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Managing the Red Eye

Managing the Red Eye. Introduction. DIFFERENTIATE RED EYE DISORDERS. Needs immediate treatment Needs treatment within a few days Does not require treatment. Decreased vision Pain Redness Characterize the complaint through history and exam. Introduction. SUBJECTIVE EYE COMPLAINTS.

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Managing the Red Eye

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  1. Managing the Red Eye

  2. Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment

  3. Decreased vision Pain Redness Characterize the complaint through history and exam. Introduction SUBJECTIVE EYE COMPLAINTS

  4. Mechanical trauma Chemical trauma Inflammation/infection Introduction TYPES OF RED EYE DISORDERS

  5. Chemical injury Angle-closure glaucoma Ocular foreign body Corneal abrasion Uveitis Conjunctivitis Ocular surface disease Subconjunctival hemorrhage Introduction ETIOLOGIES OF RED EYE

  6. Trauma Chemicals Infection Allergy Systemic conditions Evaluation RED EYE: POSSIBLE CAUSES

  7. Evaluation RED EYE: CAUSE AND EFFECT

  8. Evaluation RED EYE: CAUSE AND EFFECT (Continued)

  9. Evaluation Equipment needed to evaluate red eye

  10. Evaluation Refer red eye with vision loss to ophthalmologist for evaluation

  11. Face Adnexa • Orbital area • Lids • Ocular movements Globe • Conjunctiva, sclera • Anterior chamber (using slit lamp if possible) • Intraocular pressure Evaluation RED EYE DISORDERS:AN ANATOMIC APPROACH

  12. Disorders of the Ocular Adnexa

  13. Disorders of the Ocular Adnexa Hordeolum

  14. Disorders of the Ocular Adnexa

  15. Disorders of the Ocular Adnexa Chalazion

  16. Goal • To promote drainage Treatment • Acute/subacute: Warm-hot compresses, tid • Chronic: Refer to ophthalmologist Disorders of the Ocular Adnexa HORDEOLUM/CHALAZION:TREATMENT

  17. Inflammation of lid margin Associated with dry eyes Seborrhea causes dried skin and wax on base of lashes May have Staphylococcal infection Symptoms: lid burning, lash mattering Disorders of the Ocular Adnexa BLEPHARITIS

  18. Disorders of the Ocular Adnexa Collarettes on eyelashes of patient with blepharitis

  19. Lid and face hygiene • Warm compresses to loosen deposits on lid margin • Gentle scrubbing with nonirritating shampoo or scrub pads Artificial tears to alleviate dry eye Antibiotic or antibiotic-corticosteroid ointment Oral doxycycline 100 mg daily for refractory cases Disorders of the Ocular Adnexa BLEPHARITIS: TREATMENT

  20. Disorders of the Ocular Adnexa Preseptal cellulitis

  21. Disorders of the Ocular Adnexa Orbital cellulitis

  22. Disorders of the Ocular Adnexa ORBITAL CELLULITIS: SIGNS AND SYMPTOMS • External signs: redness, swelling • Motility impaired, painful • ± Proptosis • Often fever and leukocytosis • ± Optic nerve: decreased vision, afferent pupillary defect, disc edema

  23. Hospitalization Ophthalmology consult Eye consult Blood culture Orbital CT scan ENT consult if pre-existing sinus disease Disorders of the Ocular Adnexa ORBITAL CELLULITIS: MANAGEMENT

  24. IV antibiotics stat: Staphylococcus, Streptococcus, H. influenzae Surgical debridement if fungus, no improvement, or subperiosteal abscess Complications: cavernous sinus thrombosis, meningitis Disorders of the Ocular Adnexa ORBITAL CELLULITIS: TREATMENT

  25. Lacrimal System Disorders Lacrimal system

  26. Lacrimal System Disorders Dacryocystitis

  27. Massage tear sac daily Probing, irrigation, if chronic Systemic antibiotics if infected Lacrimal System Disorders NASOLACRIMAL DUCTOBSTRUCTION: CONGENITAL

  28. Trauma a common cause Systemic antibiotics if infected Surgical procedure after one episode of dacryocystitis (dacryocystorhinostomy) prn Lacrimal System Disorders NASOLACRIMAL DUCTOBSTRUCTION: ACQUIRED

  29. Ocular Surface Disorders

  30. Ocular Surface Disorders Dilated conjunctival blood vessels

  31. Bacterial Viral Allergic Ocular Surface Disorders ADULT CONJUNCTIVITIS:MAJOR CAUSES

  32. Ocular Surface Disorders CONJUNCTIVITIS: DISCHARGE * Preauricularlymphadenopathy signals viral infection ** Itching often accompanies

  33. Staphylococcus (skin) Streptococcus (respiratory) Haemophilus (respiratory) Ocular Surface Disorders BACTERIAL CONJUNCTIVITIS:COMMON CAUSES

  34. Topical antibiotic: qid x 7 days (aminoglycoside, erythromycin, fluoroquinolone, sulfacetamide, or trimethoprim-polymyxin) Warm compresses Refer if not markedly improved in 3 days Ocular Surface Disorders BACTERIAL CONJUNCTIVITISTREATMENT

  35. Ocular Surface Disorders Copious purulent discharge: Suspect Neisseria gonorrhoeae.

  36. Ocular Surface Disorders Viral conjunctivitis

  37. Watery discharge Highly contagious Palpable preauricular lymph node History of URI, sore throat, fever common Ocular Surface Disorders VIRAL CONJUNCTIVITIS If pain, photophobia, or decreased vision, refer.

  38. Ocular Surface Disorders Allergic conjunctivitis

  39. Associated conditions: hay fever, asthma, eczema Contact allergy: chemicals, cosmetics, pollen Treatment: topical antihistamine/decongestant drops Systemic antihistamines if necessary for systemic disease Refer refractory cases. Ocular Surface Disorders ALLERGIC CONJUNCTIVITIS

  40. Bacteria (N. gonorrhoeae, 2–4 days) Bacteria (Staphylococcus, Streptococcus, 3–5 days) Chlamydia (5–12 days) Viruses (eg, herpes, from mother) Ocular Surface Disorders NEONATAL CONJUNCTIVITIS:CAUSES

  41. Ocular Surface Disorders Neonatal gonococcal conjunctivitis

  42. Ocular Surface Disorders Neonatal chlamydial conjunctivitis

  43. Erythromycin ointment: qid x 4 weeks Erythromycin po x 2–3 weeks40–50 mg/kg/day ¸ 4 Ocular Surface Disorders NEONATAL CHLAMYDIALCONJUNCTIVITIS: TREATMENT

  44. Ocular Surface Disorders Subconjunctival hemorrhage

  45. Tear functions: • Lubrication • Bacteriostatic and immunologic functions Dry eye (keratoconjunctivitis sicca) is a tear deficiency state Ocular Surface Disorders TEARS AND DRY EYES

  46. Burning Foreign-body sensation Paradoxical reflex tearing Symptoms can be made worse by reading, computer use, television, driving, lengthy air travel Ocular Surface Disorders TEAR DEFICIENCY STATES:SYMPTOMS

  47. Aging Rheumatoid arthritis Stevens-Johnson syndrome Chemical injuries Ocular pemphigoid Systemic medications Ocular Surface Disorders TEAR DEFICIENCY STATES:ASSOCIATED CONDITIONS

  48. Artificial tears, cyclosporine drops Nonpreserved artificial tears Lubricating ointment at bedtime Punctal occlusion Counseling about activities that make dry eyes worse Ocular Surface Disorders DRY EYES: TREATMENT

  49. Ocular Surface Disorders Thyroid exophthalmos: one cause of exposure keratitis

  50. Due to incomplete lid closure Manage with lubricating solutions/ointments Tape lids shut at night Do not patch Refer severe cases Ocular Surface Disorders EXPOSURE KERATITIS: CAUSES AND MANAGEMENT

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