Presentation on theme: "How to Handle Common Eye Problems in Your Practice Shuan Dai, FRANZCO Eye Doctors Ascot Hospital"— Presentation transcript:
How to Handle Common Eye Problems in Your Practice Shuan Dai, FRANZCO Eye Doctors Ascot Hospital
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
Adnexal Redness Lids Blepharitis Stye Chalazion Topical Allergic Lacrimal System Dacryocystitis Canaliculitis Dacryoadenitis Orbit Cellulitis Preseptal Orbital
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
Lacrimal sac mucocele An uncommon variant Look for an elevated mass extending medially Life threatening if infected – refer for intravenous antibiotics
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!
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
Allergy - Papillary conjunctival reaction
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
Pingueculum & Pterygium Pingueculum is degenerative collagen within the interpalbebral fissure Pterygium extends onto the cornea
Episcleritis & Scleritis Episcleritis Less painful Younger age No systemic association Diffuse Scleritis Extremely painful Elderly, RA, systemic vasculitis
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!
Herpes Zoster Herpes Zoster Ophthalmicus Suspect ocular involvement if the tip of the nose is involved (Hutchinson’s sign) Oral acyclovir & topical acyclovir
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
Acute iritis Light sensitivity Deep dull ache Smaller/ irregular pupil Often idiopathic
Angle Closure Glaucoma
Subconjunctival Hemorrhage Can occur secondary to blunt trauma or can be spontaneous Lubrication if foreign body sensation Warm compression
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
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
Superficial Corneal Foreign Body Removed under topical anesthetic With burr or 25 gauge needle Manage same as corneal erosion Encourage safety glasses Polycarbonate lenses
Anterior Segment Linear epithelial defects is suggestive of a foreign body under the eye lid
Ultraviolet Radiation(arc eye) Sources Sunlamps, welding arcs Management Cycloplegics, antibiotic ointment, patch Avoid long term topical anaethetic drop !!!
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
Chemical Injury Thorough irrigation before referral !!!
Blunt Trauma Hyphema Indicates damage to angle and/or to the iris Management Vertical position No anti-coagulants Cycloplegics
Blunt Trauma Damage to Iris and Lens Iridodialysis, cataract Dislocation
Blunt Trauma - Sequelae Angle damage which can lead to glaucoma: can develop days to years after injury
Blunt Trauma - Sequelae A retinal tear which can progress to a retinal detachment
Open Globe Injuries Blunt trauma – rupture Sharp trauma – laceration Projectile trauma Penetrating – in and out Perforating ± intra ocular foreign body – just in
Blunt Trauma Severe trauma that resulted in a scleral rupture with delivery of the lens
Sharp Trauma Corneal laceration and traumatic cataract from a thrown beer bottle
Penetrating Eye Injuries Intraocular foreign bodies generally have to be removed, unlike orbital (extraocular) foreign bodies
Perforating Trauma Patient was hammering and noticed a spark fly up to his eye.