The Red Eye in Primary Care Frank Ahfat Consultant Ophthalmic Surgeon Somerfield Hospital Maidstone Hospital - PowerPoint PPT Presentation

1 / 64
About This Presentation
Title:

The Red Eye in Primary Care Frank Ahfat Consultant Ophthalmic Surgeon Somerfield Hospital Maidstone Hospital

Description:

... Reduce intraocular pressure IV acetazolamide pilocarpine to constrict pupil ... of iritis Peri-ocular steroid injection Treatment of iritis 4 main ... – PowerPoint PPT presentation

Number of Views:202
Avg rating:3.0/5.0
Slides: 65
Provided by: bmihe
Category:

less

Transcript and Presenter's Notes

Title: The Red Eye in Primary Care Frank Ahfat Consultant Ophthalmic Surgeon Somerfield Hospital Maidstone Hospital


1
The Red Eye in Primary CareFrank
AhfatConsultant Ophthalmic SurgeonSomerfield
HospitalMaidstone Hospital
2
(No Transcript)
3
4 main causes of red eye
  • Conjunctivitis
  • Corneal problem
  • Iritis (anterior uveitis)
  • Acute glaucoma

4
History
  • Stickiness or watery discharge (infective)
  • Photophobia (iritis) (will often have previous
    history)
  • Blurred vision
  • Pain, haloes, headache, vomiting (glaucoma)
  • Contact lens wear, trauma

5
Examination
  • Check visual acuity
  • Lid crusting, pus, discharge

6
Bacterial conjunctivitis
7
  • Conjunctivitis with herpetic vesicles on the
    eyelids

8
Mucopurulent discharge in bacterial conjunctivitis
9
Examination
  • Check visual acuity
  • Pus, discharge, lid crusting
  • Corneal examination

10
Fluorescein examination of cornea
  • Corneal abrasion Dendritic (herpetic)
    ulcer

11
Examination
  • Check visual acuity
  • Pus, discharge, lid crusting
  • Corneal examination
  • Pupil shape and reactivity (to light and dark)

12
Always examine the pupil in dim and bright light
13
Small (miosed) pupildilates poorly in dark
  • Iritis

14
Mid-dilated, non-reactive
  • Acute glaucoma

15
4 main causes of red eye
  • Conjunctivitis
  • Corneal problem
  • Iritis (anterior uveitis)
  • Acute glaucoma

16
Conjunctivitis
  • Initially unilateral, latter bilateral
  • Watery or sticky discharge
  • Bacterial or viral
  • Visual acuity normal
  • Cornea normal
  • Pupils normal
  • Rx chloramphenicol or fucithalmic
  • Review after 4-5 days
  • If no improvement, refer

17
Adenoviral keratitis
18
4 main causes of red eye
  • Conjunctivitis
  • Corneal problem
  • Iritis (anterior uveitis)
  • Acute glaucoma

19

20
Dendritic (herpetic) corneal ulcer

21
  • Herpetic vesicles on the eyelid

22
Geographic (amoeboid) ulcer following steroid
treatment
23
Herpetic scarring of the cornea
24
Dendritic (herpetic) corneal ulcer
  • Rx oc. zovirax
  • Refer within 24 48 hours

25
Bacterial ulcer (corneal abscess)
  • Risk factors
  • Contact lens wear
  • Trauma
  • Dry eyes
  • If untreated corneal perforation
  • Management
  • Immediate referral
  • Corneal scrape and culture
  • Intensive topical antibiotics

26
4 main causes of red eye
  • Conjunctivitis
  • Corneal problem
  • Iritis (anterior uveitis)
  • Acute glaucoma

27
(No Transcript)
28
Iritis (anterior uveitis)
  • Ciliary injection Miosed
    (small pupil)

29
The Pupil in Iritis
  • Small miosed pupil
    Irregular pupil with posterior

  • synechiae after dilation

30
Iritis
  • Keratic precipitates (KPs)
    Hypopyon

31
Iritis
  • Photophobia
  • Miosed (small pupil)
  • Often recurrent

32
Seronegative arthritides in association with
iritis
  • Ankylosing spondylitis

Juvenile chronic arthritis
Psoriatic arthropathy
33
Vasculitides in association with iritis
  • Sarcoidosis
  • Syphilis
  • Behcets disease

34
Inflammatory bowel disease and iritis
  • Crohns disease

Pyoderma gangrenosum
35
Complications of iritis
  • Cataract

Band keratopathy
Macular oedema
Glaucoma
36
Management of iritis
  • Refer within 24 48 hours
  • Frequent topical steroids
  • Peri-ocular steroid

37
Peri-ocular steroid injection
  • Triamcinolone
  • Depo-medrone

38
Treatment of iritis
  • Refer within 24 48 hrs
  • Topical steroids
  • Peri-ocular steroids
  • Cycloplegia
  • Immunosuppresion for systemic disease
  • Systemic steroids
  • Ciclosporin
  • Azathioprine
  • Cyclophosphamide

39
4 main causes of red eye
  • Conjunctivitis most common / least serious
  • Corneal problem
  • Herpes simplex ulcer
  • Bacterial ulcer
  • Iritis (anterior uveitis)
  • Acute glaucoma least common / most serious

40
Acute glaucoma
41
Glaucoma
  • Acute glaucoma
  • sudden onset
  • acute symptoms, painful red eye
  • may be precipitated by anticholinergic drug (e.g
    tricyclics)
  • presents to primary care physician
  • Chronic glaucoma
  • insidious
  • asymptomatic
  • not precipitated by anticholinergic drug
  • presents as incidental finding to optician or
    ophthalmologist

42
Acute glaucoma
  • Risk factors
  • age 50 yrs and over
  • F gt M
  • Hypermetropia (long-sighted)
  • Anticholinergic drugs

43
Hypermetropic patient!
44
Acute glaucoma
  • Hypermetropic eye
  • Narrow and crowded drainage angle
  • Pupillary block
  • Iris bombe
  • Closure of drainage angle
  • Sudden rise in intraocular pressure

45
Acute glaucoma
  • Risk factors
  • age 50 yrs and over
  • F gt M
  • Hypermetropia (long-sight)
  • Anticholinergic drugs
  • Symptoms
  • blurred vision, haloes
  • painful eye
  • Headache, nausea and vomiting
  • May be presenting symptoms

46
Acute glaucoma
  • Physical signs
  • Red eye
  • Reduced visual acuity
  • Hazy corneal reflex
  • Hard eye on digital pressure
  • Semi-dilated pupil, unreactive to light

47
Management of acute glaucoma
  • Urgent referral (same day)
  • Reduce intraocular pressure
  • IV acetazolamide
  • pilocarpine to constrict pupil
  • Peripheral iridotomy

48
Peripheral iridotomy for acute glaucoma
49
Acute angle closure glaucoma After
successful laser iridotomy
50
4 main causes of red eye
  • Conjunctivitis
  • Corneal problem
  • Herpes simplex ulcer
  • Bacterial ulcer
  • Iritis (anterior uveitis)
  • Acute glaucoma

51
Diagnosing the red eye
  • Is there a sticky discharge?
  • Is there fluorescein staining of the cornea?
  • Is the patient photophobic?
  • Is visual acuity reduced?
  • Is the pupil round and reactive to light (and
    dark)?

52
4 main causes of red eye
  • Conjunctivitis
  • Sticky discharge
  • Corneal problem (herpes / bacterial ulcer)
  • Fluorescein stain
  • Iritis (anterior uveitis)
  • Photophobia, small pupil
  • Acute glaucoma
  • Pain, headache, blurred vision, thick glasses
  • Mid-dilated, unreactive pupil

53
Conjunctivitis
Corneal ulcers
Iritis Acute
glaucoma
54
Other causes of red eye
  • Allergic conjunctivitis

55
Allergic conjunctivitis
  • Acute vs chronic
  • Itching prominent
  • Papillae and follicles
  • Eczema, asthma, hay fever
  • Preservatives from glaucoma drops
  • Opticrom, otrivine-antistine
  • Steroids rarely indicated

56
Other causes of red eye
  • Allergic conjunctivitis
  • Episcleritis
  • Scleritis

57
Episcleritis
  • Benign
  • Minimal pain
  • Self limiting
  • Short course of
  • topical steroids

58
Scleritis
  • Very rare
  • Potentially sight threatening
  • Painful
  • Connective tissue disease
  • (rheumatoid arthritis, SLE,
  • Wegeners, PAN)
  • Scleral necrosis, melting
  • Systemic immunosuppression

59
Other causes of red eye
  • Contact lens wear
  • Allergic conjunctivitis
  • Episcleritis
  • Scleritis

60
Causes of red eye
  • Conjunctivitis
  • Corneal problem
  • Herpes simplex ulcer
  • Bacterial ulcer
  • Iritis (anterior uveitis)
  • Acute glaucoma
  • Other causes
  • Episcleritis / scleritis
  • Allergic conjunctivitis

61
Red flags in the red eye
  • Reduced visual acuity
  • Fluorescein staining of the cornea
  • Abnormal pupil size, shape and reactivity.

62
Conjunctivitis
Corneal ulcersSticky discharge
Fluorescein stain
Iritis
Acute glaucomaPhotophobia, small pupil
Painful, pupil unreactive,
mid-dilated
63
Managing the red eye
  • Conjunctivitis
  • chloramphenicol or fucithalmic
  • If no improvement after 4 5 days, refer
  • Corneal ulcer
  • herpes ulcer Rx zovirax, refer within 24 - 48
    hrs
  • bacterial ulcer immediate referral
  • Iritis
  • refer within 24 - 48 hrs
  • Acute glaucoma
  • immediate referral

64
Thank you
Write a Comment
User Comments (0)
About PowerShow.com