Presentation on theme: "The Red Eye Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE."— Presentation transcript:
The Red Eye Dr Mahmood Fauzi ASSIST PROF OPHTHALMOLOGY AL MAAREFA COLLEGE
Objectives Define red eye Record history taking in red eye case State common symptoms and signs in red eye Describe physical exam in red eye Enlist differential diagnoses of red eye Outline red eye management by primary care physicians Summarize some important drug induced side effects in red eye
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.
Differential diagnosis of red eye Conjunctival Blepharoconjunctivitis Bacterial conjunctivitis Viral conjunctivitis Chlamydial conjunctivitis Allergic conjunctivitis Toxic/chemical reaction Dry eye Pinguecula/pteyrgium Subconjunctival hemorrhage Lid diseases Clalazion Sty Secondary to Abnormal lid function Corneal disease Abrasion Ulcer keratitis Foreign body Trauma Adnexal Disease Dacryoadenitis Dacryocystitis Carotid and dural fistula Acute angle glaucoma Anterior uveitis Episcleritis/scleritis Factitious
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?
Blepharitis Adults > children Inflammation of the lid margin Frequently associated with styes Meibomian gland dysfunction Lid hygiene, topical antibiotics, and lubricants are the mainstays of treatment
Bacterial Conjunctivitis Both adults and children Tearing, foreign body sensation, burning, stinging and photophobia Mucopurulent or purulent discharge Lid and conjunctiva maybe edematous Streptococcus pneumoniae, Haemophilus influenzae, and staphylococcus aureus and epidermidis Conjunctival swab for culture Topical broad spectrum antibiotics
Viral Conjunctivitis Acute, watery red eye with soreness, foreign body sensation and photophobia Conjunctiva is often intensely hyperaemic and there maybe follicles, haemorrhages, inflammatory membranes and a pre- auricular node The most common cause is an adenoviral infection No specific therapy but cold compresses are helpful.
Allergic Conjunctivitis Encompasses a spectrum of clinical condition All associated with the hallmark symptom of itching There is often a history of rhinitis, asthma and family history of atopy Signs may include mildly red eyes, watery discharge, chemosis, papillary hypertrophy and giant papillae Treatment consist of cold compresses, antihistamines, nonsteroidals, mast cells stabilizers, topical corticosteroids and cyclosporine
Chlamydial Conjunctivitis Usually occur in sexually active individuals with or without an associated genital infection Conjunctivitis usually unilateral with tearing, foreign body sensation, lid crusting, conjunctival discharge and follicles There is often non-tender preauricular node Treatments requires oral tetracycline or azithromycin
Subconjunctival Haemorrhage Asymptomatic Diffuse or localised area of blood under conjunctiva. Idiopathic, trauma, cough, sneezing, aspirin, HT Resolves within days
Dry Eye Syndrome Poor quality Meibomian gland disease, Acne rosacea Lid related Vitamin A deficiency Poor quantity KCS Sjogren Syndrome Rheumatoid Arthritis Lacrimal disease ie, Sarcoidosis Paralytic ie, VII CN palsy
Corneal Abrasion Surface epithelium sloughed off. Stains with fluorescein Usually due to trauma Pain, FB sensation, tearing, red eye
Corneal Ulcer Infection Bacterial: Adnexal infection, lid malposition, dry eye, CL Viral: HSV, HZO Fungal: Protozoan: Acanthamoeba in CL wearer Mechanical or trauma Chemical: Alkali injuries are worse than acid
Red Eye Treatment Algorithm History Trauma Contact lens wearer Severe pain/photophobia Significant vision changes History of prior ocular diseases Exam - Visual loss Abnormal pupil Ocular tenderness White corneal opacity Increased intraocular pressure YES Refer urgently to ophthalmologist
Red eye management Blepharitis: Warm compresses, lid care, Abx ointment or oral (if rosacea or Meibomian gland dysfunction) Stye/Chalazion Warm compresses (refer if still present after 1 month) Subconjuntival hememorrage: Will resolve in days Viral conjunctivitis Cool compresses, tears, contact precautions Bacterial conjunctivitis Cool compresses, antibiotic drop/ointment
Important drug induced Side Effects Topical anesthetics: Not to be used except for aiding in exam Inhibits growth & healing of corneal epithelium Possible severe allergic reaction Decrease blink reflex: exposure to dehydration, injury, infection Topical corticosteroids: Can potentiate growth of herpes simplex, fungus Can mask symptoms Cataract formation Elevated IOP