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The red eye

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The red eye

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    1. The red eye Jon Luck

    2. Assessment of the red eye Visual acuity Pain – nature, duration Itchiness Trauma? Contact lens wear? Discharge? – type – purulent? Mucous? Past ophthalmic history – previous episodes?

    3. Assessment of the red eye Lids – including eversion Pupil reaction Corneal clarity Pre-auricular lymph nodes? Stain with fluorescein Magnification where possible Fellow eye

    4. Bacterial conjunctivitis We hardly ever see it! Self-limiting Neonates need referral (Chlamydia, Gonococcus) Chloramphenicol, Fusidic acid

    11. Scleritis Severe pain (cf episcleritis) Associated with collagen vascular disease Prompts investigation Can be visually threatening Requires systemic immunosuppression

    12. Episcleritis Not painful (cf scleritis) Not associated with systemic disease Doesn’t prompt investigation Never visually threatening Doesn’t require systemic treatment Associated Pinguecula Topical NSAID’s (or weak topical steroids – under caution)

    13. Iritis (Uveitis) Pain (esp on accommodation) Photophobia Recurrent Systemic associations Long term management Patients experienced!

    15. Angle-closure glaucoma Painful ++ Visual loss Corneal oedema Source of confusion in the elderly Ophthalmic emergency Requires systemic treatment

    18. Microbial keratitis Bacteria cannot invade healthy cornea (exception Neisseria sp.) Contact lens wearers Dry eye Previous surgery Compromised ocular surface

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