9. acute red eye.pdf

acute red eye

1. MANAGEMENT OF ACUTE
PAINLESS RED EYE
DR.UZMA REHMAN

2. The Acute Red Eye
►Most common ocular complaint
►Common-children and adults
►Aetiology difficult to determine
►Carefulhistory vital
►Thorough clinical examination-including visual acuity
►Pentorch, fluorescein staining.

3. History
►Onset
►Location (unilateral /bilateral /sectoral)
►Pain/ discomfort (gritty, FB sensation, itch, deepache)
►Photosensitivity
►Watering +/or discharge
►Change in vision(blurring, halos etc)
►Exposure to person with red eye
►Trauma
►Travel
►Contact lens wear
►Previous ocular history(eghypermetropia)

4. Examination
►Inspect whole patient
►Visual acuity-each eye + PH
►Pupil reactions
►Lymphadenopathy-preauricular nodes
►Eyelids
►Conjunctiva (bulbar and palpebral)
►Cornea (clarity, staining with fluorescein, sensation)
►Anterior chamber (depth)
►Pupils shape/ reaction to light / accomodation
►Fundoscopy
►Eye movements

5. Causes
►Lids
1.Blepharitis
2.Trichiasis
3.Sub-tarsal foreign body
►Conjunctiva
1.Viral conjunctivitis
2.Bacterial conjunctivitis.
3.Allergic conjunctivitis
4.Subconjunctivalhaemorrhage
5.EpiscleritisvsScleritis
6.Pingueculum
7.Pterygium
►Cornea
1.Bacterial keratitis
2.Herpetic keratitis
3.Foreign body
►Anterior chamber
1.Anterior uveitis/ iritisvsvitritis
►Acute angle closure
►Trauma

6. Blepharitis
►Inflammation of lid margin
►characterized by
▪lid crusting
▪redness
▪misdirected lashes
►styesand conjunctivitis
frequent association
►Staphylococcus and other skin
flora major causes
►Often meibomiangland
abnormality
►Older patients may have dry
eye

7. Blepharitis
►Symptoms
1.Foreign body sensation/ gritty
2.Itching
3.Redness
4.Mild pain
►Mainstays of treatment
▪Lid hygiene, diluted baby
shampoo
▪Topical antibiotics
▪Lubricants
►Doxycycline-meibomiangland
disease.

8. Trichiasis
►Inward turning lashes
►Aetiology: Idiopathic/
Secondary to chronic
blepharitis, herpes zoster
ophthalmicus
►Symptoms-foreign body
sensation, tearing
►Tx
1.Lubricants
2.Epilation
3.Electrolysis-few lashes
4.Cryotherapy-many
lashes

9. Subtarsal foreign body
►History of foreign body
►Must evert eyelid
►Get patient to look down
when everting lid, easiest
to evert laterally
►Remove with cotton bud
►Stain with fluorescein for
abrasion
►+/-antibiotics

10. Viral Conjunctivitis
►Aetiology
▪Most commonly adenoviral
▪Adenovirus types 3, 4 and 7
-pharyngoconjunctivalfever
(PCF)
▪Adenovirus types 8 and 9 -
epidemic keratoconjunctivitis
►Symptoms
▪Acute onset
▪Bilateral
▪Watery discharge
▪Soreness, FB sensation
▪History of URTI

11. Viral
Conjunctivitis
►Conjunctiva is often intensely hyperaemic
▪May be associated:
►Follicles
►Haemorrhages
►Inflammatory membranes
►Lymphadenopathy (esppreauricularnode)
►Keratitis occurs on 80% with EKC and 30% PCF
►Treatment:
▪No specific therapy, self resolving, up to two weeks
▪Advice (very contagious)
▪Topical steroids.

12. Allergic
Conjunctivitis
►Three quarters associated
atopy
►Two thirds have FHx atopy
►Symptoms/Signs:
▪Itch++
▪Bilateral
▪Watery discharge
▪Chemosis (oedema)
▪Papillae (can be giant
`cobblestone’ in chronic
cases

13. Allergic Conjunctivitis
►Investigation
▪Exclude infection (generally viral is NOT itchy)
▪IgElevels.
►Treatment (severity dependent)
▪cold compresses
▪remove (reduce) allergen
▪NSAIDS
▪antihistamines oral/ topical
▪mast cell stabilizers (sodium cromoglycate)
▪topical corticosteroids
▪Immunosuppressants(cyclosporin) for steroid
resistant cases

14. Papillae vs follicles
►Papillae
►Vascular reaction consisting of fibrovascular
mounds with central vascular tuft. Can be large-
cobblestone or giant papillae-allergic conjunctivitis
►Follicles
►Small translucent, avascular mounds of plasma
cells and lymphocytes seen in keratoconjunctivits,
herpes simplex virus, chlamydia, drug reactions

15. Spontaneous subconjunctival
haemorrhage
►Painless red eye without
discharge
►VA not affected
►Clear borders
►Masks conjunctivalvessels
►Check BP
►No treatment (lubricants)
►10-14 days to resolve
►If recurrent: clotting, FBC

16. Episcleritis
►Episcleralinflammation
►Localized (sectoral) or diffuse
►Symptoms/Signs:
▪Often asymptomatic
▪Mild tearing/ irritation
▪Tender to touch
▪Vessels blanch with phenylephrine
►Self-limiting (may last for months)
►Treatment
▪Lubricants
▪NSAIDS
▪Rarely low dose steroids

17. Scleritis
►Scleral inflammation with maximal
congestion in the deep vascular plexus
►Symptoms/Signs:
▪Pain (often severe boring)
▪Significant ocular tenderness to movement
and palpation
▪Watering and photophobia
▪Appearance bluish-red
►Localized
►Diffuse
►Nodular

18. Scleritis
►Aetiology
▪usually immune rather than infectious
▪30-60% associated systemic disease-connective
tissue disease
▪Most commonly with rheumatoid arthritis
►Treatment
▪underlying condition
▪NSAIDs
▪corticosteroids
▪immunosuppression

19. Pingueculum
►Yellow-white deposits on
bulbar conjunctiva
►adjacent to the nasal or
temporal limbus
►May become acutely
inflamed-pingueculitis
►Tx
1.Normally unnecessary as
growth is slow or absent
2.Topical fluorometholone
for pingueculitis

20. Pterygium
►Fibrovascular growth
from the conjunctiva onto
the cornea
►Tx
1.Excision of pterygium-
covering of defect with a
conjunctival autograft or
amniotic membrane
2.Adjuvant mitomycin-
reduce recurrence

21. ►Multiple causes of painless red eye affecting
different structures
►Good history
►Examination (systematic)-lids, conjunctival,
cornea, anterior chamber, pupils, fundi
►Check visual acuity!