Painful Eye for PCPs Ravi Patel M D

Painful Eye for PCPs Ravi Patel, M. D. Florida Eye Specialists Cornea, Cataract, and Refractive Surgery Board Certified Ophthalmologist

No Disclosures

Case #1 22 yo l Redness OS (left eye) l 1 week h/o purulent discharge OS l Mattering of eyelids in AM l

Bacterial Conjunctivitis Papillary reaction l Purulent discharge l Eyelid mattering l l Tx: – Vigamox, Zymar, or Azasite – Good hand hygiene

Case #2 l 34 yo red eyes both eyes (OU) l ‘clear’ discharge l Recent URI

Viral Conjunctivitis Follicular reaction l Clear discharge l Preauricular lymph node l Tx: l – Tears – Cold compresses – Good hand hygiene

Case #3 l 13 yo itching both eyes (OU) l Tearing and redness l Runny nose

Allergic Conjunctivitis Papillary reaction l Clear discharge l itching l l Tx: antihistamines (I. e. Patanol; Elestat)

Conjunctivitis Conjunctival Discharge Reaction Symptoms Bacterial Papillary Purulent Viral Follicular Clear Allergic Papillary Ropy/clear Unilateral mattering URI Lymph node Itching bilateral

Case #4 l l l 78 yo Red eye right eye (OD) No pain Woke up with this condition On coumadin

Subconjunctival Hemorrhage Painless l Unilateral l l Tx: – Supportive – Self resolution

Case #5 l 9 yo unilateral swelling OD (right eye) l Periorbital redness OD l Upper respiratory tract infection

Preseptal Cellulitis Unilateral l Sinus disease l Periorbital edema and erythema l l Tx: – CT – Amoxicillin/clavulanic acid (Augmentin) or a 1 st generation cephalosporin (Keflex) – OPHTHO consult

Case #6 l 9 yo unilateral swelling OS (left eye) l Pain and fever l Upper respiratory tract infection

Orbital Cellulitis l l l Unilateral Sinus disease Periorbital edema and erythema Proptosis; limitation of ocular motility Relative afferent pupillary defect Tx: – – CT IV antibiotics Surgical drainage OPHTHO consult

Preseptal vs. Orbital Cellulitis Edema/ Pupil Proptosis Erythema Defect Preseptal + Orbital + Pain Limit Fever with eye motility +- + + +

Case #7 l 27 yo CL wearer l Slept one week in contacts l Red eye right eye (OD) l Painful and photophobia

Corneal Ulcer Unilateral l Conjunctival injection l Corneal infiltrate l +/- hypopyon l l Tx: – Fluoroquinolones (Vigamox, Zymar, Quixin, Ciloxan) – Culture and scraping – OPHTHO consult

Case #8 l 44 yo l Red eye left eye (OS) l Foreign body sensation l Recent cold sore

Herpes Simplex Keratitis Unilateral l HSV 1 l Pain; photophobia; tearing; redness l Dendritic lesion with staining l l Tx: – Topical viroptic – Consider oral acyclovir – OPHTHO consult

Case #9 l 31 yo l Mechanic with acute onset of foreign body sensation left eye (OS) l Redness and tearing OS

Corneal Foreign Body + staining l Foreign body sensation l Metallic foreign body l l Tx: – Erythromycin ointment – FB removal – OPHTHO consult

Case #10 l 31 yo l Grinder with acute onset of foreign body sensation right eye (OD) l Decreased vision; redness and tearing OD

Ruptured Globe Foreign body sensation l Prolapse of ocular tissue l Peaked pupil l Pain and decreased vision l l Tx: – Eye shield (NO patching) – Oral antibiotic (Levaquin or Cipro) – NPO – OPHTHO consult

Case #11 l 18 yo l Red eye right eye (OD) l Pain and light sensitivity

Uveitis Photophobia l Unilateral l Intraocular inflammation l Autoimmune disorders l l Tx: – Topical steroids – Cycloplegics – OPHTHO consult

Case #12 l 18 yo playing paintball l Red eye left eye (OS) l Pain and light sensitivity l Decreased vision

Hyphema Photophobia l Layered blood in anterior chamber l Blunt trauma l l Tx: – Cycloplegics (homatropine) – Topical steroids – OPHTHO consult

Case #13 l 62 yo l Red eye right eye (OD) l Severe eye pain; nausea; vomitting l Blurry vision OD

Acute Angle Glaucoma

Acute Angle Glaucoma SEVERE eye pain/headache l Nausea and vomiting l Mid-dilated pupil l Hazy cornea l l Tx: Pilocarpine Diamox Topical beta blockers Laser peripheral iridotomy – OPHTHO consult – –

Questions or Comments… Feel free to contact me with any concerns office (904) 355 -2121 cell (904)945 -0871