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The Red Eye

The Red Eye. Introduction. Relevance Red Eye Frequent presentation to GP Must be able to differentiate between serious vision threatening conditions and simple benign conditions. Conjunctival Blepharoconjunctivitis Bacterial conjunctivitis Viral conjunctivitis Chlamydial conjunctivitis

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The Red Eye

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  1. The Red Eye

  2. Introduction • Relevance • Red Eye • Frequent presentation to GP • Must be able to differentiate between serious vision threatening conditions and simple benign conditions

  3. Conjunctival Blepharoconjunctivitis Bacterial conjunctivitis Viral conjunctivitis Chlamydial conjunctivitis Allergic conjunctivitis Toxic/chemical reaction Dry eye Pinguecula/pteyrgium Subconjunctival hemorrhage Lid diseases Clalazion Sty Abnormal lid function Corneal disease Abrasion Ulcer Foreign body Trauma Dacryoadenitis Dacryocystitis Masquerade syndrome Carotid and dural fistula Acute angle glaucoma Anterior uveitis Episcleritis/scleritis Factitious Differential diagnosis of red eye

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Conjunctivitis Follicles Purulent discharge Papillae Chemosis Redness

  10. Subconjunctival Haemorrhage • Diffuse or localised area of blood under conjunctiva. Asymptomatic • Idiopathic, trauma, cough, sneezing, aspirin, HT • Resolves within 10-14 days

  11. 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

  12. Lid malposition

  13. Pterygium

  14. Corneal Abrasion • Surface epithelium sloughed off. • Stains with fluorescein • Usually due to trauma • Pain, FB sensation,tearing, red eye

  15. Foreign Body

  16. 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

  17. Episcleritis • Superficial • Idiopathic, collagen vascular disorder (RA) • Asymptomatic, mild pain • Self-limiting or topical treatment

  18. Scleritis • Deep • Idiopathic • Collagen vascular disease (RA,AS, SLE, Wegener, PAN) • Zoster • Sarcoidosis • Dull, deep pain wakes patient at night • Systemic treatment with NSAI or Prednisolone if severe

  19. Uveitis Anterior: acute recurrent and chronic Posterior: vitritis, retinal vasculitis, retinitis, choroiditis Panuveitis: anterior and posterior

  20. Anterior uveitis (iritis) • Photophobia, red eye, decreased vision • Idiopathic. Commonest • Associated to systemic disease • Seronegative arthropathies:AS, IBD, Psoriatic arthritis, Reiter’s • Autoimmune: Sarcoidosis, Behcets • Infection: Shingles, Toxoplasmosis, TB, Syphillis, HIV

  21. Ciliary flush Posterior synechiae Fibrin Flare Hypopyon KPs

  22. Acute Angle-closure Glaucoma • Symptoms • Pain, headache, nausea-vomiting • Redness, photophobia, • Reduced vision • Haloes around lights Ciliary hyperaemia Dilated pupil Corneal oedema

  23. 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

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