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 Lacrimal System Orbit Blepharitis Cellulitis Stye
Chalazion
Topical Allergic
Lacrimal System
Dacryocystitis
Canaliculitis
Dacryoadenitis
Orbit
Cellulitis
Preseptal
Orbital

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

5. Stye & Chalazion
Hot compression
Prevention
Incision draine

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

7. 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
Azithromycin can be given as a single dose of 1 g
Mum and sexual partner

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
Augmentin

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 Allergic Bacterial Seasonal Papillary reaction Viral
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
Typical watering discharge and follicular conunctivitis

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
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
Long term issue: uveitis, trigeminal neuroalgia
Acyclovir oint x4 daily 1week
Oral acyclovir 800mg bid for 1 week-10 days

21. Iritis Signs Treatment Etiology Miosis Red eye to limbus
Flare with cell
Treatment
Cycloplegia
Topical steroids REFER
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

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 Abrasion Ulcer Fluorescein Stain Transparency
Transparent
Opaque
Corneal contour
Unchanged
Uneven
Level
Epithelial only
Involves 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. Thorough irrigation before referral !!!
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
Cataract /retinal tumors -retinoblastoma

43. Thank you