Eyes Tutorial 12/7/05

Red Eye conjunctivacornea Anterior chamber infectionFBIris allergyAbrasion Acute glaucoma injuryErosion SC haemorrhage Keratitis/ulcer

Red Eye ScleraEyelidOrbit EpiscleritisChalazionCellulitis ScleritisBlepharitisTrauma HZ

Examination Pattern- danger around cornea Pattern- danger around cornea Discharge- watery/purulent Discharge- watery/purulent Ant eye chamber- pus/bld, colour, equal pupils Ant eye chamber- pus/bld, colour, equal pupils Cornea- RR, glossy/dull, FB Cornea- RR, glossy/dull, FB Proptosis Proptosis Eyelids- red,swelling, entropian, ectropian, FB Eyelids- red,swelling, entropian, ectropian, FB

Examination cont PAIN PAIN Reduced VA Reduced VA PHOTOPHOBIA PHOTOPHOBIA TRAUMA TRAUMA THEN TEST VA, PERLA, opthalmoscopy, flouriscin

Corneal Inflammation/ Keratitis (ulcer) Sxs- pain, red vision, photophobia, pericorneal redness Sxs- pain, red vision, photophobia, pericorneal redness Assc- contact lenses, Inf – HZ/HSx, Elderly (eyelid dx), poor eye closure Assc- contact lenses, Inf – HZ/HSx, Elderly (eyelid dx), poor eye closure Fx to Id may lead to perm scarring- stain with flouriscin> show up green with blue filter Fx to Id may lead to perm scarring- stain with flouriscin> show up green with blue filter Tx underlying infn Tx underlying infn

Red Eye Causes IRITIS IRITIS  Assc with inflammation of cilliary body> may be assc with abn pupil or pus/precipitate in ant chamber  Acute onset of pain, photophobia, watering, irregular pupil, pain on convergance and constriction  Systemic dx- sarcoid/ ank spond  Infn (rare)- Syphillis/TB/HZ  Urgent referral- steroids and mydritics  Relapse - common

SCLERITIS SCLERITIS  Generalised inflammation of the episclera  Can be compication of CT dx  Urgent referral  Pain, generalised redness, more florid, bluish discolouration to sclera with ischaemia  EPISCLERITIS  More common  Discomfort- dull ache  Superficial vessels- localised redness

Acute Glaucoma Severe pain, N/V, red VA/loss, mild dilated fixed pupil, pericorneal redness, steamy cornea, eyeball feels hard Severe pain, N/V, red VA/loss, mild dilated fixed pupil, pericorneal redness, steamy cornea, eyeball feels hard Warning halos Warning halos Recent use of dilators Recent use of dilators Middle or old age Middle or old age Blockage of aqueous drainage from ant chamber> sudden inc in IO pressure Blockage of aqueous drainage from ant chamber> sudden inc in IO pressure Refer immd Refer immd Pilorcarpine drops/ surgery pr laser when pressure ok Pilorcarpine drops/ surgery pr laser when pressure ok

Summary danger s and s Sxs Sxs  Ocular pain  Photophobia  Reduced VA Signs Signs  Pericorneal redness  Clouding/ staining of cornea  Abn pupil  proptosis

Conjunctivitis Inf- Bact/ viral Inf- Bact/ viral Allergy-atopy/CL Allergy-atopy/CL Tear Fn- Tear Fn- Eyedrops- glaucoma drops, allergy Eyedrops- glaucoma drops, allergy Injury- FB, CL, trauma Injury- FB, CL, trauma Eyelid- blepharitis Eyelid- blepharitis

Others SC haemorrhage SC haemorrhage  Spont localised haemorrhage  Elderly, bleeding dx (rare), raised BP, trauma  Redness- sharp boundaries  1-2 weeks-  Consider referral if trauma and post edge not visible (orbital haematoma)

Orbital cellulitis Orbital cellulitis  Infn spread from paranasal sinuses  Fever, swelling, proptosis, pain moving eyeball  Refer for IV antibiotics immd  Complicns- meningitis, cav sinus thrombosis, blindness