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The Red Eye

WAOPS Spring Conference May 31, 2014 The Waters at Minocqua 8116 US 51 South Minocqua, WI Shiloh A. Simons, DO Ministry Medical Group Ophthalmology Stevens Point , WI. The Red Eye. History Symptoms: itching, discharge, irritation, pain, photophobia, blurred vision

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The Red Eye

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  1. WAOPS Spring Conference • May 31, 2014 • The Waters at Minocqua8116 US 51 SouthMinocqua, WI • Shiloh A. Simons, DO • Ministry Medical Group Ophthalmology • Stevens Point , WI The Red Eye

  2. History Symptoms: itching, discharge, irritation, pain, photophobia, blurred vision Unilateral or bilateral presentation Character of discharge Recent exposure to an infected individual Trauma: mechanical, chemical, ultraviolet Contact lens wear: lens type, hygiene, and use regimen Systemic diseases (e.g., genitourinary discharge, dysuria, dysphagia, upper respiratory infection, skin and mucosal lesions) Allergy, asthma, eczema Use of topical and systemic medications Red Eye Workup

  3. Physical Exam Measure Visual Acuity External Examination Pupil Exam, Motility Exam Slit-lamp examination Intraocular pressures Dilated Exam Red Eye Workup

  4. External Exam Regional lymphadenopathy,particularly preauricular Skin: signs of rosacea, eczema, seborrhea Abnormalities of the eyelids: swelling, discoloration, malposition, laxity Conjunctiva: pattern of injection, subconjunctival hemorrhage, chemosis, cicatricial change Red Eye Workup

  5. Slit-lamp Exam Eyelid margins: inflammation, vesicles Eyelashes: loss of lashes, trichiasis Lacrimalpuncta and tear film Conjunctiva: injection, papillae, follicles Cornea: Epithelial defects, punctatekeratopathy, dendrites, filaments, ulceration, subepithelial infiltrates Anterior chamber/iris: cells, flare, synechiae, transillumination defects Red Eye Workup

  6. Diagnostic Testing Cultures: Bacterial, Viral, Chlamydial : Suspected cases of adult and in all cases of suspected neonatal conjunctivitis. Smears/Cytology: Smears for cytology and special stains (Gram, Giemsa) Blood Tests Biopsy: Conjunctival biopsy may be helpful in cases of conjunctivitis unresponsive to therapy. Red Eye Workup

  7. Red Eye Diagnosis • Ocular Infections • Corneal Ulcers • Bacterial • Fungal • Acanthamoeba • OphthalmiaNeonatorum

  8. Red Eye Diagnosis • Ocular Infections • Viral • Herpes Simplex • Herpes Zoster • Epidemic Keratoconjunctivitis • Hemorrhagic Conjunctivitis • PreseptalCellulitis • Orbital Cellulitis

  9. Red Eye Diagnosis • Conjunctivitis • Allergic • Mechanical • Immune Mediated • Neoplasia

  10. Red Eye Diagnosis • Trauma • Corneal Abrasion • Foreign Bodies • Subconjunctival Hemorrhage • Iritis • Chalazion • Nasolacrimal Duct Obstruction • Angle Closure Glaucoma

  11. Ocular Infections • Corneal Ulcers • Bacterial • Fungal • Acanthamoeba • Viral

  12. Ocular Infections • Bacterial • Staphylococci • 50% of the infections • Streptococci • Haemophilus • Pseudomonas • Serratia

  13. Ocular Infections • Fungal • Candida • Gray white with feathery border • Fusarium • Outbreaks due to contact lens solution contaminant

  14. Ocular Infections • Acanthamoeba • Contact lenses • Poor hygiene • Homemade solution • Swimming • Hot tubs • Extremely painful

  15. Ocular Infections • Ophthalmia Neonatorum • Chemical • Neisseria Gonorrhoeae • Chlamydia Trachomatis • Staph, Strep, Gram Neg • Herpes Simplex Virus

  16. Ocular Infections • Viral • Herpes Simplex Keratitis • Typical dendrite staining pattern • 90% exposure to virus by age 10

  17. Ocular Infections • Herpes Zoster Ophthalmicus • Hutchinson’s Sign

  18. Ocular Infections • Viral • Epidemic Keratoconjunctivitis • Adenovirus • Hemorrhagic Conjunctivitis • Coxsackie A

  19. Ocular Infections • Preseptal Cellulitis • Tenderness, redness, swelling of lids • Minimal or no pain with eye movement • Dacryocystitis, sinusitis, trauma

  20. Ocular Infections • Orbital Cellulitis • Pain on attempted eye movement • Proptosis, chemosis, fever • Admit to hospital • Trauma, sinusitis, surgery

  21. Allergic Seasonal allergic conjunctivitis Vernal conjunctivitis Atopic conjunctivitis Giant papillary conjunctivitis (GPC), which also has a mechanical component Conjunctivitis

  22. Conjunctivitis • Allergic • papillae • giant papillae

  23. Mechanical Superior limbic keratoconjunctivitis (SLK) Contact-lens-related keratoconjunctivitis Floppy eyelid syndrome Pediculosispalpebrarum (Phthirus pubis) Medication-induced keratoconjunctivitis Conjunctivalchalasis Conjunctivitis

  24. Mechanical Floppy eyelid syndrome Conjunctivitis

  25. Immune-mediated Ocular mucous membrane pemphigoid (OMMP) Graft-versus-host disease (GVHD) Stevens-Johnson syndrome Conjunctivitis

  26. Neoplastic Sebaceous (meibomian) carcinoma Ocular surface squamousneoplasia Melanoma Conjunctivitis

  27. No entry into anterior chamber Decreased Vision Pain, usually improves with topical anesthesia Corneal Abrasion

  28. Corneal Conjunctival Intraocular Orbital Foreign Bodies

  29. Subconjunctival Hemorrhage • Typically not painful, not infection. • Often noticed by another or when looking in mirror.

  30. Dull, aching, throbbing pain Photophobia Recurrent or initial, traumatic Iritis

  31. Chalazion • Inflamed meibomian gland of eyelid • Usually sterile, granuloma

  32. Nasal Lacrimal Duct Obstruction • Usually congenital and often clears by 1 year.

  33. Acute Angle Closure Glaucoma • Eye/Orbit Pain, Headache • Blurred/Decreased Vision • Colored Halos • Nausea and Vomiting

  34. Acute Angle Closure Glaucoma • Signs • Elevated intraocular pressure • Shallow anterior chamber • Corneal edema • Mid dilated pupil • Ciliary flush

  35. Questions? shiloh.simons@ministryhealth.org (715) 342-7825 office (715) 340-2337 cell

  36. References American Academy of Ophthalmology . Preferred Practice Patterns. San Francisco: American Academy of Ophthalmology, 2013. The Wills Eye Manual. 6th ed. Office and Emergency Room Diagnosis and Treatment of Eye Disease. Philadelphia: Lippincott Williams and Wilkins, 2012.

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