Presented by: Awatif K. Al-Mutairi Hind K. Bin-Drees Sarah N. Al-Gubaisi Supervised by: Dr. Al-Johara Al- Quaiz

Red Eye Iron deficiencyAnaemia acne

RED EYE Outlines: What is red eye? Red eye in PHC. DDx. How to deal with pt. with red eye?

A 14-year-old boy. Complains of itching eyes for three years with sticky clear discharge. VA 6/6.

Six-year-old male. Painful eye for ten days. Had malaria one month ago. Corneal sensation reduced when tested. VA 6/60.

25 year-old woman. No pain or discharge. Complained of red eye since this morning. VA 6/6.

19 -year-old male. Complains of gritty foreign body sensation, painful eye for three days with sticky yellowish discharge. VA 6/9.

Back ground  Cardinal sign of ocular inflammation.  Most cases can managed effectively by the PC provider.  Account ≈ 2% of GP consultation (at least 1 case/week).  In KSA, trachoma prevalence was 22.2% in 1984, while in 1994, it was 10.7%.  Conjunctivitis in KSA is very common but least researched.

Pathophysiology  Due to dilatation of BVs in the eye.  BV either ciliary OR conj. Injection Ant. cil. a. superficial a. (cornea,iris, ↑↑ redness cili.body) ↔ ê topical VC

DDx

Blepharitis  either staphylococcal or seborreic,  FB sensation, burning,  matting of the lashes,  Worse in the morning.

Cellulitis  Preseptal: tender, swollen, red lid,,, ??? insect bites, minor trauma, and sinus disease.  Orbital: tender, swollen, and red eyelid.

Dacrocystitis  Pain, redness, and swelling over lacrimal sac  Tearing and discharge from the sac.  The vision is unchanged  Antibiotics, if not improve >>> refer

Conjunctivitis  Viral: –Watery discharge, redness, discomfort, photophobia. –Bilateral –lymphoid follicles –Enlarged tender preauricular nodes.

Conjunctivitis (Cont.)  Bacterial: –acute redness(pink eye), grittiness, burning –mucupurulent discharge – crusted eyelids on waking

Conjunctivitis (Cont.)  Chlamydia (trachoma): –red, mildly irritated eye, mucopurulent discharge. –lids stuck together on awakening. –Unilateral, preauricular node, papillae

Conjunctivitis (Cont.) allergic rhinoconjunc.: –red, itchy, watery eyes, –sneezing, watery nasal discharge

Conjunctivitis (Cont.) Vernal keratoconjunctivitis –itching, lacrimation, burning, FB sensation, photophobia. –Hx of atopy, –Giant Papillae, Tranta's Dots.

Keratoconj. Sicca  sandy sensation, dryness, burning  peak in the afternoon  Rx: eye lubricants

Corneal abrasion/ulcer  Pain (a.m), ↓ ↓ VA, photophopia  FB, bacterial,  fungal(contact lenses),  herpis(dendritic keratitis)

Scleritis  globe is tender, sclera swollen, ↓ ↓ VA  Deep scleral injection  If sever, deep violet discoloration

Iritis + Uveitis  Pain, perilimbal flush, ↓ ↓ VA, photophopia, small pupil.  minor trauma, chronic inflammatory conditions UC.  ??? acute glaucoma, cataract.

Acute angle closure glaucoma  red, hard eye,  mid dilated pupil,  cloudy cornea  unilateral

Medication  salt solution, alcohol, ground cowries, human sputum, bird and lizard faeces, urine, …etc.)  corneal ulcers,scars or eye perforations

How to approach the patient  At first: is this emergency case?  Neonates should always be referred to an ophthalmologist.

Management Rule out serious ophthalmic conditions YES NO Refer URGENTLY corneal abrasion Conjunctivitis cellulitisHordeolumBlepharitis

Management (cont.) corneal abrasion Conjunctivitis cellulitesHordeolumBlepharitis Lid hygiene Abcs (fusidic acid Tetracycli) HOT COMPRESS NO Abcs (??stye) periorb. Abcs Orbital refer Superficialdeep LA Abcs Erythrom NSAID refer

Management (cont.) Conjunctivit is Watery discharge Preauric.LN (Viral conj.) Preaur.LN. hx sex. Contact (chlamydia ) Mucopurul. stick lid (a.m) (bact. Conj.) Severe itching (allergic) lid vesicle (HSV, HZ) REFER Adeno. Cold comp. Herpis Cold comp. Antihist. Abcs (Fucithalmic) 1wk. Not improve

A 14-year-old boy. Complains of itching eyes for three years with sticky clear discharge. VA 6/6.

Six-year-old male. Painful eye for ten days. Had malaria one month ago. Corneal sensation reduced when tested. VA 6/60.

25 year-old woman. No pain or discharge. Complained of red eye since this morning. VA 6/6.

19 -year-old male. Complains of gritty foreign body sensation, painful eye for three days with sticky yellowish discharge. VA 6/9.

conclusion

Refrences Farina A.2005.red eye evaluation.e-medicine. Yorston d., Zondervan m Red eye: the role of primary care.community Eye Health Journal Vol 18 No p78 Allan V. Diagnosis and Treatment of Red Eye.Primary Care Case Reviews: Volume 4(1) March 2001 pp Leibowitz H. The red eye. N Engl J Med ;343(5): Jacobs DH. Evaluation of the Red Eye. UpToDate Tabbara KF, al-Omar OM. Trachoma in Saudi Arabia. Ophthalmic Epidemiol Sep;4(3):