The Red Eye conjuctival diseases of the eyepptx

The Red Eye conjuctival diseases of the eyepptx

1. The Red Eye Dr Kumale T.

2. Introduction Redness of the eye Multi factorial causes ranging from self limiting to life threatening All red eyes are not necessarily conjunctivitis

3. Classifications of red eye Painless red eye Conjunctivitis Pterygium and others Painful red eye Keratitis and corneal ulcer Iridocyclitis Acute angle closure glaucoma Episcleritis and Scleritis

4. Symptom conjunctivitis Corneal lesions, abrasion, FB, abrasion etc Acute iritis Acute angle closure glaucoma Episclerits / scleritis Pain discomfort Pain, photophobia Pain, photophobia Severe pain Aching pain localized tenderness discharge Muco -purulent watery watery Slightly watery Slightly watery vision Never impaired May be Impaired impaired Severely impaired normal hyperemia generalized Ciliary / localized nearest to lesion ciliary ciliary Near affected area cornea normal Alteration of surface reflection and /or opacity normal Steamy-loss of luster normal pupil normal May be irregular or miotic Small and /or Irregular Dilated and non reactive normal IOP/ tension Normal normal May be raised raised normal

5. Conjunctivitis Defn : any inflammation of the conjunctiva. Epidemiology The prevalence of each is different in pediatric and adult population The vast majority of pediatric cases are bacteria I n adult’s bacterial and viral causes are equally common

6. Bacterial conjunctivitis Causes: commonly staphylococcus aureus , streptococcus pneumonia, Hemophilic influenza, and moraxella catarrhalis S. aureus is common in adults Symptoms: Redness and discharge in one eye; can also be bilateral “stuck shut” in the morning Purulent discharge continues through out the day The discharge is thick; it may be yellow, white or green. No real pain as the conjunctiva has few sensory nerve supplies but complain of irritation, itching and discomfort Vision is almost always normal

7. Bacterial conjunctivitis Sign: purulent discharge at the lid margins and in the corners of the eye More purulent discharge appears within minutes of wiping the lids Cornea is mostly clear; but if it is involved, there will be different degree of corneal opacity it is common special in untreated and delayed patients

8. Bacterial conjunctivitis Red eye – due to dilatation of superficial blood vessels as apart of inflammation Edema of the conjunctiva ( chemosis ) and eyelids swelling Diagnosis: Mostly clinical Gram stains Course : lasts for 1 - 2 weeks and then it usually resolves spontaneously

9. Bacterial conjunctivitis Treatment: Chloramphenicol eye drop or ointment QID Ciprofloxacillin eye drop QID Tetracycline eye ointment BID Evaluate the patient after 48 hrs and if no improvement, refer to ophthalmic center for better evaluation N.B. Don’t use steroid or steroid containing antibiotic as they will reduce local immunity and encourage micro organism to multiply

10. Viral conjunctivitis highly contagious spread by direct contact with the patient and his or her secretions or with contaminated objects & surface Symptoms: watering, photophobia, irritation mostly associated with upper respiratory tract infection Treatment: Self limiting Prophylactic topical antibiotics, Chloramphenicol TID Never use steroid or steroid containing antibiotics

11. Allergic conjunctivitis Pathophysiology : caused by air borne allergy contacting the eye With specific IgE , causes local mast cell degranulation and the release of chemical mediators including histamines, eosinophil chemo tactic factors and platelets activating factors Symptoms: Red eye Severe and persistent itching of both eyes Mucoid eye discharge No visual reduction

12. Allergic conjunctivitis Signs: V/A is normal papillary reaction to hypertrophy on tarsal conjunctiva Treatment: Cold compress Vasoconstrictor-antihistamine like cromolyn sodium Topical steroid - Terracortril eye suspension

13. Neonatal Conjunctivitis ( Ophthalmia Neonatorum ) Defn : conjunctivitis in a newborn (in the first 28 days of life) Etiology: Gonococcus (most serious) and Chlamydia are the commonest Symptoms: profuse thin to thick purulent eye discharge Sign: purulent eye discharge, eye lids are swollen If cornea is involved, ulcer, scarring, lately cornea will shrink

14. Neonatal Conjunctivitis ( Ophthalmia Neonatorum ) Treatment: It is sight threatening condition N eeds systemic antibiotic and close follow up in better ophthalmic center Start with tetracycline eye ointment 3-4 times a day Urgent referral to ophthalmic center for further evaluation and management

15. Pterygium Fleshy growth of the conjunctiva that encroaches the cornea and cover cornea Pterygium means wing It usually starts nasally, but occasionally temporally in the 3 o'clock or 9 o'clock More common in dry, hot and dusty environment

16. Pterygium Patient complains slight cosmetic blemish, irritation of the eye If it grows into the pupil, it will cause blurring of vision to blindness Treatment Protection from sun with eye glass or hat If irritated, topical steroid- Terracotril eye suspension BID Extensive crossing the limbus --referral for surgical excision

17. Painful Red Eye Those causes are so severe and sight threatening The diagnosis need: E xperienced ophthalmic worker Appropriate instruments Especial diagnostic tests and procedures. should be evaluated by the ophthalmologist Visual out come highly depends on: The time interval between onset of the disease Initiation of treatment Subsequent close follow up Early referral to best center may salvage their vision

18. Keratitis and corneal ulcer The cornea is exposed to the atmosphere, and so often suffers from injury, inflammation or infection. Common terms used in corneal disease: Keratitis - any type of corneal inflammation Corneal ulcer - loss of some of corneal epithelium and inflammation in surrounding cornea Corneal scar - white and opaque cornea, the final result of any serious inflammation Etiology - Virus, bacteria, fungi

19. Keratitis and corneal ulcer Symptoms Pain - sharp, and severe. Blurred vision - because the ulcer makes the corneal surface irregular and less transparent Photophobia Red eye

20. Keratitis and corneal ulcer Signs red eye - circumcorneal injection cornea -grayish to whitish infiltrate, hazy with loss of clarity and opacity of different degree

21. Keratitis and corneal ulcer Treatment Start with gentamycin or ciprofloxacillin eye drop frequently For proper diagnosis, it needs slit lamp examination and culture Early referral to ophthalmic center

22. Iridocyclitis Defn : inflammation of the iris and ciliary body Classification: Etiology Associated with systemic diseases Infection Mostly idiopathic Duration Acute duration less than six weeks Chronic duration above six weeks

23. Iridocyclitis Symptoms Painful red eye Photophobia Reduction of vision Sign V/A may be reduced Cornea is relatively clear Circum corneal injection Miosis (small pupil), may be irregular Anterior chamber may be hazy or loss of clarity

24. Iridocyclitis Treatment Start with topical steroids E.g.- Dexamethasone eye drop _QID Atropine eye drop 1% BID to prevent adhesion and to reduce pain Refer as soon as possible to ophthalmic center

25. Acute angle closure glaucoma Defn : an elevation of IOP as a result of obstruction of aqueous outflow Symptoms Painful red eye Sudden reduction of vision Rapid progressive visual impairment Periocular pain Nausea and vomiting, ipsilateral headache Rain –bow (haloes) vision around light

26. Acute angle closure glaucoma Signs V/A is decreased Firm to hard eyeball on digital palpation Circum corneal injection Cornea is hazy or loss of its clarity Anterior chamber will be shallow Pupil is mid dilated, sluggish and fixed Difficult to evaluate the fundus due to cornea edema

27. Acute angle closure glaucoma Treatment Timolol eye drop 0.25% every 30 minutes Acetazolamide ( Diamox ) 500mg PO stat and then 250 mg po QID Urgent referral to ophthalmic center

28. Episcleritis Inflammation of the episclera below the conjunctiva Ocular redness without irritation or pain The redness typically persists for 24 to 72 hours Resolves spontaneously May be localized or diffuse Treatment N ot sight threatening S elf limiting process Topical vasoconstricting agent may reduce redness

29. Scleritis Inflammation of the sclera Symptoms Painful disorder-typically a constant severe boring pain that worsens at night or in the early morning hours and radiates to the face and periorbital region Pain is severe enough to limit activity and often to prevent sleep Watering, redness, and photophobia Highly associated with systemic disease like RA,SLE,etc

30. Scleritis Signs Sclera edema Tenderness Treatment – Early referral for better management

31. Other causes of red eye Adnexal & lacrimal system Hordeolum / stye Chalazion Blepharitis Dacryocystitis Canaliculitis Dacryoadenitis Preceptal cellulitis Orbital cellulitis

32. Other causes of red eye Conjunctiva Subconjunctival hemorrhage Pinguecula Cornea Abrasion Foreign body Endophthalmitis sleeplessness and fatigue

33. Carotid cavernous fistula life threatening conditions Communication b/n carotid artery & cavernous sinus Causes: trauma75% Spontaneous ruptured aneurysm Symptoms: triad Pulsatile proptosis Chemosis Whoosing noise in the head

34. Carotid cavernous fistula Signs: severe epibulbar injection Ptosis Hemorrhagic chemosis Pulsatile proptosis , bruit & thrill Increased IOP Anterior segment ischemia: corneal edema, iris atrophy, cataract, AC cells & flares, rubeosis iridis Ophthalmoplegia Treatment : urgent referral

35. Cavernous sinus thrombo sis Cause: spread of infection from orbital cellulitis CF: rapid progression of proptosis Development of ophthalmoplegia Anesthesia in both 1 st & 2 nd division of trigeminal nerve