Presentation on theme: "Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE"— Presentation transcript:
1 Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE The Red EyeDr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE
2 Objectives Define red eye Record history taking in red eye case State common symptoms and signs in red eyeDescribe physical exam in red eyeEnlist differential diagnoses of red eyeOutline red eye management by primary care physiciansSummarize some important drug induced side effects in red eye
3 What is “RED EYE” Red Eye is a non-specific term. Usually refers to injection and prominence of the superficial blood vessels of the conjunctiva, or sclera, which may be caused by disorders of these or adjacent structures.Slit lamp Examination is Invaluable in diagnosis but initial assessment can be performed using a careful history, testing vision (visual acuity), and carrying out a penlight examination.
4 Differential diagnosis of red eye ConjunctivalBlepharoconjunctivitisBacterial conjunctivitisViral conjunctivitisChlamydial conjunctivitisAllergic conjunctivitisToxic/chemical reactionDry eyePinguecula/pteyrgiumSubconjunctival hemorrhageLid diseasesClalazionStySecondary to Abnormal lid functionCorneal diseaseAbrasionUlcerkeratitisForeign bodyTraumaAdnexal DiseaseDacryoadenitisDacryocystitisCarotid and dural fistulaAcute angle glaucomaAnterior uveitisEpiscleritis/scleritisFactitious
5 History Onset? Sudden? Progressive? Constant? Family/friends with red eye?Using meds in eye?Trauma?Recent eye surgery?Contact lens wearer?Recent URTI?Decreased VA? Pain? Discharge? Itching? Photophobia? Eye rubbing?Other symptoms?
6 Red Eye: SymptomsDecreased VA (Inflamed cornea, Iridocyclitis, Acute glaucoma)Pain (keratitis, Ulcer, Iridocyclitis, Acute Glaucoma)Photophobia (Iritis Conjunctivitis)Colored halos (Acute Glaucoma)Discharge (Conj. or lid inflammation, corneal ulcer)Purulent/mucopurulent: BacterialWatery: ViralScant, white, stringy: allergy, dry eyesItching (allergy)
7 Physical Exam Vision Pupil asymmetry or irregularity Inspect: pattern of redness (heme, injection, ciliary flush)Amount & type of dischargeCorneal opacities or irregularitiesAC shallow? Hypopyon? Hyphema?Fluorescein stainingIOPProptosis? Lid abnormality? Limitation EOM?
10 Blepharitis Adults > children Inflammation of the lid margin Frequently associated with styesMeibomian gland dysfunctionLid hygiene, topical antibiotics, and lubricants are the mainstays of treatment
12 Bacterial Conjunctivitis Both adults and childrenTearing, foreign body sensation, burning, stinging and photophobiaMucopurulent or purulent dischargeLid and conjunctiva maybe edematousStreptococcus pneumoniae, Haemophilus influenzae, and staphylococcus aureus and epidermidisConjunctival swab for cultureTopical broad spectrum antibiotics
14 Viral ConjunctivitisAcute, watery red eye with soreness, foreign body sensation and photophobiaConjunctiva is often intensely hyperaemic and there maybe follicles, haemorrhages, inflammatory membranes and a pre-auricular nodeThe most common cause is an adenoviral infectionNo specific therapy but cold compresses are helpful.
15 Allergic Conjunctivitis Encompasses a spectrum of clinical conditionAll associated with the hallmark symptom of itchingThere is often a history of rhinitis, asthma and family history of atopySigns may include mildly red eyes, watery discharge, chemosis, papillary hypertrophy and giant papillaeTreatment consist of cold compresses, antihistamines, nonsteroidals, mast cells stabilizers, topical corticosteroids and cyclosporine
18 Chlamydial Conjunctivitis Usually occur in sexually active individuals with or without an associated genital infectionConjunctivitis usually unilateral with tearing, foreign body sensation, lid crusting, conjunctival discharge and folliclesThere is often non-tender preauricular nodeTreatments requires oral tetracycline or azithromycin
26 Corneal Ulcer Infection Mechanical or trauma Bacterial: Adnexal infection, lid malposition, dry eye, CLViral: HSV, HZOFungal:Protozoan: Acanthamoeba in CL wearerMechanical or traumaChemical: Alkali injuries are worse than acid
40 Red eye management Blepharitis: Stye/Chalazion Warm compresses, lid care, Abx ointment or oral (if rosacea or Meibomian gland dysfunction)Stye/ChalazionWarm compresses (refer if still present after 1 month)Subconjuntival hememorrage:Will resolve in daysViral conjunctivitisCool compresses, tears, contact precautionsBacterial conjunctivitisCool compresses, antibiotic drop/ointment
41 Important drug induced Side Effects Topical anesthetics:Not to be used except for aiding in examInhibits growth & healing of corneal epitheliumPossible severe allergic reactionDecrease blink reflex: exposure to dehydration, injury, infectionTopical corticosteroids:Can potentiate growth of herpes simplex, fungusCan mask symptomsCataract formationElevated IOP