1 / 43

How to Handle Common Eye Problems in Your Practice

How to Handle Common Eye Problems in Your Practice. Shuan Dai, FRANZCO Eye Doctors Ascot Hospital shuandai@eyedoctors.co.nz. The Red Eye. A “ Red Eye ” may be due to an abnormality of the ocular structures including: Adnexa Lid Disorders Lacrimal System Orbital Disease Globe

rhea
Download Presentation

How to Handle Common Eye Problems in Your Practice

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. How to Handle Common Eye Problemsin Your Practice Shuan Dai, FRANZCO Eye Doctors Ascot Hospital shuandai@eyedoctors.co.nz

  2. The Red Eye • A “Red Eye” may be due to an abnormality of the ocular structures including: • Adnexa • Lid Disorders • Lacrimal System • Orbital Disease • Globe • Conjunctival / Scleral Disorders • Corneal Disease • Uveitis • Glaucoma

  3. Adnexal Redness • Lids • Blepharitis • Stye • Chalazion • Topical Allergic • Lacrimal System • Dacryocystitis • Canaliculitis • Dacryoadenitis • Orbit • Cellulitis • Preseptal • Orbital

  4. Blepharitis • Symptoms & signs • Crusting • Oil droplets • Grittiness • Treatment • Lid hygiene • Doxycycline 100mg daily 4-6 weeks

  5. Stye& Chalazion

  6. Dacryocystitis • Recurrent watering eye • Mucous/purulent discharge • Abscess /lump over lacrimal sac • Blocked tear duct

  7. Ophthalmia Neonatorum • Infantile purulent conjunctivitis • Chemical from antibiotic drops/silver nitrate • Chlamydia • Gonorrhea • An ocular emergency as GC can invade the intact cornea and perforate the globe

  8. Lacrimal sac mucocele • An uncommon variant • Look for an elevated mass extending medially • Life threatening if infected – refer for intravenous antibiotics

  9. Dacryoadenitis • Acute painful • Swelling lateral upper lid • Viral/bacteria infection • Oral/iv antibiotics

  10. OrbitalCellulitis • Proptosis • Limited eye movement • Reduced vision

  11. Redness Confined to the Globe • Conjunctiva / Sclera • Subconjunctival hemorrhage • Ocular injection – conjunctivitis • Pingueculum / Pterygium • Episcleritis • Scleritis • Cornea • Keratitis • Corneal abrasion • Corneal ulcer • Anterior chamber • Iritis • Endophthalmitis

  12. Conjunctivitis • Bacterial • Purulent discharge • Papillary reaction • Associated blepharitis • Viral • Mucoid discharge • Follicular reaction • Associated URTI, epidemic • Allergic • Seasonal • Papillary reaction • Associated rhinitis, itching

  13. Bacterial Conjunctivitis • Symptoms: discharge, irritation • Signs: papillary conjunctivitis, perilimbal injection if associated keratitis • Treatment: chloramphenicol/fucithalmic • Danger: if hyperpurulent (gonococcal) or recent intraocular surgery REFER!

  14. Viral Conjunctivitis • Highly contagious, epidemics • Symptoms: previous URTI, previous contacts, mucoid discharge, often photophobia • Signs: preauricular node, pseudoptosis, follicular conjunctivitis ,conjunctival injection, punctate keratitis • Treatment: cool compresses, ocular lubricants. Referal • Warning: extreme infectivity, second eye at one week, lasts 10 – 14 days

  15. Allergy -Papillary conjunctival reaction

  16. Allergic Conjunctivitis • Symptoms: itching, seasonal, atopic history, rhinitis • Signs: papillary reaction, mucus • Treatment: cool compresses, ocular lubricants, anti-histamines - topical (Vasocon A) or systemic, Opticrom (Na chromoglycate) prophylaxis • Possible history of contact lens wear with giant papillary conjunctivitis • Treatment: • Lomide • Patanol • Steroid, i.e. FML

  17. Pingueculum & Pterygium Pingueculum is degenerative collagen within the interpalbebral fissure Pterygium extends onto the cornea

  18. Episcleritis & Scleritis Diffuse Scleritis Extremely painful Elderly, RA, systemic vasculitis Episcleritis Less painful Younger age No systemic association

  19. Herpes Simplex Keratitis • Viral replication in cornea • Symptoms: irritation, photophobia • Signs: • red eye involving limbus, • dendrite with terminal bulbs • seen best with staining • ulcer formation • Treatment: refer, antivirals, BEWARE STEROIDS!

  20. Herpes Zoster • Herpes Zoster Ophthalmicus • Suspect ocular involvement if the tip of the nose is involved (Hutchinson’s sign) • Oral acyclovir & topical acyclovir

  21. Iritis • Etiology • 50% idiopathic, unknown • Ocular disease • Large abrasion • HSV, HZV • Primary disease in young patients • Systemic disease • JRA – pauciarticular disease • Ankylosing spondylitis • Symptoms • Extreme photophobia • Reduced vision • Signs • Miosis • Red eye to limbus • Flare with cell • Treatment • Cycloplegia • Topical steroidsREFER

  22. Acute iritis • Light sensitivity • Deep dull ache • Smaller/ irregular pupil • Often idiopathic

  23. Angle Closure Glaucoma

  24. Subconjunctival Hemorrhage • Can occur secondary to blunt trauma or can be spontaneous • Lubrication if foreign body sensation • Warm compression

  25. Corneal Abrasion • Management • Non-contact lens wearer • Antibiotic ointment and patch • Follow-up one day • Contact lens wearer • DO NOT PATCH • Antibiotic ointment or drops • Follow up daily until healed • Treat abrasions created with organic material in this manner

  26. Corneal Ulcer • Risk of corneal ulcer when epithelium compromised, especially in contact lens wearers • Contact lens wearers have a higher rate of colonization with Pseudomonas

  27. Abrasion versus Ulcer

  28. Superficial Corneal Foreign Body • Removed under topical anesthetic • With burr or 25 gauge needle • Manage same as corneal erosion • Encourage safety glasses • Polycarbonate lenses

  29. Anterior Segment • Linear epithelial defects is suggestive of a foreign body under the eye lid

  30. Ultraviolet Radiation(arc eye) • Sources • Sunlamps, welding arcs • Management • Cycloplegics, antibiotic ointment, patch • Avoid long term topical anaethetic drop !!!

  31. Chemical Injury • Acid precipitates quickly • Alkali continues to penetrate • Therefore can progress over an extended period of time • Management • Continuous irrigation with saline until neutral pH • Test fornices with Litmus paper • Sweep fornices to remove retain debris • Antibiotic ointment, cycloplegics

  32. Chemical Injury Thorough irrigation before referral !!!

  33. Blunt Trauma • Hyphema • Indicates damage to angle and/or to the iris • Management • Vertical position • No anti-coagulants • Cycloplegics

  34. Blunt Trauma • Damage to Iris and Lens • Iridodialysis, cataract • Dislocation

  35. Blunt Trauma - Sequelae • Angle damage which can lead to glaucoma: can develop days to years after injury

  36. Blunt Trauma - Sequelae • A retinal tear which can progress to a retinal detachment

  37. Open Globe Injuries • Blunt trauma – rupture • Sharp trauma – laceration • Projectile trauma • Penetrating – in and out • Perforating ± intra ocular foreign body – just in

  38. Blunt Trauma • Severe trauma that resulted in a scleral rupture with delivery of the lens

  39. Sharp Trauma • Corneal laceration and traumatic cataract from a thrown beer bottle

  40. Penetrating Eye Injuries • Intraocular foreign bodies generally have to be removed, unlike orbital (extraocular) foreign bodies

  41. Perforating Trauma • Patient was hammering and noticed a spark fly up to his eye.

  42. Child with poor red reflex

  43. Thank you

More Related