1 / 39

Red Eye

Red Eye . Grace Wong GPST1. Aims . Assessment of the red eye Common causes of red eye Painful and Non Painful Signs and symptoms Management of each condition. Red Eye. Common presentation in primary care and in A+E Most cases due to relatively trivial problems

brosh
Download Presentation

Red Eye

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Red Eye Grace Wong GPST1

  2. Aims • Assessment of the red eye • Common causes of red eye • Painful and Non Painful • Signs and symptoms • Management of each condition

  3. Red Eye • Common presentation in primary care and in A+E • Most cases due to relatively trivial problems • Most common is conjunctivitis • Small proportion are serious and need urgeny treatment • Sometimes difficulty in discerning between causes • Most practical way is; • Pain or not • Visual acuity

  4. History • Onset • Pain • Visual Changes • Photophobia • Foreign body sensation • Trauma • Discharge, clear or colored • Bilateral or unilateral

  5. Social history • Nursery school teacher • Co-morbid condition • Collagen vascular disorders • Rheumatoid, gout • TB, sarcoidosis • HTN • Past Ocular History • E.g. Similar episodes • Surgery • Lazy eye • Contact lenses

  6. Examination • Visual acuity • Extra ocular movements • Pen light examination (reactivity, corneal opacity, pupil shape, discharge, infection) • Test for direct and consensual photophobia • Slit lamp examination – with and without fluorescein • Anterior chamber evaluation – depth, cells • IOP meaurements

  7. Differential Diagnosis • Think systemically about the structures within the eye to common to differential diagnosis • Inflammation of orbit? • Lid Disease • Scleral inflammation • Corneal disease • Uveal/iris inflammation • Other e.g. glaucoma

  8. ?

  9. Conjunctivitis • Most common cause of red eye • Inflammation of the conjunctiva • Sore red eye (gritty or itchy discomfort) • Discharge (clear, mucoid or muco-purulent) • Sticky eyelids • No visual changes • Unilateral or bilateral • Examination - enlarged papillae under upper eye lid or pre auricular lymph nodes

  10. Causes • Allergic, viral or bacterial • Difficult to distinguish between types • Both bacterial and viral can occur after a viral URTI

  11. Management - Infective • 85% of cases clear in <7 days with or without tx • Advise patients to bathe the affected eye with boiled cooled water am and pm • If symptoms not improve in >5 days • Swab for MC+S • Treat empirically with chloramphenicol QDS • consider alternative diagnosis e.g. allergy, dry eyes, Consider referral >7-10 days or if suspicion of herpetic infection

  12. Management - Allergic • Topic or systemic anti histamines e.g. sodium cromoglicate eye drops • Avoid topical steroids – long term complications e.g. cataract, glaucoma, fungal infection • Consider cold compress and wash out with cold water during acute exacerbation Refer if symptoms are persistent despite treatment or if vision is affected

  13. ?

  14. Subconjunctival Haemorrhage • Spontaneous painless localised haemorrhage under the conjunctiva • Common in the elderly • Spontaneous or traumatic • Looks alarming but generally painless (may cause some aching) • Clear spontaneously in 1-2 weeks but may recur

  15. Associations • Hypertension • Clotting disorders • Leukaemia • Increased venous pressure • Check BP • If severe/recurrent • Check FBC and clotting screen

  16. Signs • Blood under conjunctiva covering part or all of eye • Normal Visual Acuity • Consider referral if; • Follows trauma • More than a slight discomfort • Fails to settle spontaneously over 1 week

  17. ?

  18. Blepharitis • Chronic low grade inflammation of meibomian glands and lid margins • Both eyes usually affected • Often associated with Dry eye syndrome, seborrhoeic dermatitis, rosacea

  19. Causes • Staphylococcal • Seborrhoeic – associated with seborrhoeic dermatitis. Yeast is involved and can trigger inflammatory reaction • Meibomain – gland dysfunction unable to lubricate eye

  20. Symptoms • Presents with long history of irritable burning dry red eyes • Eyelids have red margins • Look inflamed and greasy • Tiny flakes or scales on eyelids • Sticky with discharge • Meibomian glands may block an fill with oily fluid • Symptoms come and go

  21. Treatment • Regular eyelid hygiene – warm, massage and cleansing • Remove scales and crusts from lid margins • Treat dry eye symptoms with preservative free tear supplements e.g. liquifilm • Antibiotic eye treatment if eyelid becomes infection e.g. fusidic acid (topical on eyelid). Can be up to 3 month course

  22. ?

  23. Keratitis • Inflammation of the cornea • Bacterial, viral or fungal infections • Can be non infective e.g. trauma or auto-immune, dry eyes, entropion • History of contact lens wear • Previous episodes e.g. HSV infection

  24. Signs • Very painful red eye • Photophobia • Foreign body sensation • Reduced visual acuity depends on nature of problem • Circumcornealinjection • Conjunctiva is also inflamed – keratoconjuncivitis • Discharge – water, mucoid or purulent • Pupil may be small • Fluorescinreadily demonstrates any ulceration

  25. Complications • Significant loss of vision secondary to scarring or astigmastism • Complications can lead to blindness; • Corneal perforation • Choroidal detachment • Endopthalmitis • CORNEAL ULCERATION IS AN OPTHALMOLOGIC EMERGENCY

  26. Treatment • The cause must be identified prior to treatment - some therapies benefit whilst others can harm • Refer the same day for urgent ophthalmological review • Delay may result in loss of sight

  27. Caution • If caused by Herpes simplex infection and dendritic ulcer • AVOID topical steroids as can cause massive amoebic ulceration and blindness • Typical dendritic ulcer – delicate branching pattern

  28. ?

  29. Scleritis • Severe inflammation that occurs throughout the entire thickness of the sclera • Rare • Average age 52 yrs • Can be unilateral or bilateral • Affects more women than men • Can affect anterior or posterior segment • Either nodular, diffuse or necrotizing

  30. Associated • The sclera is an avascular structure • 50% is associated with systemic illness; • Herpes Zoster • Rheumatoid arthritis • SLE • Polyarteritisnodosum • Wegner’s granulomatosis • Trauma • Infection • Surgery

  31. Presentation • Red eye • Severe boring eye pain – may radiate to forehead, brow or jaw • Key symptom; gradual onset (days or weeks) • Pain worse with movement of eye and at night • Watering • Photophobia • Decreased visual acuity • Eye is tender to touch and may have deep purple hue • There may be accompanying uveitis and keratitis

  32. Treatment • Urgent referral to ophthalmology • Treated with steroids • Complications include • Cataract • Glaucoma • Retinal detachment

  33. ?

  34. Iritis (anterior uveitis) • Most common in young/middle aged adults • Acute onset of pain • Increasing pain as eye converges and pupil constrict • Photophobia • Blurred vision • Decreased visual acuity • Watering • Circumcornealrednress • Small or irregular pupil • +hypopyon (pus causing white fluid level line)

  35. Causes • Secondary to corneal graft rejection • Eye infections e.g. toxoplasmosis, herpes virus keratitis • 30% are associated with seronegativearthropathies e.g. AS

  36. Management • Refer urgently to ophthalmology • Complications include; • Posterior synechiae (irregular pupil shape) • Glaucoma • Cataract Relapses are common

  37. Red Flag signs of a Red Eye • Decreased visual acuity • Pain deep in the eye – not surface irritation • Photophobia • Absent or sluggish pupil response • Corneal Damage on fluorseceinstaining or opacification • History of trauma These need same day referral

  38. Questions? • http://www.patient.co.uk/doctor/The-Red-Eye.htm

More Related