assessment of the red eye for primary care physicians
DESCRIPTION
ASSESSMENT OF THE RED EYE FOR PRIMARY CARE PHYSICIANS. Ahmed Bawazeer, MD, FRCSC Department of ophthalmology King Abdulaziz University. CAUSES OF RED EYE. TRAUMATIC RED EYE NONE TRAUMATIC RED EYE. CAUSES OF RED EYE. TRAUMATIC CORNEAL ABRASION CORNEAL FOREIGN BODY F.B. UNDER EYELID - PowerPoint PPT PresentationTRANSCRIPT
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ASSESSMENT OF THE RED EYE FOR PRIMARY CARE
PHYSICIANS
Ahmed Bawazeer, MD, FRCSC
Department of ophthalmology
King Abdulaziz University
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CAUSES OF RED EYE
• TRAUMATIC RED EYE
• NONE TRAUMATIC RED EYE
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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.
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CAUSES OF RED EYE
• NONE TRAUMATIC– CONJUNCTIVITIS– SUBCONJUNCTIVAL HEMORRHAGE– IRITIS– ORBITAL OR PERIORBITAL CELLULITIS– HSV KERATITIS– ACUTE GLAUCOMA– SCLERITIS AND EPISCLERITIS
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CLINICAL EVALUATION
• OPHTHALMIC HISTORY
• ASSESS VISUAL ACUITY
• INSPECT THE CONJUNCTIVA
• ASSESS THE TYPE OF DISCHARGE
• DETECT CORNEAL OPACITIES
• SEARCH FOR EPITHELIAL DISRUPTION
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CLINICAL EVALUATION
• STUDY THE ANTERIOR CHAMBER
• OBSERVE THE PUPIL
• ASK ABOUT OTHER SYMPTOMS
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STEP 1: ASSESS VISUAL ACUITY
• NORMAL V.A– CONJUNCTIVITIS
– S/C HEMORRHAGE
– PRESEPTAL CELLULITIS
• DECREASED V.A.– ALL TRAUMATIC
CAUSES
– KERATITIS
– IRITIS
– ACUTE GLAUCOMA
– ORBITAL CELLULITIS
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STEP 2: INSPECTION OF THE CONJUNCTIVA
• LOCALIZED CONGESTION– S/C HEMORRHAGE– SCLERITIS/EPISCLERITIS
• PERILIMBAL INJECTION– IRITIS– ACUTE GLAUCOMA
• DIFFUSE CONGESTION
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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
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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
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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)
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STEP 3: ASSESS THE TYPE OF DISCHARGE
• NONE– S/C HEMORRHAGE
• CLEAR– ALL TRAUMATIC CAUSES– ALLERGY – KERATITIS– IRITIS– GALUCOMA
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ASSESS THE TYPE OF DISCHARGE
• PURULENT– BACTERIAL INFECTION
• BACTERIAL CONJUNCTIVITS
• ORBITAL AND PERIORBITAL CELLULITIS
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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
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STEP 4: DETECT CORNEAL OPACITIES
• NONE– CONJUNCTIVITS
• DIFFUSE HAZE– ACUTE GLAUCOMA– U.V. KERATITIS
• LOCALIZED OPACITY– HERPETIC KERATITIS– CORNEAL ULCER
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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
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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
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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
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STEP 5: SEARCH FOR EPITHELIAL DISRUPTION
• EPITHELIAL DISRUPTION– HERPETIC KERATITIS– CORNEAL ABRASION– CONTACT LENS OVERWEAR– U.V. KERATITIS– CHEMICAL INJURY
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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
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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
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STEP 6: STUDY THE ANTERIOR CHAMBER
• ABSENT– LACERATED GLOBE
• SHLLOW– ACUTE GLAUCOMA
• BLOOD (HYPHEMA)– RUPTURED GLOBE
• PUS (HYPOPYON)– CORNEAL ULCER
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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
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STEP 7: OBSERVE THE PUPILS
• DILATED– TRAUMA
– THIRD NERVE PALSY
– ADIE’S PUPIL
– ACUTE GLAUCOMA
– DRUGS
• CONSTRICTED – IRITIS
– HORNER’S
– DRUGS
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STEP 8: ASK ABOUT OTHER SYMPTOMS
• PAIN AND PHOTOPHOBIA– ALL TRAUMATIC CAUSES– KERATITIS– IRITIS– GLAUCOMA
• COLOURED HALOES– ACUTE GLAUCOMA
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STEP 8: ASK ABOUT OTHER SYMPTOMS
• ITCH AND CHEMOSIS– ALLERGIC CONJUNCTIVITS– BLEPHARITIS
• PREAURICULAR NODES– VIRAL CONJUNCTIVITS
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OTHER COMMON EYE PROBLEMS
• BLEPHARITIS
• CHALAZION AND STYE
• ALLERGIC CONJUNCTIVITIS
• VIRAL CONJUNCTIVIS
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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.
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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
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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
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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
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THANK YOU