1. Chapter 9 Medical Considerations
Disorders of the Eye
Chapter 9
Medical Considerations

2. RED EYE (NON-VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION-THREATENING DISORDERS)
Subconjunctival hemorrhage
Conjunctivitis
Blepharitis
Keratitis
Dry eye
Pterygium/pingueculum
This is obviously an arbitrary classification as many problems that do not initially appear serious may rapidly progress to a vision-threatening problem. For example, a viral keratitis can develop into a perforating corneal ulcer if secondarily infected by gram-negative bacteria.

3. RED EYE (VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (VISION-THREATENING DISORDERS)
Iritis/uveitis
Corneal ulcers
Angle-closure glaucoma
Preseptal/orbital cellulitis
Endophthalmitis
Trauma
This is just a partial list but all we have time for.

4. External examination Subconjunctival hemorrhage Conjunctival injection
RED EYE and TRAUMA
External examination
It is diagnostically important to distinguish between a sub-conjunctival hemorrhage and an inflammatory reaction due to dilated conjunctival vessels.
Subconjunctival
hemorrhage
Conjunctival injection

5. External examination Conjunctival injection RED EYE and TRAUMA
The pattern of injection can provide useful diagnostic ideas. Clockwise from upper left: “ciliary flush” of intra-ocular inflammation, segmental scleritis of rheumatoid arthritis and other auto-immune diseases, gonococcal conjunctivitis, and contact lens irritation with lid reaction.
Conjunctival
injection

6. RED EYE (NON-VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION-THREATENING DISORDERS)
Subconjunctival hemorrhage
Most non-traumatic sub-conjunctival hemorrhages are not associated with disease and will resolve in days. Many occur spontaneously in older individuals with vascular fragility who are often on anticoagulants as well.

7. RED EYE (NON-VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION-THREATENING DISORDERS)
Subconjuntival hemorrhage with chemosis
Conjunctival epithelium will keratinize if allowed to remain dry for extended periods.
Keep conjunctiva moist with antibiotic ointment

8. Posterior petechial hemorrhages RED EYE and TRAUMA
Don’t forget to look under the lids too!

9. Subconjunctival air! RED EYE and TRAUMA
Air from high pressure hose was forced into left nostril, through the medial wall of the orbit, and into the sub-conjunctival space. This resolved by itself in 1 week!

10. RED EYE (NON-VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION-THREATENING DISORDERS)
Conjunctivitis: NOT
Unilateral red eye is not usually due to an infectious agent. Contagious conjunctivitis is always bilateral, although it may be in different stages in the two eyes.

11. RED EYE (NON-VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION-THREATENING DISORDERS)
Conjunctivitis
allergic
Allergic to Polytrim
The history should help you here.

12. RED EYE (NON-VISION-THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION-THREATENING DISORDERS)
Conjunctivitis
bacterial
This is the classical BILATERAL appearance of the “pink eye” conjunctivitis so often seen in grade school age children. Most respond promptly to a broad-spectrum antibiotic such as Polytrim.

13. RED EYE (NON-VISION THREATENING DISORDERS)
RED EYE and TRAUMA
RED EYE (NON-VISION THREATENING DISORDERS)
Conjunctivitis
chemical
Proparacaine abuse
The ‘caines are toxic to the corneal epithelium causing a severe keratitis with repeated application.

14. EYELID ANATOMY MEIBOMIAN GLAND Tarsal plate RED EYE and TRAUMA
Note the Meibomian glands are encased in the cartilaginous portions of they eyelids, called tarsal plates. Their openings adjacent to the lashes provide ready access to bacteria, and the resulting Meibomianitis is commonly known as a sty, or in medical terms, a hordeolum. The sebaceous products of these glands are a vital component of the tears.
MEIBOMIAN GLAND

15. Meibomianitis RED EYE and TRAUMA
Note the Meibomian gland openings right along the lid margin as well as the staph folliculitis. The latter leads to scarring of the lash follicles and may result in uncomfortable trichiasis.

16. (NON-VISION-THREATENING DISORDERS
RED EYE and TRAUMA
RED EYE
(NON-VISION-THREATENING DISORDERS
Blepharitis
Acute
Acute blepharitis due to inflammation of a Meibomian gland. At this stage there is mainly a cellulitis and the treatment is application of warm compresses q.i.d. Topical antibiotics do not penetrate sufficiently. Note the distortion of the upper lid crease suggesting that this patient has had previous styes.

17. BLEPHARITIS Subacute Chronic RED EYE and TRAUMA
Sometimes the inflammation in the eyelids is more generalized and indolent. These should be treated promptly also as progressive disease wipes out Meibomian glands as in the upper eyelid in the right photo leading eventually to serious surface-wetting problems.

18. External hordeolum RED EYE and TRAUMA
This sty is progressing into a chalazion, the end-stage scar that sometimes results from a sty.

19. Internal hordeolum RED EYE and TRAUMA
Heat applied to a sty often brings it to a head and if the pimple is ruptured, the purulent material will drain and chalazion development may be avoided.

20. Chalazion RED EYE and TRAUMA
This chalazion will need to be excised and the contents drained.

21. Chalazia RED EYE and TRAUMA
Chalazia come in all sizes and shapes. Remember to apply heat during the acute cellulitis phase and to drain any pustules. Otherwise, it is a wait-and-see game to determine if excision is required after the cellular inflammation quiets down.

22. Blepharo-conjunctivitis
RED EYE and TRAUMA
Blepharo-conjunctivitis
Don’t forget that the lids and the globes may be simultaneously involved.