THE RED EYES PRESENTATION............pdf

The Red Eye Presentation...............................................




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1. RED EYE.
18
TH
APRIL 2024
ELIZABETH NAGAWA
OPHTHALMOLOGY DEPARTMENT

2. OBJECTIVES.
Understand;
1.Causes
2.Diagnosis
3.Treatment
4.Public health Importance.
5.Prevention of red eye.

3. Anatomy

4. RED EYE aka CONJUNCTIVAL HYPEREMIA
discharge, eyelids sticking or crusting worse
upon awakening from sleep, foreign body
sensation,
<4-week duration of symptoms.

6. Ddx.
1.Bacterial( non gonococcal or gonococcal)
2.Viral
3.Allergic
4.Dry eye
5.Drug-induced
6.Sleep deprivation
7.Systemic diseases
8.Trauma

7. BACTERIAL CONJUNCTIVITIS
Symptoms.
Redness, foreign body sensation, discharge;
itching is much less prominent
Signs
Purulent white-yellow discharge of mild-to-
moderate degree.
Conjunctival papillae, chemosis
preauricular node typically absent
ALLERGIC CONJUNCTIVITIS
symptoms
Itching, watery discharge, history of allergies
and Usually bilateral.
Signs
Chemosis, red and edematous eyelids,
conjunctival papillae, periocular
hyperpigmentation, no preauricular node

8. The outbreak!

11. 324 patients seen
from March 1
st
to
date.

12. Etiology and Variants of Viral Conjunctivitis
Most commonly adenovirus.
❖Epidemic keratoconjunctivitis is most commonly caused by subgroup D of serotypes 8, 19, and
37.
❖Pharyngoconjunctival fever is associated with pharyngitis and fever, usually in children, and is
most commonly caused by serotypes 3 and 7.
Acute hemorrhagic conjunctivitis:
❖Associated with prominent subconjunctival hemorrhages, usually 1 to 2 weeks in duration.
❖Tends to occur in tropical regions.
❖Caused by enterovirus 70 (rarely followed by polio-like paralysis), coxsackievirus A24, and
adenovirus serotype 11

13. VIROLOGY
•It is a non-enveloped virus with a linear Ds-DNA genome and icosahedral capsids.
•Adenoviral-based ocular surface infections are attributed to subtypes of group B and D HAdV.
•These viruses bind cd46, a ubiquitously expressed transmembrane protein, to infect the host.
•Exposure of the host to HAdV occurs through the interaction between adenoviral fiber protein
and primary host cellular receptors such as cd46, sialic acid, and heparin-sulfate proteoglycan,
facilitating attachment and internalization of HAdV.
•Interactions between the penton base of the virus and vitronectin-binding integrins of the host
support internalization and acidification of the endosome, triggering conformational changes to
the viral capsid.
•This process leads to the release of the viral DNA genome into the host nucleus, where viral
replication occurs.

14. VIRAL CONJUNCTIVITIS/EPIDEMIC
KERATOCONJUNCTIVITIS
Symptoms
•Redness
•Itching
•burning
•tearing
• gritty or foreign body sensation
• history of recent upper respiratory tract infection
•contact with someone with viral conjunctivitis.
•Starts in one eye, and involves the fellow eye a few days later.

15. VIRAL CONJUNCTIVITIS.
SPREAD.
1.Close personal contact; touching and shaking hands
2.Air droplets; coughing and sneezing
3.Direct contact; discharge from eye to eye
4.Surfaces to eyes
NOTE: Viral conjunctivitis is highly contagious (usually for 10 to 12 days from onset) as long as the
eyes are red (when not on steroids) or have active discharge/tearing.
Due to its highly contagious nature, adenovirus conjunctivitis outbreaks can occur in various
settings, including schools, hospitals, and communities, leading to localized epidemics.

18. Signs
•Inferior palpebral conjunctival follicles
•Tender palpable preauricular lymph node.
•Watery discharge,
•Red and edematous eyelids,
•Pinpoint subconjunctival hemorrhages,
•punctate keratopathy membrane/pseudomembrane.
•Fine intraepithelial microcysts
•Subepithelial (anterior stromal) infiltrates (SEIs).

21. Work-Up
•No conjunctival cultures/swabs are indicated unless discharge is excessive or
the condition becomes chronic.
•laboratory testing (e.g., RT-PCR, viral culture, rapid antigen testing, )
•serological assays.( IgM)

22. Management.
Medical treatment.
1.Counsel the patient that viral conjunctivitis is a self-limited condition that typically gets
worse for the first 4 to 7 days after onset and may not resolve for 2 to 3 weeks (potentially
longer with corneal involvement).
2.Preservative-free artificial tears or tear ointment four to eight times per day for 1 to 3 weeks.
Advise single-use vials to limit tip contamination and spread of the condition.
3.Antihistamine drops (e.g., olopatadine) if itching is severe

23. 4. Topical non-steroidal anti-inflammatory drops may be used to reduce the redness and pain.
5. Cool compresses several times per day.
6. Saline eye wash
7. Steroid ointment in the presence of significant tearing to maintain longer medication exposure.
for SEIs alone, a weaker steroid with less frequent dosing is usually sufficient.
NOTE: Steroids may hasten the resolution of the symptoms but prolong the infectious period.

24. NOTE:
Routine use of topical antibiotics for viral conjunctivitis is discouraged unless:
•corneal erosions are present
•there is mucopurulent discharge suggestive of bacterial conjunctivitis
Surgical treatment.
1. Pseudomembrane peeling to prevent symblepharon formation.
2.phototherapeutic keratectomy (PTK) to improve corneal transparency and visual outcomes – for post-
infection corneal scars.
Follow up.
In 2 to 3 weeks, but sooner if the condition worsens significantly or if topical
steroids are prescribed.

25. Povidone-Iodine (PVI) irrigation:
◦Broad-spectrum microbicide solution effective against viruses, bacteria, parasites, fungi, yeasts, molds,
and protozoans.
◦Commercially available as betadine in 5% and 10% concentrations.
mode of action:
◦oxidizes pathogen nucleotides, amino acids, and proteins, damaging vital bacterial cellular mechanisms.
◦impedes host's inflammatory response to viral pathogens.
Characteristics:
◦Broad antimicrobial spectrum, lack of resistance, ability to penetrate biofilms.
◦Low cytotoxicity, suitable tolerability, favorable risk/benefit profile.
free iodine released from PVI complex provides microbicidal activity.
antimicrobial activity proportional to concentration of free iodine.

26. Ctn
•Effective against ocular HAdV types, with virucidal reductions observed.
•Off-label use in-office PVI irrigation aims to reduce viral load and shedding.
•Protocol involves pre-irrigation NSAID drop, followed by 5% PVI solution application and ocular
lavage.
•Exasperation of conjunctivitis symptoms post-procedure.
•PVI irrigation may help decrease colonization of ocular surface and reduce transmission of
adenoviral kerato-conjunctivitis.
•PVI also used in treatment formulations:
◦1.25% PVI ophthalmic solution effective in pediatric conjunctivitis treatment.
◦0.5% PVI with artificial tears showed faster recovery from adenoviral keratoconjunctivitis.

27. Other treatment modalities.
1.Immunoglobulin (Ig)-Based Therapy
2.Immunotherapy and Cardiotonic Steroids ( cyclosporine, tacrolimus)
3.Antiviral therapy (cidofovir, ganciclovir)

28. Public health concerns and Preventative
strategies
•large-scale epidemics impose significant social and economic burdens, emphasizing the
importance of health education in limiting spread.
•Avoid touching and rubbing eyes, shaking hands, handkerchiefs, sharing towels or pillows.
•Restrict work and exposure to others while the eyes are red, teary and with discharge.
•Encourage children to stay home during the infectious phase; helps limit disease spread

29. •Hand Hygiene
•Avoiding Contact with Infected Individuals
•Contact with infected items such as towels, soap, bedding, and door handles should be avoided
•Environmental Cleaning and Disinfection
•Proper Use of Personal Protective Equipment e.g masks, gloves
NOTE Use of steroids has public health implications, as number of viruses circulating in the population and
environment (the viral reservoir) is increased.

30. Challenges
1.High contagion risk.
2.Potential for long-term complications.
3. Lack of FDA-approved drugs.
4.Investigation challenges.
Future research is needed to establish a standard treatment protocol and address challenges in
management.

31. References
1.The_Wills_Eye_Manual_7th.pdf
2.COMMUNITY EYE HEALTH JOURNAL | VOLUME 33 | NUMBER 108 | 2020
3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094151/

32. ACKNOWLEDGEMENTS
•KNRH Administration
•Ophthalmology department
•Mu pharmaceuticals
•UHF