sequelae Angle damage which can lead to glaucoma: can develop days to years after injury
36Blunt Trauma - Sequelae A retinal tear which can progress to a retinal detachment
37Open Globe Injuries Blunt trauma – rupture Sharp trauma – laceration Projectile traumaPenetrating – in and outPerforating ± intra ocular foreign body – just in
38Blunt TraumaSevere trauma that resulted in a scleral rupture with delivery of the lens
39Sharp TraumaCorneal laceration and traumatic cataract from a thrown beer bottle
40Penetrating Eye Injuries Intraocular foreign bodies generally have to be removed, unlike orbital (extraocular) foreign bodies
41Perforating TraumaPatient was hammering and noticed a spark fly up to his eye.
42Child with poor red reflex Cataract /retinal tumors -retinoblastoma