ASSESSMENT OF THE RED EYE FOR PRIMARY CARE PHYSICIANS

1. ASSESSMENT OF THE RED EYE FOR PRIMARY CARE PHYSICIANS Ahmed Bawazeer, MD, FRCSC Department of ophthalmology King Abdulaziz University

2. CAUSES OF RED EYE • TRAUMATIC RED EYE • NONE TRAUMATIC RED EYE

3. CAUSES OF RED EYE • TRAUMATIC • CORNEAL ABRASION • CORNEAL FOREIGN BODY • F.B. UNDER EYELID • HYPHEMA • U.V. KERATITIS • CHEMICAL INJURY • CORNEAL LACERATION AND I.O.F.B.

4. CAUSES OF RED EYE • NONE TRAUMATIC • CONJUNCTIVITIS • SUBCONJUNCTIVAL HEMORRHAGE • IRITIS • ORBITAL OR PERIORBITAL CELLULITIS • HSV KERATITIS • ACUTE GLAUCOMA • SCLERITIS AND EPISCLERITIS

5. CLINICAL EVALUATION • OPHTHALMIC HISTORY • ASSESS VISUAL ACUITY • INSPECT THE CONJUNCTIVA • ASSESS THE TYPE OF DISCHARGE • DETECT CORNEAL OPACITIES • SEARCH FOR EPITHELIAL DISRUPTION

6. CLINICAL EVALUATION • STUDY THE ANTERIOR CHAMBER • OBSERVE THE PUPIL • ASK ABOUT OTHER SYMPTOMS

7. NORMAL V.A CONJUNCTIVITIS S/C HEMORRHAGE PRESEPTAL CELLULITIS DECREASED V.A. ALL TRAUMATIC CAUSES KERATITIS IRITIS ACUTE GLAUCOMA ORBITAL CELLULITIS STEP 1: ASSESS VISUAL ACUITY

8. STEP 2: INSPECTION OF THE CONJUNCTIVA • LOCALIZED CONGESTION • S/C HEMORRHAGE • SCLERITIS/EPISCLERITIS • PERILIMBAL INJECTION • IRITIS • ACUTE GLAUCOMA • DIFFUSE CONGESTION

9. INSPECTION OF THE CONJUNCTIVA • SUBCONJUNCTIVAL HEMORRHAGE • WELL DEMARCATED, COMPLETELY RED AND OBSCURES UNDERLYING BLOOD VESSELS • VALSALVA MANOEUVRE • H.T, D.M, GLAUCOMA AND BLEEDING DISORDERS • RESOLVE IN 3-4 WEEKS

10. INSPECTION OF THE CONJUNCTIVA • EPISCLERITIS • IDIOPATHIC • PAINLESS LOCALIZED OR DIFFUSE REDNESS • RESOLVE SPONTANEOUSLY IN 2-3 WEEKS • SCLERITIS • R/O AUTOIMMUNE DISEASES • PAINFUL LOCALIZED OR DIFFUSE REDNESS • REFER TO OPHTHALMOLOGIST

11. INSPECTION OF THE CONJUNCTIVA • IRITIS • PAINFUL RED EYE WITH DECRESED V.A • PHOTOPHOBIA • CILIARY FLUSH • IRREGULAR PUPIL AND HAZY RED REFLEX • IMMEDIATE REFERRAL • STEROIDS (ONLY BY OPHTHALMOLOGIST)

12. STEP 3: ASSESS THE TYPE OF DISCHARGE • NONE • S/C HEMORRHAGE • CLEAR • ALL TRAUMATIC CAUSES • ALLERGY • KERATITIS • IRITIS • GALUCOMA

13. ASSESS THE TYPE OF DISCHARGE • PURULENT • BACTERIAL INFECTION • BACTERIAL CONJUNCTIVITS • ORBITAL AND PERIORBITAL CELLULITIS

14. ASSESS THE TYPE OF DISCHARGE • BACTERIAL CONJUNCTIVITIS • ACUTE OR CHRONIC • STAPH, STREPT, H.INFLUENZAE • DIFFUSE CONJUNCTIVAL INJECTION • PURULENT DISCHARGE • TOBRA, GENTA, SULPHA OR OFLOX • REFER IF NO IMPROVEMENT IN 5-7 DAYS • IMMEDIATE REFERRAL IF HYPERACUTE

15. STEP 4: DETECT CORNEAL OPACITIES • NONE • CONJUNCTIVITS • DIFFUSE HAZE • ACUTE GLAUCOMA • U.V. KERATITIS • LOCALIZED OPACITY • HERPETIC KERATITIS • CORNEAL ULCER

16. DETECT CORNEAL OPACITIES • ACUTE ANGLE CLOSURE GLAUCOMA • ACUTE PAINFUL INCREASE IN I.O.P • REDNESS, HEADACHE, PHOTOPHOBIA, NAUSEA, VOMITING, AND HALOS • HAZY CORNEA AND MID DILATED PUPIL • PILOCARPINE, TIMOLOL, CAI, AND OTHERS • IMMEDIATE REFERRAL

17. DETECT CORNEAL OPACITIES • ULTRAVIOLET KERATITIS • USUALLY BILATERAL • WELDER’S ARC, TANNING SALONS, SNOW • SEVERE PAIN WITH PHOTOPHOBIA AND DECREASE IN V.A. 6-12 HOURS AFTER EXPOSURE TO U.V • MULTIPLE PUNCTATE CORNEAL EROSIONS • EYE PATCH, ANTIBIOTIC, CYCLOPLEGIA

18. DETECT CORNEAL OPACITIES • CORNEAL ULCERS • OCULAR EMERGENCY • HISTORY OF CONTACT LENS WEAR • WHITE LOCALIZED CORNEAL OPACITY WITH OVERLYING EPITHELIAL DEFECT • HYPOPYON • AGGRESSIVE ANTIBIOTIC TREATMENT • IMMEDIATE REFERRAL

19. STEP 5: SEARCH FOR EPITHELIAL DISRUPTION • EPITHELIAL DISRUPTION • HERPETIC KERATITIS • CORNEAL ABRASION • CONTACT LENS OVERWEAR • U.V. KERATITIS • CHEMICAL INJURY

20. SEARCH FOR EPITHELIAL DISRUPTION • HERPETIC KERATITS • UNILATERAL CORNEAL EPITHELIAL DENDRITES • HSV TYPE 1 • PAINFUL RED EYE • STAINS WITH FLUORESCEIN • TOPICAL ANTIVIRAL MEDICATION • REFER TO OPHTHALMOLOGIST

21. SEARCH FOR EPITHELIAL DISRUPTION • CORNEAL ABRASION • PAINFUL RED EYE WITH PHOTOPHOBIA AND INCREASED LACRIMATION • EPITHELIAL DEFECT STAINS WITH FLUORESCEIN STRIP • EYE PATCH, ANTIBIOTC, AND CYCLOPLEGIA • FOLLW THE PATIENT DAILY

22. STEP 6: STUDY THE ANTERIOR CHAMBER • ABSENT • LACERATED GLOBE • SHLLOW • ACUTE GLAUCOMA • BLOOD (HYPHEMA) • RUPTURED GLOBE • PUS (HYPOPYON) • CORNEAL ULCER

23. STEP 6: STUDY THE ANTERIOR CHAMBER • HYPHEMA • SPONTANEOUS OR TRAUMATIC • BLEEDING FROM ANTERIOR FACE OF THE CILIARY BODY • REBLEED IN 4 - 40% WITHIN TWO TO FIVE DAYS • BED REST • IMMEDIATE REFERRAL

24. DILATED TRAUMA THIRD NERVE PALSY ADIE’S PUPIL ACUTE GLAUCOMA DRUGS CONSTRICTED IRITIS HORNER’S DRUGS STEP 7: OBSERVE THE PUPILS

25. STEP 8: ASK ABOUT OTHER SYMPTOMS • PAIN AND PHOTOPHOBIA • ALL TRAUMATIC CAUSES • KERATITIS • IRITIS • GLAUCOMA • COLOURED HALOES • ACUTE GLAUCOMA

26. STEP 8: ASK ABOUT OTHER SYMPTOMS • ITCH AND CHEMOSIS • ALLERGIC CONJUNCTIVITS • BLEPHARITIS • PREAURICULAR NODES • VIRAL CONJUNCTIVITS

27. OTHER COMMON EYE PROBLEMS • BLEPHARITIS • CHALAZION AND STYE • ALLERGIC CONJUNCTIVITIS • VIRAL CONJUNCTIVIS

28. OTHER COMMON EYE PROBLEMS • BLEPHARITIS / MEIBOMIANITIS • INFLAMMATION OF LID MARGIN AND MEIBOMIAN GLANDS (STAPH. AUREUS) • BILATERAL ITCHY EYE WITH BURNING SENSATION • STICKY EYELID AND PROMINENT MEIBOMIAN ORIFICES • DRY EYE WITH CRUSTING • LID CARE, TEAR DROPS, ANTIBOTIC OINT.

29. OTHER COMMON EYE PROBLEMS • CHALAZION AND STYE • CHRONIC GRANULOMATOUS PAINLESS INFLAMMATION OF MEIBOMIAN GLAND • STYE IS ACUTE AND PAINFUL • SECONDARY TO BLEPHARITIS • WARM COMPRESSES • IF NO RESPONSE I&D • SYSTEMIC ANTIBIOTIC IN SEVERE CASES

30. OTHER COMMON EYE PROBLEMS • ALLERGIC CONJUNCTIVITS • ALWAYS BILATERAL • SEVERE ITCHING • WATERY AND MUCOID DISCHARGE • REDNESS AND CHEMOSIS • TOPICAL ANTIHISTAMINE AND MAST CELL STABILIZING AGENT • STEROIDS AND NONSTEROIDAL AGENTS

31. OTHER COMMON EYE PROBLEMS • VIRAL CONJUNCTIVITIS (E.K.C) • HIGHLY CONTAGIOUS • ADENOVIRUS 3, 4, 7, 8, 19, 29, 37 • RED EYE WITH WATERY DISCHARGE • TENDER PREAURICULAR NODE • FOLLICULAR CONJUNCTIVITIS WITH CORNEAL INVOLVEMENT • NO TREATMENT AVAILABLE

32. THANK YOU