Red Eye : a cardinal sign of ocular inflammation, which can be caused by several conditions.Week 7 : eye & hearingConjunctivitis (bacterial/viral/chlamidyal/allergic)PterygiumSubconjunctival hemorrhageEpiscleritis and scleritis

Red eyes, normal vision

Keratitis Cornea Ulcer Anterior Uveitis (iritis, iridocyclitis)Acute GlaucomaEndophthalmitis

Red eyes, visus

Eyes Anatomy

Limbus

Algorithm

Perbedaan Conjunctival Injection vs Ciliary InjectionPosterior Conjunctival arteries

Anterior Ciliary Arteries

Mobile, loosely attach in bulbar conjunctiva

Immobile with movement

Fornix location

Corneal circumference

Larger toward periphery

Lesser toward fornix

Blanching in adrenalin drop

No reaction in adrenalin drop

Conjunctivitis (GP Competencies)Clinical presentation-Discharge: watery, mucoid, purulent or mucopurulent-Nonspecific: watery eyes, irritation, stinging, foreign body sensation, photophobia or itchiness-Conjunctival injection-Eyelid swelling-Tarsal conjunctiva: papillae/follicles/membrane-Cornea and pupils usually normalClinical FindingBacterial DiseaseViral Disease

Bilateral disease at onset50-74%35%

Conjunctival responsePapillary or nonspecificFollicular

Conjunctival dischargeMucopurulent (thick and globular)Watery or mucoid

Conjunctival membraneLate onsetEarly onset

Preauricular adenopathy NoYes

Concurrent otitis media20-73%10%

Tx : Eye hygiene, Eyedrops(viral self-limiting, antibiotics,bacterial antibiotics,allergic/vernal antiallergy, steroids) ,3 days w/o improvement: refer

Gonococcal Conjuctivitis : foreign body sensation; the eye may be glued shut with severe purulent discharge, dicuci tidak hilang

Vernal Keratoconjunctivitis Frequently associated with atopy: asthma, hay fever and dermatitis Recurrent, bilateral Affects children and young adults More common in males and in warm climates, seasonal Itching, mucoid discharge and lacrimationPF : Cobblestone papillae(Palpebra),Horner- Trantas dots(Limbus)

Atopic Keratoconjunctivitis Typically affects young patients with atopic dermatitis Eyelids are red, thickened, macerated and fissuredPterygium Episcleritis common, benign, self-limiting young adult related to systemic disease types: - simple (sectoral,diffuse), - nodular

Triangular fibrovascular tissue Risk factors :hot climate, chronic dryness and high sunlight exposure Sailor Apex always in the cornea side, often with Fe depositSubconjunctival Hemorrhage No pain, no dischargeScleritis: -granulomatous inflammation -less common-rheumatoid arthritis, connective tissue disorder-types: anterior scleritis (non-necrotizing / necrotizing), scleritis posterior

Well-demarcated Self-limiting within 2 weeks

Red Eye, visus Keratitis(inflamasi kornea), jika sampai ke stroma korneal ulcer, dgn gejala sbb :photophobia, periocular pain, foreign body sensation, corneal opacity, ciliary flush.Diagnosis : reduced cornea sensibility, fluorescein test,assessment of corneal regularity.

Anterior Uveitis(Iridoksilitis) : inflamasi iris+ciliary body, usually auto-immune.

Endopthalmitis : inflamasi intraocular cavities (ie, the aqueous and/or vitreous humor).-Causes : 1. infection through the cornea Bacterial/fungal, most common: staphylococcus aureus, proteus and pseudomonas2. trauma post-surgery (mainly: cataract surgery), or endogenous.-If with extraocular infection: panophtalmitisClinical presentation: periocular pain chemosis(edema conjunctiva) eyelid swelling corneal opacity anterior uveitis hypopion

TandaKeratitisIridosiklitis akutGlaukoma akut

SakitGanjelSedang --> N.VBerat --> N.V

InjeksiKornealPerikornealKonjungtiva, perikorneal,

episclera

PupilNMiosis, iregularMidriasis, lonjong

Reaksi cahayaNKurangKurang --> negatif

MediaKeruh, infiltratKP, flare, oedem, oedem, katarak

katarak, oklusi,

vitreus keruh, hipopion

Visus --> 0

OnsetLambatLambatTiba-tiba

Sistemik-Sedikitmuntah-muntah

Sekret+--

TIONN -, N, N +N +++

Hearing Loss : symptom of a disease in the ear, ranging from a simple cerumen impaction (causing a conductive hearing loss) to middle and inner ear disorders to problems affecting the eighth cranial (or auditory) nerve (CN VIII) itself (e.g., acoustic neuroma or cerebellopontile-angle neoplasm)

Hearing Loss

Salisilat (aspirin)NSAID(diclofenac ,ibuprofen ,indomethacin ,naproxen ,piroxicam) Antibiotik(aminoglycoside, eritromisin)Diuretic